What is Written Exposure Therapy?
Written exposure therapy is a structured, evidence-based PTSD treatment using guided writing to reduce avoidance, process trauma, and improve patient outcomes.
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What is Written Exposure Therapy?
Written Exposure Therapy (WET) is an evidence-based, structured intervention for PTSD that utilizes written narrative exposure to facilitate trauma processing. Designed as a brief exposure-based treatment, WET consists of five structured sessions, guiding patients through controlled trauma confrontation to reduce avoidance and promote emotional integration.
Key features of WET
WET is a standardized, short-term intervention, making it more accessible than traditional trauma-focused treatments. Patients engage in structured writing sessions rather than prolonged verbal discussions, ensuring treatment protocol consistency while minimizing emotional overwhelm. Research, including randomized clinical trials, has demonstrated that WET has lower dropout rates compared to other trauma-focused treatments, as its structured writing approach reduces distress while maintaining clinically significant symptom change. WET leads to long-term treatment gains, with substantial PTSD symptom reduction over time (Sloan & Marx, 2019).
The structure of WET sessions
Each written exposure therapy session follows a structured approach, guiding patients through progressive trauma processing with prompts and detailed instructions.
Session 1: Introduction & first trauma narrative
The first treatment session begins with psychoeducation on posttraumatic stress disorder (PTSD) and an overview of the WET protocol. Patients engage in expressive writing, creating a detailed narrative of their trauma event, incorporating thoughts, emotions, and sensory experiences. This structured approach establishes engagement with trauma-related memories and sets the foundation for future sessions.
Session 2: Continued exposure & detail expansion
The therapist reviews the patient’s writing session from the previous session, ensuring adherence to the treatment protocol. Patients refine and expand their trauma narratives by incorporating negative feelings and cognitive details, promoting deeper emotional engagement.
Session 3: Deeper emotional processing & life impact
Patients reflect on the broader impact of their trauma, considering how it has shaped their physical health, self-perception, relationships, and worldview. If previous narratives lack depth, therapists encourage written exposure therapy prompts to enhance emotional processing.
Session 4: Refinement & addressing lingering effects
The focus shifts to the most distressing aspects of the trauma and its influence on identity, beliefs, and behavior. Patients often begin to notice clinically significant symptom change, demonstrating increased resilience through repeated exposure.
Session 5: Conclusion & moving forward
The final session allows patients to assess their progress and prepare for long-term symptom management. Therapists discuss coping strategies, long-term treatment gains, and, if needed, additional trauma-focused treatments. The goal is to empower patients with skills to manage future symptoms and ensure effective treatment outcomes.
How WET differs from other PTSD therapies
Written exposure therapy differs from other trauma-focused therapies in several key ways, particularly in its brevity, structure, and reduced patient burden. Unlike traditional treatments such as prolonged exposure (PE) or cognitive processing therapy (CPT), WET is a shorter, more streamlined intervention that does not require prolonged exposure to trauma-related cues outside of therapy sessions.
One major distinction is that WET consists of only five sessions, whereas PE and CPT typically require 8 to 15 sessions. Another key difference is that WET does not require homework between sessions. In contrast, PE involves daily in vivo exposure exercises and listening to recorded trauma narratives, while CPT requires written and cognitive assignments between sessions.
Mechanisms of action in WET
WET is based on well-established principles of exposure therapy, which aim to reduce PTSD symptoms by encouraging patients to confront and process their trauma memories. Repeated written exposure to trauma narratives reduces avoidance behaviors, a key factor in PTSD maintenance. By engaging with their trauma memories in a structured manner, patients learn to tolerate distressing emotions rather than suppress or avoid them.
Cognitive and emotional processing also plays a crucial role in WET’s effectiveness. Writing allows individuals to organize their memories and make sense of their experiences, reducing emotional distress. WET's structured approach prevents patients from disengaging from their trauma processing and encourages a more complete emotional and cognitive integration of their traumatic experience.
Avoidance is a common coping mechanism in PTSD, where individuals try to suppress or evade distressing thoughts and memories. WET directly addresses this issue by requiring patients to repeatedly write about their trauma, gradually reducing avoidance tendencies and desensitizing them to distressing thoughts and feelings.
Clinical applications of written exposure therapy
The following are the clinical applications of written exposure therapy:
Effectiveness for trauma survivors
WET has been studied extensively in traumatic stress studies and has been shown to produce significant symptom reduction in a variety of trauma survivors, including motor vehicle accident survivors, veterans, and individuals exposed to combat or assault (DeJesus et al., 2024).
Research and validation
Multiple randomized controlled trials have validated WET as an effective treatment for PTSD, with studies conducted within the Department of Veterans Affairs and Veterans Affairs clinics demonstrating its efficacy for service members (DeJesus et al., 2024). A comprehensive manual on WET provides detailed guidance on its implementation, supporting clinicians in following a standardized treatment rationale.
Integration into clinical practice
WET is a valuable addition to clinical psychology and trauma therapy programs, offering a structured approach that can be implemented in primary care and mental health settings. The use of the PTSD checklist allows clinicians to monitor progress, ensuring clinically significant symptom change throughout the therapy process. By providing clear writing instructions and a structured format, WET enables trauma survivors to process distressing experiences in a controlled, supportive environment, making it an essential tool in clinical practice.
References
Sloan, D. M., & Marx, B. P. (2019). Written exposure therapy for PTSD: A brief treatment approach for mental health professionals. American Psychological Association. https://doi.org/10.1037/0000139-000
DeJesus, C. R., Trendel, S. L., & Sloan, D. M. (2024). A systematic review of written exposure therapy for the treatment of posttraumatic stress symptoms. Psychological trauma: Theory, research, practice and policy, 10.1037/tra0001659. Advance online publication. https://doi.org/10.1037/tra0001659
Commonly asked questions
WET is an effective treatment for posttraumatic stress disorder, using structured expressive writing to help individuals process trauma-related memories. By engaging in repeated writing sessions over five treatment sessions, patients gradually reduce avoidance behaviors and experience PTSD symptom reduction, leading to clinically significant symptom change.
Yes, WET has been tested in multiple randomized clinical trials, including research conducted at the VA Boston Healthcare System and the National Center for post-traumatic stress disorder (PTSD). These studies have demonstrated WET’s effectiveness in reducing PTSD symptoms, with long-term treatment gains comparable to other trauma-focused treatments.
WET is a brief exposure-based treatment that differs from other trauma-focused treatments like prolonged exposure therapy and cognitive processing therapy. Unlike these approaches, WET does not require between-session assignments or in-session verbal recounting of the trauma event, making it a more accessible option for many patients, including military service members and active duty service members.
Yes, WET has been found to be beneficial for individuals with acute stress disorder, especially when trauma occurs spontaneously in flashbacks or intrusive thoughts. By following a structured treatment protocol, WET helps individuals process their trauma in a controlled manner, leading to treatment gains and improvements in physical health and overall well-being.
