Written Exposure Therapy as Effective as Cognitive Processing Therapy at Reducing PTSD Symptoms

pen and notebook
pen and notebook
Cognitive processing therapy was directly compared with written exposure therapy for individuals with PTSD.

Patients seeking treatment for posttraumatic stress disorder (PTSD) who were receiving either written exposure therapy or cognitive processing therapy had equivalent reductions in PTSD symptom severity, according to results published in JAMA Psychiatry.

The efficacy of written exposure therapy (n=63) and cognitive processing therapy (n=63) was evaluated in study participants meeting Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria for PTSD. Symptom relief was evaluated using the Clinician-Administered PTSD Scale for DSM-5 and was compared between groups.

Among those treated with written exposure therapy and those treated with cognitive processing therapy, Clinician-Administered PTSD Scale for DSM-5 severity scores between treatments were non-inferior at any assessment point. Additionally, during the 24- and 36-week follow-up, fewer than half of participants in both treatment groups failed to meet the diagnostic criteria for PSTD.  

Furthermore, participants in the written exposure therapy treatment group were less likely to discontinue therapy (n=5 in the written exposure therapy group; n=20 cognitive processing therapy group).

No differences in baseline PTSD severity, expectations of treatment results, or treatment satisfaction were seen for either treatment group.

Written exposure therapy and cognitive processing therapy differ in at least one important aspect: the 5-week treatment timeframe for written exposure therapy compared with 12 weeks for cognitive processing therapy.

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In discussing this important difference, the study investigators wrote: “Our findings have important implications for treating individuals with PTSD, especially given the high clinical demand for PTSD treatment among veterans and military service members. The availability of a treatment that is time efficient for both the patients and the clinicians may address some of the barriers to care that have been identified in the Veterans Affairs and Department of Defense settings.” 

The study investigators concluded that written exposure therapy is a durable and efficacious form of PTSD treatment that may address currently observed high treatment attrition rates.


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 [published online January 17, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.4249