In a groundbreaking study, it was discovered that both written exposure therapy and prolonged exposure therapy were equally effective in treating post-traumatic stress disorder (PTSD). Surprisingly, only 12.5 percent of participants dropped out of the written exposure therapy group before completing the treatment, whereas 35.6 percent dropped out of the prolonged exposure therapy group. Further research conducted in 2018 confirmed that written exposure therapy was just as effective as cognitive processing therapy, which is considered the gold standard treatment for PTSD.
One of the advantages of written exposure therapy is that it may be easier for individuals who feel shame or embarrassment about their traumatic experiences. Denise Sloan, a psychologist and co-author of the study, explained that patients were asked to write by hand, engaging with their memories on a deeper level. This intentional slower process allows them to carefully reflect on the sequence of events, the people involved, and their dialogue. The act of writing facilitates a more thorough exploration compared to simply verbalizing their experiences.
The inception of this therapy was inspired by James Pennebaker’s “expressive writing” technique, which dates back to the 1980s. Pennebaker discovered that individuals who regularly wrote about negative life events had stronger immune systems and sought medical help less frequently.
The first study on written exposure therapy for PTSD was published in 2012. The therapy works by allowing clients to confront their traumatic memories, reducing fear and avoidance, and helping them correct misconceptions such as self-blame.
Why It Matters
Cognitive processing therapy and prolonged exposure therapy have been widely used since the 1980s and are highly recommended by the Departments of Veterans Affairs and Defense. However, both treatments are time-intensive and have high dropout rates. On average, 20 percent of patients, and sometimes even 50 percent, do not complete the full course of treatment. Written exposure therapy offers similar benefits in fewer sessions.
Dr. Sloan emphasized the need to rethink the standard treatment duration due to the high demand for mental health services. Treating patients for 12 to 16 sessions is often impractical for many people.
What’s Next
Research on the effectiveness of written exposure therapy is still emerging. The studies comparing it to other therapies aim to demonstrate non-inferiority rather than superiority. Dr. Barbara Rothbaum, a developer of prolonged exposure therapy, mentioned that dropout rates at her clinic were around 10 percent.
Speaking about the success of talk therapy in PTSD treatment, Dr. Rothbaum acknowledged the healing power of expressing the most distressing moments to a compassionate listener. However, she also recognized that alternative methods, like written exposure therapy, can be effective.
Notably, written exposure therapy was not endorsed as a primary intervention by the Departments of Veterans Affairs and Defense in their latest clinical practice guidelines. This was primarily due to the limited number of published studies on the therapy. However, Dr. Sloan anticipates a change in the coming years as larger trials are completed and more evidence emerges. Clinicians will need to adapt to the idea of incorporating writing, alongside traditional talk therapy, to address sensitive subjects with their patients.
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