The Effect of Writing as Exposure Therapy on PTSD Symptoms
The majority of empirically supported treatments for Posttraumatic Stress Disorder involve some form of exposure, which desensitizes an individual to trauma-related information. Theoretical work has suggested that the mechanism of exposure may explain the tendency for writing to lessen symptoms, and empirical evidence of writing and PTSD symptoms suggests that modifying the writing paradigm may result in better symptom relief. The present investigation aimed to compare the efficacy of an exposure-based writing intervention to the standard writing paradigm. A total of 68 undergraduates that were screened for PTSD symptoms were randomly assigned to write about their most severe trauma for 40 minutes, their most severe trauma for 20 minutes, or a control topic for 20 minutes across four weekly writing sessions. The final sample included 48 participants who completed all four days of writing and the Posttraumatic Checklist-Civilian Version, Impact of Events Scale - Revised, and Posttraumatic Dissociation Scale at pretest and follow-up. Participants that wrote about trauma for 40 minutes were expected to report less PTSD symptoms, dissociation, and health visits than participants that write about trauma or a control topic for 20 minutes. No condition differences were found. However, all participants improved on dependent measures regardless of writing condition. Linguistic analysis of writing samples and essay ratings indicated that participants generally followed directions, yet also suggested some possible design error for the present control topic. Analysis of continuous SUDS ratings, a unique aspect of the present study, indicated that writing for 40 minutes was associated with an initial increase then gradual decrease in anxiety. The present study was also unique in that all writing occurred within one year of Hurricane Katrina, which affected the present university and may have affected results. The present study is consistent with findings of other investigations of writing and PTSD that have found no effect, yet differ from a few investigations that have found an effect for PTSD symptoms, trauma reactivity, and depression. Future studies should consider implementing further design modifications to the writing paradigm in order to increase exposure to trauma and enhance effects for trauma-related outcomes.