Written exposure therapy

Domain VI · Brief, integrative, trauma, hypnosis & coaching · Denise M. Sloan, Brian P. Marx · Boston

What it is

Written Exposure Therapy (WET) is a brief, manualised, exposure-based treatment for PTSD developed by Denise M. Sloan and Brian P. Marx (National Center for PTSD, VA Boston Healthcare System / Boston University). The client writes by hand about one index trauma for 30 minutes in each of five…

Format

• Phase 1: Session 1 – psychoeducation, rationale, first writing. Goal: client understands PTSD, avoidance and why writing helps, and starts approaching the memory. Contents: weekly measures; psychoeducation read from the script with a pause to ask which symptoms are familiar; rationale; SUDS…
• Phase 2: Session 2 – detail. Goal: a full, detailed account of the event with sensory detail and the thoughts and feelings felt during and right after it. Contents: measures; brief check-in; feedback on narrative 1; instructions (continue where you stopped, or rewrite the whole event if finished,…

Who practises it, and how they are trained or regulated

• Format. Individual, five sessions, normally weekly (the longest interval studied is one week; the developers expect longer gaps to dilute gains). Session 1 lasts 60 minutes in every source. Later sessions last 40 minutes in the WET vs CPT trial (Sloan et al., 2018) and in CDP training, and about 45 minutes in the WET vs PE trial report (Sloan et al., 2023) and Sloan & Marx (2024); the NCPTSD page gives about 50.…
• Phase 0: Pre-treatment assessment. Goal: confirm WET fits and pick the index trauma. Use a PTSD diagnostic assessment (CAPS-5 in trials) or the PCL-5, plus a depression screen (PHQ-9 in CDP training); assess suicide risk, psychosis, bipolar stability, substance use severity, cognitive impairment and current safety. Select one index trauma. Move on when: PTSD or significant subclinical PTSD tied to a clearly…
• Phase 3: Sessions 3–4 – meaning and impact. Goal: keep approaching the memory (whole event again or its most upsetting part) while writing about how the trauma has changed the client's life, view of life, sense of meaning and relationships. Criterion to move here: the client wrote adequately about the event itself in sessions 1–2; if not, delay the shift and repeat detail-focused instructions. In the WET vs PE…

Evidence status, as the guide reports it

• After session 5 – residual symptoms. Options named by the trainers: add writing sessions, repeat WET on another trauma (usually only a couple of extra sessions are needed), switch to another PTSD evidence-based treatment, or treat remaining problems with another EBP (e.g. CBT for depression).…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Gradual addition of emotion words over sessions.
• Early 'wrapping up' that skips the memory entirely.
• Repeated dissociation that prevents writing (see Section 5).
• Endless extensions without adherence; switch approach instead.
• Long pauses, staring, writing off-topic, or signs of dissociation (see 4.19).

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.