Written Exposure in Substance Treatment

Potomac Health Foundations50 enrolled

Overview

The purpose of this pilot randomized clinical trial is to test the feasibility and efficacy of written exposure therapy (WET) for posttraumatic stress disorder (PTSD) within the context of residential substance use disorder (SUD) treatment. All participants meet criteria for PTSD and are in a short term residential SUD treatment program (target residential treatment duration = 28 days) regardless of the research. The main questions the study aims to answer are: 1) Is the delivery of WET feasible in short term residential SUD treatment for individuals with severe SUD; 2) Do participants in the TAU+WET condition have greater reductions in PTSD symptoms pre/post treatment compared to participants in TAU alone?

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Posttraumatic Stress Disorder Substance Use Disorders

Interventions

Written Exposure Therapy is a brief, evidenced based intervention for PTSD. WET is generally delivered individually across 5 sessions in which the therapist guides the patient through writing exercises. Across exposure sessions, participants experience habituation so that their symptoms decrease by the end of treatment. WET has an established evidence base in general outpatient psychotherapy for PTSD, but has not been adapted or tested in residential SUD treatment settings.

Treatment as UsualBEHAVIORAL

Treatment as Usual will include a variety of standard care services offered in short term residential treatment. For example, participants receiving TAU will participate in individual case management/general counseling sessions focused on their substance use disorder and its consequences, group based psychoeducation sessions, group based counseling sessions (e.g., relapse prevention planning), individual services with a medical provider and pharmacotherapy (e.g., for withdrawal, relapse prevention, or co-occurring conditions)

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * At least 18 years old * Fluent in English * Cognitively able to provide consent to the research * Enrolled in inpatient treatment at the clinical site where the research takes place * Meet criteria for probable PTSD based on PCL-5 score * Be early enough in their residential stay to allow time to complete the WET protocol * Have a clear memory of the traumatic event so they are able to write about itin detail Exclusion Criteria: * Reports significant suicidal or homicidal ideation with intent, untreated psychosis, or have other health limitations that may interfere with their ability to participate in the research

Outcomes

Primary Outcomes

Efficacy of WET

PTSD symptom reduction pre/post intervention by treatment arm as measured by the posttraumatic checklist for DSM-5 (PCL-5). The PCL-5 is a self-report questionnaire yielding scores ranging from 0-80 with higher scores indicating greater symptomology.

Time frame: Pre/post intervention window (approximately 3 weeks)

Secondary Outcomes

Feasibility of WET delivered in residential SUD treatment context

Percentage of participants in the WET arm who were able to complete the treatment (5 sessions) prior to discharge

Time frame: Up to 4 weeks, or until the participant discharges from residential treatment (whichever comes first).

Acceptability of WET delivered in residential SUD treatment context

Treatment satisfaction scores among WET participants as measured by the 2-part credibility/expectancies questionnaire (CEQ). The CEQ utilizes two scoring systems that range from 1-9 or 0%-100%. with higher scores indicating greater acceptability.

Time frame: Collected post intervention window (approximately 3 weeks from randomization)