Written exposure therapy

Domain VIII · Creative & expressive arts therapies · Denise Sloan, Brian Marx · 2012

What it is

Written Exposure Therapy (WET) is a brief, individual, trauma-focused exposure treatment for adults with PTSD. It was developed by Denise Sloan and Brian Marx (National Center for PTSD; Boston University). Over five sessions the client writes by hand or types for 30 minutes per session about one…

Format

• Format. Individual sessions, usually weekly in the VA trial. Session 1 lasts about 60 minutes and sessions 2–5 about 40 minutes. Each session has a 30-minute writing period timed by the therapist. The sources differ on how the remaining time is split:
• 2012 motor-vehicle-accident trial (46 survivors, WET vs waitlist): five weekly sessions of psychoeducation, rationale and repeated written exposure, with instructions to write about the deepest thoughts and feelings about the accident, and no in vivo assignments. Minutes are not reported in this…

Who practises it, and how they are trained or regulated

• Primary-care adaptation in the developers' 2022 training slides: six sessions. Session 1 is psychoeducation and rationale only, with no writing. Sessions 2–6 are check-in, feedback and 20 minutes of writing. This is a different version; do not mix it with the standard protocol.
• The training slides advise against WET when:
• The developers' own 2022 training slides add to this list. Poor candidates also include people with active psychosis, people with heavy substance use who will not abstain for two hours before and after sessions, and people with physical problems that prevent writing. Suitable candidates include people with co-occurring mental disorders, personality disorders, chronic or severe PTSD, multiple or chronic trauma,…

Evidence status, as the guide reports it

• After session 5, the options for residual symptoms are: add sessions, repeat WET with a different trauma, switch to another evidence-based PTSD therapy, or treat the remaining problems with another evidence-based treatment.

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?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• 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

• a device that lets the client drift into email or messages. Disable notifications.
• clients who start writing at home on their own. Ask how it went, but do not encourage it.
• writing only about the impact and skipping the event itself. The event writing must continue.
• the client nodding along without taking it in. Ask them to say the task back in their own words.
• leaving with SUDS near peak plus risk factors. Extend the session or arrange a same-day follow-up call.

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.