Effectiveness of Written Exposure Therapy for Posttraumatic Stress Disorder in the Department of Veterans Affairs Healthcare System

Objective: Written Exposure Therapy (WET) for posttraumatic stress disorder (PTSD) has been shown to be efficacious in clinical trials; however, research is needed to determine WET's effectiveness in clinical practice settings. Additionally, research is needed to understand whether patient characteristics or treatment delivery format moderate outcomes. Method: Patient outcomes (n = 277) were assessed as part of a multisite training and implementation program in the Department of Veterans Affairs (VA). During treatment, patients completed self-report measures of PTSD, depression, and functional impairment. Patient characteristics (i.e., demographics, psychiatric comorbidity, trauma type) and treatment delivery format (i.e., telehealth vs. in-person) were assessed as treatment moderators. Results: Intent-to-treat analyses indicated that WET was effective in reducing PTSD symptoms (d = .84), depression symptoms (d = .47), and functional impairment (d = .36) during treatment. Approximately one quarter of patients dropped out of treatment prematurely. No moderators of PTSD treatment outcome were observed; however, telehealth delivery was associated with lower dropout. Conclusions: WET was an effective approach across a range of patient characteristics in this sample of veterans with PTSD. WET was also effective whether delivered in-person or via telehealth. WET is a promising treatment option for veteran patients in VA clinical care settings. Clinical Impact Statement Veterans receiving WET from therapists in the VA had significant symptom improvement. There was similar symptom reduction across patient characteristics and regardless of whether care was in-person or via telehealth. These findings provide support for WET's effectiveness and show it can be successfully delivered via telehealth.