Written Exposure Therapy (WET) for post-traumatic stress disorder (PTSD)

Written exposure therapy (WET) is an manualised type of therapy for people with post-traumatic stress disorders (PTSD). The exposure is mainly done through writing assignments and the therapy is administered over five sessions.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202402 Registration no: SBU 2023/1284

Question

What scientific studies have been published regarding written exposure therapy for people with post-traumatic stress disorder?

Method

A systematic literature search was performed using the following databases: Medline (via Ovid), Scopus and CINAHL, PsycInfo, SocINDEX, Psychology and behavioral science collection via EBSCO.

Two authors independently assessed the abstracts of all identified studies.
Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.

Identified literature

No relevant systematic reviews with low to moderate risk of bias were identified. In one relevant systematic review, the risk of bias was considered to be high, therefore the results and conclusions are not reported [1]. In addition, nine relevant primary studies were identified [2-10]. Primary studies are not assessed for risk for bias.

References

  1. Jericho B, Luo A, Berle D. Trauma-focused psychotherapies for post-traumatic stress disorder: A systematic review and network meta-analysis. Acta Psychiatr Scand. 2022;145(2):132-55. Available from: https://doi.org/10.1111/acps.13366.
  2. Ellis RA, Darnell BC, Orcutt HK. Comparing written exposure therapy delivered via telehealth to trauma-focused expressive writing in undergraduates: A proof-of-concept trial. J Trauma Stress. 2023;36(6):1157-66. Available from: https://doi.org/10.1002/jts.22969.
  3. Sloan DM, Marx BP, Acierno R, Messina M, Muzzy W, Gallagher MW, et al. Written Exposure Therapy vs Prolonged Exposure Therapy in the Treatment of Posttraumatic Stress Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2023;80(11):1093-100. Available from: https://doi.org/10.1001/jamapsychiatry.2023.2810.
  4. Sloan DM, Marx BP, Bovin MJ, Feinstein BA, Gallagher MW. Written exposure as an intervention for PTSD: a randomized clinical trial with motor vehicle accident survivors. Behav Res Ther. 2012;50(10):627-35. Available from: https://doi.org/10.1016/j.brat.2012.07.001.
  5. Sloan DM, Marx BP, Lee DJ, Resick PA. A Brief Exposure-Based Treatment vs Cognitive Processing Therapy for Posttraumatic Stress Disorder: A Randomized Noninferiority Clinical Trial. JAMA Psychiatry. 2018;75(3):233-9. Available from: https://doi.org/10.1001/jamapsychiatry.2017.4249.
  6. Sloan DM, Marx BP, Resick PA, Young-McCaughan S, Dondanville KA, Straud CL, et al. Effect of Written Exposure Therapy vs Cognitive Processing Therapy on Increasing Treatment Efficiency Among Military Service Members With Posttraumatic Stress Disorder: A Randomized Noninferiority Trial. JAMA Netw Open. 2022;5(1):e2140911. Available from: https://doi.org/10.1001/jamanetworkopen.2021.40911.
  7. Sloan DM, Thompson-Hollands J, Hayes AM, Lee DJ, Alpert E, Marx BP. Sudden Gains in Two Trauma-Focused Treatments for Posttraumatic Stress Disorder. Behav Ther. 2022;53(2):255-66. Available from: https://doi.org/10.1016/j.beth.2021.08.003.
  8. Thompson-Hollands J, Marx BP, Lee DJ, Resick PA, Sloan DM. Long-term treatment gains of a brief exposure-based treatment for PTSD. Depress Anxiety. 2018;35(10):985-91. Available from: https://doi.org/10.1002/da.22825.
  9. Wisco BE, Sloan DM, Marx BP. Cognitive Emotion Regulation and Written Exposure Therapy for Posttraumatic Stress Disorder. Clin Psychol Sci. 2013;1(4):435-42. Available from: https://doi.org/10.1177/2167702613486630.
  10. Zolfa R, Moradi A, Mahdavi M, Parhoon H, Parhoon K, Jobson L. Feasibility and acceptability of written exposure therapy in addressing posttraumatic stress disorder in Iranian patients with breast cancer. Psychooncology. 2023;32(1):68-76. Available from: https://doi.org/10.1002/pon.6037.

