Written Exposure Therapy for Posttraumatic Stress Disorder and Integration of a Mindfulness-Based App in China: A Pilot Randomized Controlled Trial.

Despite posttraumatic stress disorder's (PTSD) significant burden in China, accessible and effective treatments remain limited. This pilot randomized controlled trial examined the feasibility, acceptability, and preliminary efficacy of Written Exposure Therapy (WET) for PTSD in China and explored whether adding a mindfulness-based app (MBA) improved insomnia outcomes. Forty-six adults meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for PTSD or subthreshold PTSD with associated insomnia were randomly assigned to WET (n = 15), WET + MBA (n = 15), or minimal contact control (MCC, n = 16). PTSD severity was measured using the PTSD Symptom Scale Interview (PSSI-5) and PTSD Checklist (PCL-5), and insomnia with the Insomnia Severity Index (ISI). Assessments occurred at baseline and posttreatment for all groups, with a 3-month follow-up for WET and WET + MBA. Effect sizes were measured with Hedges's g. Patient satisfaction was high for WET completers and moderate for WET + MBA completers. WET led to significantly greater reductions in PCL-5 (p = .022, g = -.66) and marginally greater reductions in PSSI-5 (p = .053, g = -.66) than MCC at posttreatment, with effects maintained at follow-up. While both conditions reduced insomnia (WET: g = -1.50; WET + MBA: g = -.67), WET alone produced significantly greater improvements than WET + MBA. WET appears to be a promising brief intervention for PTSD in Chinese samples. Exploring MBA clarifies the nuances of combining therapeutic approaches. Cultural adaptation might enhance engagement and inform optimized interventions for PTSD and associated insomnia.