Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 10;20(1):11.
doi: 10.1186/s13722-024-00531-0.

A pilot study of twice-weekly group-based written exposure therapy for veterans in residential substance use treatment: effects on PTSD and depressive symptoms

Natalia Van Doren  1   2 , Fang-Hsi Chang  3   4 , Amanda Nguyen  4 , Kevin R McKenna  5 , Derek D Satre  6   7 , Shannon Wiltsey-Stirman  5   8   9
Affiliations

A pilot study of twice-weekly group-based written exposure therapy for veterans in residential substance use treatment: effects on PTSD and depressive symptoms

Natalia Van Doren et al. Addict Sci Clin Pract. .

Abstract

Background: Posttraumatic stress disorder (PTSD) is highly comorbid with substance use disorders (SUDs), resulting in high prevalence of PTSD among individuals in residential SUD care. However, there is limited research on integrating trauma treatment into residential SUD care settings. The aim of the present project was to conduct an initial evaluation of the effects of group-based Written Exposure Therapy (WET) on PTSD and depressive symptoms that was integrated into programming for individuals in residential SUD treatment.

Methods: Participants were 48 Veterans with comorbid PTSD-SUD from a 28 day residential SUD program at a Veterans Affairs Medical Center. Eligible participants were enrolled in 5 sessions of WET, delivered twice-weekly in an adapted group format. PTSD symptoms and depressive symptoms were assessed at each session with the Posttraumatic Stress Disorder Checklist, DSM-5 version (PCL-5) and the Patient Health Questionnaire (PHQ-9).

Results: Over 5 months, 76.2% of the target population were successfully enrolled. Of the enrolled sample, 48 participants, 92% (n = 44) completed 3 sessions, while 56% (n = 28) completed 5 sessions. Generalized Estimating Equations (GEE) showed significant within-person reductions in PTSD symptoms over time, with an average decrease of 3.18 per session (χ² = 23.21, p = .006) and moderate effect sizes (d = 0.46 and d = 0.51 at mid- and post-treatment). In addition, there were significant reductions in depressive symptoms within-persons over time, with an average per-session reduction of 1.13 (χ² = 23.10, p = .006).

Conclusion: Findings demonstrate that brief, group-delivered WET is feasible and shows promise for addressing PTSD and depressive symptoms in residential SUD treatment. Results of the present evaluation could inform further efficacy testing and implementation of PTSD treatment into residential SUD settings.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Participant flow diagram with reasons for dropout. WET written exposure therapy
Fig. 2
Fig. 2
Change in PTSD symptoms over time. Average PTSD symptom scores across the entire sample from. Session 1 to Session 5. PCL-5 = PTSD Checklist, DSM-5 version.
Fig. 3
Fig. 3
Change in depressive symptoms over time. Average depressive symptoms across the entire sample from. Session 1 to Session 5. PHQ-9 = patient health questionnaire, 9-item version.
See this image and copyright information in PMC

Update of

References

    1. Aloisio KM, Micali N, Swanson SA, Field A, Horton NJ. Analysis of partially observed clustered data using generalized estimating equations and multiple imputation. Stata J. 2014;14(4):863–83. - DOI - PMC - PubMed
    1. Back S, Dansky BS, Coffey SF, Saladin ME, Sonne S, Brady KT. Cocaine dependence with and without post-traumatic stress disorder: a comparison of substance use, trauma history and psychiatric comorbidity. Am J Addictn. 2000;9(1):51–62. - DOI - PubMed
    1. Back SE, Waldrop AE, Brady KT. Treatment challenges associated with comorbid substance use and posttraumatic stress disorder: clinicians’ perspectives. Am J Addictn. 2009;18(1):15–20. 10.1080/10550490802545141. - DOI - PMC - PubMed
    1. Back SE, Killeen T, Badour CL, Flanagan JC, Allan NP, Santa Ana E, Brady KT. Concurrent treatment of substance use disorders and PTSD using prolonged exposure: A randomized clinical trial in military veterans. Addictive behaviors. 2019; 90:369–77. - PMC - PubMed
    1. Baker DE, Edmonds KA, Calvert ML, Sanders SM, Bridges AJ, Rhea MA, Kosloff S. Predicting attrition in long-term residential substance use disorder treatment: a modifiable risk factors perspective. Psychol Serv. 2020;17(4):472–82. 10.1037/ser0000333. - DOI - PubMed