Five supervised 30-minute sessions of writing about horrific events are equally helpful as the treatments most recommended by government authorities for treating post-traumatic stress disorder, according to a research released on Wednesday.
The therapy, known as written exposure therapy, has patients write out their reactions to a traumatic incident and then discuss them with their therapist. Later sessions will have them reflect on the experience via writing.
A total of 178 veterans with PTSD were treated in the new study published in JAMA Psychiatry. Half of the patients received written exposure therapy, while the other half received prolonged exposure therapy, which consists of eight to fifteen 90-minute therapy sessions in which the patient vividly imagines the terrifying situation and then confronts real-world reminders of it in between sessions.
It was determined that both treatments were beneficial, with just 12.5% of patients dropping out of the written exposure group before finishing therapy, compared to 35.6% of patients in the extended exposure group. Written exposure therapy was shown to be equally effective as cognitive processing therapy, another first-line or highly recommended PTSD treatment, in a 2018 research by the same team.
Denise Sloan, a psychologist who helped create the therapy and is also an author of the paper, said that writing down horrific memories may be easier for some individuals if they feel shame or humiliation about what occurred to them. She said that patients were instructed to use pen and paper because it forces them to slow down and think about the content.
Inspired by the work of Texas psychologist James Pennebaker, who in the 1980s started experimenting with what he termed “expressive writing,” and discovered that individuals who routinely wrote about difficult life situations had stronger immune systems and made fewer trips to the doctor, this treatment is now widely used.
The first clinical trial of written exposure therapy for posttraumatic stress disorder was published the same year. According to Dr. Sloan, it is effective because it encourages the patient to face the painful experience head-on, which reduces anxiety and avoidance and helps the patient recognise erroneous beliefs, such as self-blame.
Overwhelming evidence supports cognitive processing therapy and extended exposure therapy, the two therapies most recommended by the Departments of Veterans Affairs and Defence. Both have been widely used since the 1980s. Eye movement desensitisation and reprocessing is a relatively recent approach that is gaining in popularity.
However, each takes a considerable amount of time, with sessions lasting an average of 60–90 minutes over the course of three months. Research shows that many patients (up to half in certain cases) abandon their treatment plans before they are finished.
Dr. Sloan has said that written exposure treatment seems to have comparable outcomes in fewer sessions.
Research on the efficacy of written exposure treatment is in its infancy.
According to Dr. Barbara Rothbaum, one of the creators of prolonged exposure therapy, the studies comparing it to cognitive processing therapy and prolonged exposure therapy are non-inferiority trials, designed to show that a newer treatment is not worse than an established one, and “not as scientifically stringent” as trials designed to determine superiority. She also said that there was a 10% attrition rate at her Emory University clinic.
She explained why talk therapy has been effective in the past in relieving symptoms of post-traumatic stress disorder.
She said that “there is something inherently healing” about sharing one’s “worst, scariest, most embarrassing, and most shameful moment of life” with another human being who is really trying to assist. Is that what must happen? No.”
According to Dr Sloan, the lack of published trials on written exposure treatment is a major reason why the Departments of Veterans Affairs and Defence did not support it as a first-line intervention in their most current clinical practise guidelines.
She predicted a shift in that direction over the following two years, after the conclusion of many major studies. In addition to patients, clinicians will need to become accustomed to communicating in writing when discussing sensitive issues.