Written exposure therapy as treatment for comorbid PTSD and SUD: a systematic review and meta-analysis.
Tooba Fatima, Sarah Catchlove, Satish Melwani et al.
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In 30 seconds
This systematic review and meta-analysis assessed Written Exposure Therapy (WET) as a component of integrated treatment for people with comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD). Twelve studies were included; a random-effects meta-analysis of six studies found a large pre-to-post reduction in PTSD severity (Hedges' g = 1.18, 95% CI [0.68, 1.72], p < 0.001). Retention was 69.03%, and most participants and providers considered WET feasible and acceptable. The findings support WET as a potentially useful integrated-treatment component, while evidence about SUD outcomes remains limited.
Key findings
- Across six studies, PTSD severity decreased from before to after treatment (Hedges' g = 1.18, 95% CI [0.68, 1.72], p < 0.001).
- Retention was 69.03%, higher than typically reported for integrated prolonged exposure treatments for PTSD-SUD.
- Most participants and providers considered WET feasible and acceptable, although some participants found concurrent treatment burdensome.
Why it matters
PTSD and SUD can be treated concurrently, but integrated approaches may impose treatment burden. These findings suggest that WET, described as brief and low-burden to integrate, may be a feasible option within such care. The evidence is preliminary, however, and does not establish comparative effectiveness or clarify effects on SUD.
What to keep in mind
The review reports small samples, lack of comparator groups, and limited information about treatment components and changes in SUD.