Denise M. Sloan, PhD - US grants

DESCRIPTION (provided by applicant): There is a long line of work demonstrating that, relative to writing about neutral topics, writing about traumatic experiences produces improvements in physical health. Out of enthusiasm for this line of work, some have suggested that the written disclosure paradigm developed by Dr. James Pennebaker might be used as a therapeutic tool. Although the writing paradigm has been linked to improvements in physical health, relatively little is known about the effects of the paradigm on psychological health. There has also been speculation that males experience greater benefits from the paradigm than females, though no study has directly examined sex differences. Another important issue related to the paradigm relates to the underlying mechanism. While many investigators have studied the paradigm, few studies have examined the mechanism of action. The purpose of the proposed project is to investigate whether written disclosure is associated with improvements in psychological health, in addition to physical health, examine whether sex affects outcome, and if exposure underlies the efficacy of the paradigm. Participants with a history of traumatic experiences will be assigned to either a written emotional disclosure condition or a trivial writing, control condition, For both conditions writing sessions will take place on three consecutive days, for twenty minutes each day. Follow-up visits will take place one month and three months following the writing sessions. Outcome will be evaluated using a both psychological measures and a physical health measure completed at baseline and at the follow-up visits. In addition, both statisticai and clinical significance testing will be conducted. The hypothesis that exposure underlies the effectiveness of the written disclosure paradigm will be examined using self-reported emotion and physiological reactivity to each session. It is expected that the participants assigned to the disclosure condition will show improvement at follow-up compared to participants assigned to the control condition, and that males in the disclosure condition will show greater improvements at follow-up compared females in the same condition. Consistent with an exposure hypothesis, it is expected that disclosure participants will display habituation of emotion (both subjective and physiological) from the first to the last writing session. Further, initial emotional engagement and habituation of emotion is anticipated to be significantly related to symptom improvements at follow-up for the disclosure participants.

[unreadable] DESCRIPTION (provided by applicant): Motor vehicle accidents (MVAs) are extremely common in the United States, with approximately 3 million MVA's occurring every year. MVA's are also the single leading cause of posttraumatic stress disorder (PTSD) in the general population. Given the substantial associated financial costs of PTSD, it is imperative to develop effective, brief, and easily implemented treatments for MVA survivors with PTSD. Several treatments have been developed, however, many MVA survivors do not present for treatment for several reasons, including financial barriers and difficulty accessing treatment. There is also a shortage of available clinicians who are trained in evidence-based treatments for PTSD. The identification and development of a relatively inexpensive (and portable) treatment that can be implemented by a wide range of health care providers would represent a substantial public health advance. One potential intervention is the written disclosure intervention that has shown promise as an efficacious intervention in recent years. Building on a line of research conducted by the PI and funded by NIMH (R03MH068223-1A1), the goal of this project is to investigate whether written disclosure is an efficacious intervention for MVA-related PTSD. Men and women with MVA-related PTSD will be randomly assigned to either a clinic-based written disclosure intervention condition, a home-based written disclosure condition, or a supportive counseling intervention condition (standard care). Follow-up assessments will take place immediately post-treatment and at 3, 6, and 12 months following treatment. In addition to the main goal of examining the efficacy of written disclosure for PTSD, we will also examine the portability of the intervention with the inclusion on a home-based written disclosure treatment arm. In order to make additional refinement to the intervention we will investigate underlying mechanisms (e.g., physiological arousal that occurs during the writing session, narrative structure) and moderators of outcome (e.g., gender). Moreover, information gathered from patient feedback and focus groups of potential implementers will be used to make further refinements to the intervention. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): Prior research has demonstrated that written exposure therapy (WET), is an efficient, well- tolerated, and efficacious treatment for PTSD. The proposed project takes the next step in establishing WET as an intervention for PTSD by examining whether WET is noninferior to an evidence-based treatment for PTSD. Using a randomized noninferiority controlled trial, 126 adults with a primary diagnosis of PTSD will be assigned to either WET or Cognitive Processing Therapy (CPT). Outcome data will be collected at baseline and 6-, 12-, 18-, 24 and 60-weeks post-baseline. The primary aim is to examine whether PTSD participants assigned to WET demonstrate PTSD symptom severity outcome that is noninferior to PTSD participants assigned to CPT. Secondary aims include examining whether expected treatment gains are sustained for both treatments and whether WET has a lower treatment dropout rate relative to CPT. Exploratory aims include examining moderators and mediators of WET and CPT. If the hypothesis that WET is noninferior to CPT is confirmed then a brief treatment option for PTSD will be established. PUBLIC HEALTH RELEVANCE: Although evidence-based treatments for PTSD exist, a significant minority of individuals do not benefit from these treatments and many individuals do not seek treatment, citing barriers such as time commitment and expense of treatment. The goal of the proposed study is to establish an alternative PTSD treatment that is effective and efficient.