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Narrative Writing as a Treatment for PTSD

Denise M. Sloan

National Center for PTSD at VA Boston Healthcare System Boston University School of Medicine

Narrative writing

•  A long tradition of viewing narrative writing as a form of therapy

•  “Writing is a very sturdy ladder out of the pit.” (Alice Walker)

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Why would narrative writing be efficacious in treating PTSD? •  Emotional Inhibition/Catharsis (Freud,

1895; Pennebaker, 1989)

•  Exposure model (Bootzin, 1997; Rachman, 1980)

•  Cognitive Processing/meaning making (Horowitz, 1986)

Narrative Exposure Therapy (Neuner et al., 2002)

•  A community-based approach for use with survivors of war and torture

•  Trauma survivor develops a narration of

their entire life while focusing on detailed account of traumatic events

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NET vs. IPT

20

30

40

50

60

70

Pre Post Follow-up

CA

PS

Assessment Period

NET IPT

Schall et al. (2009). Psychotherapy and Psychosomatics

p < .01

NET vs. Trauma Counseling and Monitoring Group

0

5

10

15

20

25

30

Pre Post Follow-up

PDS

Scor

e

Assessment Period

NET TC MG

Neuner et al. (2008). Journal of Consulting and Clinical Psychology

p < .01

p < .04

4

Written Disclosure Procedure

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Is written disclosure efficacious for individuals with trauma exposure and at least

moderate PTSD severity?

Is Written Disclosure Beneficial for Trauma Survivors?

Sloan & Marx (2004). Journal of Consulting and Clinical Psychology

baseline follow-up0

5

10

15

20disclosure control

6

Extinction of Fear Response

1 2 31

3

5

7

9

writing session

Disclosure

Control

Sloan & Marx (2004). Journal of Consulting and Clinical Psychology

Does it matter if a person writes about the same

traumatic experience at each session?

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Does it matter if you write about the same or different trauma events?

Sloan et al. (2005). Journal of Consulting and Clinical Psychology

baseline 1 month 2 months0

4

8

12

16

20

24

PDS

mea

n sc

ore Repeat

Different

Control

* *

Extinction of Fear Response

1

3

5

7

9

ple

asa

nt

u

np

lea

san

t

writing session

repeat

different

control

Sloan et al. (2005). Journal of Consulting and Clinical Psychology

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Is written disclosure efficacious for individuals

with PTSD?

Written Disclosure as an Intervention for PTSD

baseline 2 months0

5

10

15

20

25

30

mea

n P

SS

I sco

re Disclosure

Control

Sloan, Marx, & Greenberg (2011). Behaviour Research and Therapy

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Heart Rate Change as a Function of Condition and Session

1 2 3 -1

0

1

2

3

4

5

6

Hea

rt R

ate

(BP

M) C

hang

e

Writing Session

Disclosure

Control

Sloan et al. (2011). Behaviour Research and Therapy

Self-Reported Valence as a Function of Condition and Session

1 2 31

3

5

7

9

plea

sant

unpl

easa

nt

writing session

Disclosure

Control

Sloan et al. (2011). Behaviour Research and Therapy

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Altering Written Disclosure to be Beneficial for PTSD

•  Added psychoeducation of PTSD

•  Added treatment rationale

•  Directed writing about a specific trauma event, with focus on detail and emotion felt at the time of the event

•  Increase dose to 5, 30 minute sessions

Participants •  46 adults with a primary diagnosis of

motor vehicle accident related PTSD •  Average age of 41, 65% women,

racially diverse (37% Caucasian, 37% African-American)

•  Median time since MVA was 20 months

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WET Participants

•  Low treatment drop-out rate (n = 2; 9%)

•  High client satisfaction ratings •  Mean score 28.20 (highest possible rating

= 32)

Efficacy of Written Exposure Treatment for PTSD

0

10

20

30

40

50

60

70

80

90

Baseline Post 3-Month 6-Month

Mea

n C

APS

WET WL

g = 3.49

g = 2.18

Sloan et al. (in press). Behaviour Research and Therapy

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WET vs. other PTSD treatments

10

20

30

40

50

60

70

80

Pre Post 3-Month 6+ Month

CA

PS T

otal

Sco

re

Assessment Period

CPT WET PE MA

30 vs. 60 min of imaginal exposure

van Minnen & Foa (2006). Journal of Traumatic Stress

0

5

10

15

20

25

30

Pre Post FU

PSS-

SR S

core

Assessment Period

60-minute 30-minute

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How many treatment sessions are needed?

0

5

10

15

20

25

30

PSS-

SR S

core

Sessions

60-minute 30-minute

60 min = 6.8 sessions 30 min = 7.2 sessions

van Minnen & Foa (2006). Journal of Traumatic Stress

Future Research •  Narrative writing is a promising treatment

approach for PTSD

•  Directly compare narrative writing (e.g., WET) to evidence-based treatments for PTSD

•  What is optimal dose of PTSD treatment?

•  Narrative therapy delivered by lay counselors

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Acknowledgements

•  Funded by NIMH R03-MH068223-01A1 and R34-MH077658-01A2

•  Brian Marx, Brian Feinstein, Daniel Lee, Michelle Bovin, Matt Gallagher, Eva Greenberg, and Tobias Bennett

Thank you!