Search strategy

Medline via OvidSP 24 Jan 2024
/ = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract;.kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf.; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other.; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population
1. Stress Disorders, Post-Traumatic/ 42 340
2. (ptsd or post traumatic or posttraumatic).ab,bt,kw,ti. 89 252
3. 1 or 2 98 420
Intervention
4. written exposure therapy.ab,bt,kw,ti 48
5. exp Psychotherapy/  
6. (psychotherapy or ((exposure or psychological) adj3 (therapy or treatment))).ab,bt,kf,ti. 65 554
7. 5 or 6 249 794
Study types: systematic reviews and meta-analysis
8. ((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/))  
Combined sets
9. 3 and 7 and 8 751
10. 4 or 9 798
Final result
11.   798

 

Scopus via scopus.com 24 Jan 2024
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); />ALL = All fields W/n = Within. Proximity operator retrieving terms within n words from each other. PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words. LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range. DOCTYPE = Publication type “re” = review “le” = letter “ed” = editorial “ch” = book chapter “cp” = conference proceedings * = Truncation “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population
1. TITLE-ABS-KEY ( ptsd OR posttraumatic OR "post traumatic" ) 144 937
Intervention
2. TITLE-ABS-KEY(“written exposure therapy”) 50
3. TITLE-ABS-KEY ( psychotherapy OR ( ( exposure OR psychological ) W/3 ( treatment OR therapy ) ) ) 214 380
Study types: systematic reviews and meta-analysis
4. TITLE-ABS-KEY ( ( systematic W/2 review ) OR "meta analy*" OR metaanaly* ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”))  
Combined sets
5. 1 AND 3 AND 4 1150
6. 2 OR 5 1196
Final result
7.   1196

 

CINAHL, PsycInfo, SocINDEX, Psychology and behavioral science collection via EBSCO 24 Jan 2023
TI = Title AB = Abstract SU = Keyword, exact or part (including all other fields for indexed and author keywords) MH = Exact subject heading, indexed keywords TX = All text PT = Publication type Nn = Near. Proximity operator retrieving terms within n words from each other. * = Truncation “ “ = Citation Marks; searches for an exact phrase

a. Glanville J, Dooley G, Wisniewski S, Foxlee R, Noel-Storr A. Development of a search filter to identify reports of controlled clinical trials within CINAHL Plus. Health Info Libr J. 2019;36(1):73-90. Available from: https://doi.org/10.1111/hir.12251.
Search terms Items found
Population
1. TI ( ptsd OR posttraumatic OR "post traumatic" ) OR AB ( ptsd OR posttraumatic OR "post traumatic" ) OR SU ( ptsd OR posttraumatic OR "post traumatic" ) 141 192
Intervention
2. TI (“written exposure therapy”) OR AB(“written exposure therapy”) OR SU (“written exposure therapy”) 64
3. TI ( ( psychotherapy OR ( ( exposure OR psychological ) N3 ( treatment OR therapy ) ) ) ) OR AB ( ( psychotherapy OR ( ( exposure OR psychological ) N3 ( treatment OR therapy ) ) ) ) OR SU ( ( psychotherapy OR ( ( exposure OR psychological ) N3 ( treatment OR therapy ) ) ) ) 314 850
Study types: systematic reviews and meta-analysis / randomized controlled trialsa.
4. ((TI((systematic N3 review) OR "meta analys*" OR metaanalys*) OR AB((systematic N3 review) OR "meta analys*" OR metaanalys*) OR SU((systematic N3 review) OR "meta analys*" OR metaanalys*)) OR (PT "Systematic Review" OR PT "meta analysis")) NOT (MH "Case Studies" OR PT "Commentary" OR PT "Editorial" OR PT "Letter")  
Combined sets:
5. 1 AND 3 AND 4 1073
6. 2 OR 5 1162
Final result
7.   1162
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