The two treatments were found to be equally effective, with only 12.5 percent of subjects in the written exposure group dropping out before completing the course of treatment compared to 35.6 percent in the long-term exposure group. In 2018, a study by the same team found written exposure therapy to be as effective as another first-line or most highly recommended PTSD treatment, cognitive processing therapy.
Denise Sloan, a psychologist who helped develop the treatment and author of the study, said it’s easier to write down traumatic memories when you’re embarrassed or embarrassed about what happened to you. Some people may become, he said. She said patients were asked to write by hand, which took longer and allowed them to work on their memory.
“It’s a slow process that allows you to better think about ‘what happened next, who was there and what they said’ because you’re writing about it.” said Dr. Sloan, Associate Director of Behavioral Sciences. Division of the National PTSD Center. “Everything is slower than just saying it out loud.”
The therapy was inspired by the work of Texas psychologist James Pennebaker, who began experimenting with what he called “expressive writing” in the 1980s, and regularly wrote about negative experiences in life. They found that those who wrote positively had stronger immunity and visited less frequently. to the doctor.
The first study of written exposure therapy as a treatment for PTSD was published in 2012. Dr. Sloan says it works just like other trauma-focused treatments. This means that clients can work with traumatic memories by alleviating fears and avoidance, and recognizing misconceptions such as guilt.
why it matters
Cognitive processing therapy and long-term exposure therapy, the two most highly recommended treatments by the Department of Veterans Affairs and the Department of Defense, have been widely used since the 1980s and are backed by a wealth of research. A new method, eye movement desensitization and reprocessing, is rapidly gaining popularity.
But all three are time consuming, requiring 60-90 minute sessions over three months. Studies show that a large number of patients (on average 20 percent, sometimes as high as 50 percent) drop out before completing a course of treatment.
Dr. Sloan says written exposure therapy appears to have similar benefits in fewer sessions.
“There are a lot of people who need mental health treatment and we can’t meet the demand,” she said. “We need to rethink what we are doing and how much we need to get good results because most people get 12 to 16 treatments. because you can’t.”
Data on the effectiveness of written exposure therapy are still emerging.
Studies comparing cognitive processing therapy and long-term exposure therapy are non-inferiority trials designed to show that new treatments are no worse than established treatments, and are designed to determine superiority. “It’s not as scientifically rigorous” as the exam, he said. Barbara Rothbaum, one of the developers of long-term exposure therapy. She added that the dropout rate at her clinic at Emory University was about 10 percent.
There’s a reason talk therapy has been so successful in treating PTSD, she said.
“There is inherent healing in saying out loud the worst, scariest, most embarrassing, most shameful moments of your life to another human being trying to help,” she said. “Do I have to? No.”
Written exposure therapy is not approved as a first-line intervention in the latest VA and Department of Defense clinical practice guidelines, Sloan said, largely because of the small number of published studies examining it. said Dr.
Things are likely to change in the next two years as many large trials are completed, she said. Clinicians will also need to get used to the idea of using text in addition to voice to interact with patients about painful subjects.
“Some people find this intimidating because it challenges the core of what they do,” she says. “It goes against what they think is important in therapy.”