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PTSD: Can an Exposure-Based Narrative Treatment Help?

American researchers compare brief, exposure-based treatment against traditional cognitive processing in the treatment of PTSD.

Therapy for post-traumatic stress disorder (PTSD) has grown vastly since the first real identification of the disorder. The most common treatment for PTSD has been cognitive processing therapy, but researchers in Boston, Massachusetts are examining a new treatment that involves a more intense form of narrative therapy. Written exposure therapy (WET) is a trauma-focused intervention where those afflicted with PTSD recount their traumatic experience through writing with guided instruction.

WET Therapy

There are five sessions in the WET program and individuals are asked to write about their experiences for 30 uninterrupted minutes following some minor psychiatric trauma education. After each session, therapists provide feedback regarding the individual’s adherence to the writing protocol. A recent study published in JAMA Psychiatry aimed to see if WET programs were inferior to cognitive processing therapy (CPT), which requires more and extended sessions and higher trained clinician supervision.

There were 126 adults (60 women and 66 men) involved in this study with an average age of 44 years. Those eligible were required to meet PTSD diagnosis criteria and, if medicated, must be on a stable prescription for a minimum of four weeks. Clinical trials took place between February 28, 2013, and November 6, 2016, at a Veteran Affairs facility and subjects were randomized into either written exposure therapy or cognitive processing therapy sessions.

Comparable to Cognitive Processing Therapy

Even though the WET session duration was shorter than CPT (6 weeks versus 12 weeks), the outcome showed written exposure therapy to be an efficient method for PTSD recovery, comparable to cognitive processing therapy. Moreover, there were significantly fewer program dropouts in the WET versus CPT after a 24-week checkup assessment. This difference between conditional therapies was not maintained or increased over time as indicated by the next checkup assessment at 36 weeks.

There was a mix of trauma experiences between subjects as opposed to a singular point of trauma study and this may limit the interpretation of the results, but researchers are confident that with the right changes WET could be a more tolerable approach to PTSD recovery in the future. This study demonstrates that both written exposure therapy and cognitive processing therapy are effective treatments for PTSD.

Written by Cooper Powers, BSc

Reference: Sloan, D.M., Marx, B.P., Lee, D.J., Resick, P.A. (2018). A Brief Exposure-Based Treatment vs Cognitive Processing Therapy for Posttraumatic Stress Disorder: A Randomized Noninferiority Clinical Trial. JAMA Psychiatry. Retrieved from



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