Narrative Writing as a Treatment for PTSD

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1 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) 1

2 Why would narrative writing be efficacious in treating PTSD? Emotional Inhibition/Catharsis (Freud, 189; Pennebaker, 1989) Exposure model (Bootzin, 1997; Rachman, 198) Cognitive Processing/meaning making (Horowitz, 1986) Narrative Exposure Therapy (Neuner et al., 2) 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 2

3 NET vs. IPT 7 CAPS Pre Post Follow-up Assessment Period p <.1 NET IPT Schall et al. (9). Psychotherapy and Psychosomatics NET vs. Trauma Counseling and Monitoring Group 3 2 PDS Score 1 p <.1 p <.4 NET TC MG Pre Post Follow-up Assessment Period Neuner et al. (8). Journal of Consulting and Clinical Psychology 3

4 Written Disclosure Procedure 4

5 Is written disclosure efficacious for individuals with trauma exposure and at least moderate PTSD severity? Is Written Disclosure Beneficial for Trauma Survivors? disclosure control 1 baseline follow-up Sloan & Marx (4). Journal of Consulting and Clinical Psychology

6 Extinction of Fear Response 9 7 Disclosure Control writing session Sloan & Marx (4). Journal of Consulting and Clinical Psychology Does it matter if a person writes about the same traumatic experience at each session? 6

7 Does it matter if you write about the same or different trauma events? 24 PDS mean score * * Repeat Different Control 4 baseline 1 month 2 months Sloan et al. (). Journal of Consulting and Clinical Psychology Extinction of Fear Response pleasant unpleasant repeat different control writing session Sloan et al. (). Journal of Consulting and Clinical Psychology 7

8 Is written disclosure efficacious for individuals with PTSD? Written Disclosure as an Intervention for PTSD 3 mean PSSI score 2 1 Disclosure Control baseline 2 months Sloan, Marx, & Greenberg (11). Behaviour Research and Therapy 8

9 Heart Rate Change as a Function of Condition and Session Heart Rate (BPM) Change Writing Session Disclosure Control Sloan et al. (11). Behaviour Research and Therapy Self-Reported Valence as a Function of Condition and Session pleasant unpleasant Disclosure Control writing session Sloan et al. (11). Behaviour Research and Therapy 9

10 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, 3 minute sessions Participants 46 adults with a primary diagnosis of motor vehicle accident related PTSD Average age of 41, 6% women, racially diverse (37% Caucasian, 37% African-American) Median time since MVA was months

11 WET Participants Low treatment drop-out rate (n = 2; 9%) High client satisfaction ratings Mean score 28. (highest possible rating = 32) Efficacy of Written Exposure Treatment for PTSD 9 8 g = 3.49 Mean CAPS g = 2.18 Baseline Post 3-Month 6-Month WET WL Sloan et al. (in press). Behaviour Research and Therapy 11

12 WET vs. other PTSD treatments 8 7 CAPS Total Score CPT WET PE MA Pre Post 3-Month 6+ Month Assessment Period 3 vs. 6 min of imaginal exposure 3 PSS-SR Score minute 3-minute Pre Post FU Assessment Period van Minnen & Foa (6). Journal of Traumatic Stress 12

13 How many treatment sessions are needed? 3 PSS-SR Score min = 6.8 sessions 3 min = 7.2 sessions 6-minute 3-minute Sessions van Minnen & Foa (6). 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 13

14 Acknowledgements Funded by NIMH R3-MH A1 and R34-MH7768-1A2 Brian Marx, Brian Feinstein, Daniel Lee, Michelle Bovin, Matt Gallagher, Eva Greenberg, and Tobias Bennett Thank you! 14

MICHELE BEDARD-GILLIGAN, PH.D. ASSISTANT PROFESSOR DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES UNIVERSITY OF WASHINGTON

Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences PTSD IN PRIMARY CARE MICHELE BEDARD-GILLIGAN, PH.D. ASSISTANT PROFESSOR DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL