Verified by Written Exposure Therapy
Written exposure therapy (WET) is a brief, evidence-based behavioral psychotherapy designed to relieve the distress associated with traumatic memories. Exposure therapy is a well-established treatment for anxiety and post-traumatic stress disorder (PTSD), in which people are gradually exposed in a safe way to what they fear so that they no longer experience overwhelming distress in its presence and no longer need to avoid what they fear. Whereas traditional exposure therapy is conducted in the physical presence of the feared object or experience (in vivo exposure), written exposure therapy involves only the imagined presence of the troubling object or experience (imaginal exposure).
In a series of five brief (50 to 60-minute) sessions, the therapist guides a person to bring to mind the traumatic experience and write in detail about the thoughts and emotions they had at the time of the event. Studies show it is an effective way to extinguish the fear that makes PTSD and other forms of severe anxiety so distressing and disabling and to reduce the intrusive thoughts, flashbacks, disturbing nightmares, feelings of hopelessness, depression, and hypervigilance that accompany PTSD.
WET was specifically developed as an individual treatment for people suffering from PTSD. Like all other forms of exposure therapy, WET can create moderate distress as individuals engage with trauma-related thoughts and feelings, But the distress is short-lived and paves the way for feeling significantly better and safer after treatment.
WET is especially suited to the treatment of military service members and veterans. It is recommended by the Veterans Administration/Department of Defense Clinical Practice Guideline for Managing PTSD. WET can also be conducted via video platforms.
Expect a course of treatment that consists of five sessions, all one hour or less, typically delivered once a week or more frequently, based on the severity of the person’s distress. Before undergoing WET, the individual seeking treatment is evaluated by the therapist to determine whether they are a suitable candidate; they must have no suicidal thoughts. The therapist and client then decide on a specific traumatic life experience that will be the focus of WET.
The first half of the first treatment session, which is one hour long, consists of psychoeducation about trauma, PTSD, and WET. The second half consists of writing about the trauma for 30 minutes as the therapist provides memory prompts. Individuals can expect to experience some level of emotional and physical discomfort while recalling distressing memories.
In the remaining (shorter) sessions, the therapist provides feedback on what was written in the prior session and, based on that review, helps the individual home in on especially significant aspects of the trauma memory. The therapist then guides the individual through another 30 minutes of free-form writing about the trauma, with special prompts to access feelings as well as facts. In the final two sessions, individuals are prompted to focus their writing on the effect the disturbing event has had on their lives.
Each session begins with a check-in whereby the therapist and client discuss any changes in symptoms or in the traumatic memory itself. Typically, the therapist also measures PTSD symptoms using a PTSD checklist. There is no homework between sessions.
As individuals write about the specific traumatic life experience that is the subject of therapy, they are encouraged to provide as much detail as possible about their thoughts and feelings at the time of the experience. The writing is personal, free-form, expressive, and informal. Yet, it enables individuals to process the distressing experience, link feelings to events, and make meaning of them.
WET is built on the pioneering work of social psychologist James Pennebaker, begun in the 1980s, on the therapeutic value of confronting traumatic memories through writing. His studies, and many others inspired by his work, have assessed the effects of expressive writing on mental and physical health. They have shown that a series of brief sessions of writing about a disruptive experience, focusing especially on the feelings pertaining to the event and the event’s emotional impact, produces symptoms of physiologic arousal at the time of writing—but in the long term, it reduces physiological arousal and negative feelings and leads to measurably better health. And, in fact, those who benefit most are those whose writing contains more negative emotion words than positive emotion ones. They had better immune function, lower blood pressure, reduced anxiety and depression, brighter moods, less distractibility, and improved social relations. Writing calms the minds of people haunted by emotional upheaval; they can approach their experience and make sense of it.
Studies show that WET is at least as effective in reducing or eliminating symptoms of PTSD as prolonged exposure therapy, currently the first-line treatment. What researchers find especially promising is that individuals are not inclined to drop out of WET therapy; they are more likely to complete a course of WET, with its fewer and shorter sessions, than other treatments for PTSD. While in-vivo exposure is not a part of WET, researchers have found that confronting previously avoided people, situations, and places related to the trauma occurs spontaneously in WET.
Feelings of safety are essential to healing from PTSD. With any form of therapy, it is important to seek a therapist with whom it is possible to establish clarity of communication and a sense of good fit; it is especially important for those seeking help for PTSD.
In addition to a good fit, experience counts, so it is advisable to seek a therapist who has had extensive training and experience using WET to treat people presenting with mental health concerns similar to yours. WET has been tested and found effective; therapists follow a specific script in guiding individuals through the process of writing about their distressing memories. It is important that the therapist be well-versed in and follow the WET protocol.
You might ask a prospective therapist such questions as:
- How often have you dealt with problems such as mine before?
- How do you know whether a person is a good candidate for WET?
- How does WET work?
- What is a typical plan of treatment, and how long is a typical course of therapy?
- How do you measure progress?
- How will I know the treatment is working?
