Feasibility of written exposure therapy for PTSD in a psychiatric outpatient clinic: in-person and remote delivery.

Objectives

Previous trials have demonstrated that Written Exposure Therapy (WET) is effective in treating post-traumatic stress disorder (PTSD), achieving comparable outcomes to more time-intensive treatments such as prolonged exposure and cognitive processing therapy, but with lower dropout rates. Its short duration, absence of between-session homework, and high adherence rates make WET a promising alternative to traditional more time-intensive therapy. Despite established efficacy of WET in controlled trials, questions remain about its feasibility, tolerability, and flexibility when implemented in routine psychiatric outpatient settings. This study addresses these gaps.Method: Twenty-four patients, most with moderate to severe PTSD and significant psychiatric comorbidities, were recruited from a specialised psychiatric outpatient clinic for PTSD and underwent WET over a five-to-six-week period. Feasibility was assessed in terms of adherence, client satisfaction, adverse events, effectiveness, time requirements, and flexibility. PTSD symptom severity was measured at baseline, post-treatment, and one-month follow-up using the PTSD Checklist for DSM-5. The treatment was delivered either through face-to-face sessions at the clinic (n = 7) or via video conferencing (n = 15), with two participants receiving a combination of formats.

Results

Adherence was high, with 23 of 24 participants completed treatment. Client satisfaction was excellent, with a mean score of 25.91 (SD = 4.27) on the Client Satisfaction Questionnaire. Average therapist time required was under six hours per patient. Within-group analyses showed significant reductions in PTSD symptoms at one-month follow-up (d = 1.08, 95% CI: 0.47-1.69). No serious adverse events were reported. WET was feasible, resource-efficient, video-compatible, and suitable for delivery by individual therapists with limited training.

Conclusion

WET proved to be a feasible, effective, and resource-efficient intervention for PTSD in routine psychiatric care. Its implementation may expand access to evidence-based treatment and reduce reliance on full-dose CBT. Further research should explore its role in optimising care pathways and addressing waiting lists.Trial registration: ClinicalTrials.gov identifier: NCT04328935.