Implementation and Adaptations of Written Exposure Therapy: Lessons Learned Across Settings

Abstract

Written Exposure Therapy (WET) is a promising evidence-based psychotherapy (EBP) for posttraumatic stress disorder (PTSD), in part because it is less time-intensive (i.e., five sessions with no between-session assignments) and has lower dropout than other first-line PTSD psychotherapies. As such, WET has the potential to improve access to quality care and reduce attrition, particularly among difficult-to-reach populations (e.g., veterans, military service members, and minoritized groups). The process of effectively translating WET to diverse practice settings is likely to require the development of customized treatment-congruent adaptations to facilitate access to care and the uptake of the intervention.This article outlines several recent efforts to implement WET in novel ways, while maintaining an emphasis on fidelity to the core mechanisms of the treatment. Implementation efforts include a cultural center with Spanish-speaking immigrants, active-duty military behavioral health, technology-based approaches, and group format in residential and outpatient Veterans Affairs (VA) settings. We will review lessons learned and program evaluation data from the included sites and will offer suggestions for clinic administrators and providers hoping to implement WET.