Narrative Writing as a Treatment for PTSD · 2015-09-12 · Narrative Writing as a Treatment for...
Transcript of Narrative Writing as a Treatment for PTSD · 2015-09-12 · Narrative Writing as a Treatment for...
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)
2
Why would narrative writing be efficacious in treating PTSD? • Emotional Inhibition/Catharsis (Freud,
1895; Pennebaker, 1989)
• Exposure model (Bootzin, 1997; Rachman, 1980)
• Cognitive Processing/meaning making (Horowitz, 1986)
Narrative Exposure Therapy (Neuner et al., 2002)
• 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
3
NET vs. IPT
20
30
40
50
60
70
Pre Post Follow-up
CA
PS
Assessment Period
NET IPT
Schall et al. (2009). Psychotherapy and Psychosomatics
p < .01
NET vs. Trauma Counseling and Monitoring Group
0
5
10
15
20
25
30
Pre Post Follow-up
PDS
Scor
e
Assessment Period
NET TC MG
Neuner et al. (2008). Journal of Consulting and Clinical Psychology
p < .01
p < .04
5
Is written disclosure efficacious for individuals with trauma exposure and at least
moderate PTSD severity?
Is Written Disclosure Beneficial for Trauma Survivors?
Sloan & Marx (2004). Journal of Consulting and Clinical Psychology
baseline follow-up0
5
10
15
20disclosure control
6
Extinction of Fear Response
1 2 31
3
5
7
9
writing session
Disclosure
Control
Sloan & Marx (2004). Journal of Consulting and Clinical Psychology
Does it matter if a person writes about the same
traumatic experience at each session?
7
Does it matter if you write about the same or different trauma events?
Sloan et al. (2005). Journal of Consulting and Clinical Psychology
baseline 1 month 2 months0
4
8
12
16
20
24
PDS
mea
n sc
ore Repeat
Different
Control
* *
Extinction of Fear Response
1
3
5
7
9
ple
asa
nt
u
np
lea
san
t
writing session
repeat
different
control
Sloan et al. (2005). Journal of Consulting and Clinical Psychology
8
Is written disclosure efficacious for individuals
with PTSD?
Written Disclosure as an Intervention for PTSD
baseline 2 months0
5
10
15
20
25
30
mea
n P
SS
I sco
re Disclosure
Control
Sloan, Marx, & Greenberg (2011). Behaviour Research and Therapy
9
Heart Rate Change as a Function of Condition and Session
1 2 3 -1
0
1
2
3
4
5
6
Hea
rt R
ate
(BP
M) C
hang
e
Writing Session
Disclosure
Control
Sloan et al. (2011). Behaviour Research and Therapy
Self-Reported Valence as a Function of Condition and Session
1 2 31
3
5
7
9
plea
sant
unpl
easa
nt
writing session
Disclosure
Control
Sloan et al. (2011). Behaviour Research and Therapy
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 5, 30 minute sessions
Participants • 46 adults with a primary diagnosis of
motor vehicle accident related PTSD • Average age of 41, 65% women,
racially diverse (37% Caucasian, 37% African-American)
• Median time since MVA was 20 months
11
WET Participants
• Low treatment drop-out rate (n = 2; 9%)
• High client satisfaction ratings • Mean score 28.20 (highest possible rating
= 32)
Efficacy of Written Exposure Treatment for PTSD
0
10
20
30
40
50
60
70
80
90
Baseline Post 3-Month 6-Month
Mea
n C
APS
WET WL
g = 3.49
g = 2.18
Sloan et al. (in press). Behaviour Research and Therapy
12
WET vs. other PTSD treatments
10
20
30
40
50
60
70
80
Pre Post 3-Month 6+ Month
CA
PS T
otal
Sco
re
Assessment Period
CPT WET PE MA
30 vs. 60 min of imaginal exposure
van Minnen & Foa (2006). Journal of Traumatic Stress
0
5
10
15
20
25
30
Pre Post FU
PSS-
SR S
core
Assessment Period
60-minute 30-minute
13
How many treatment sessions are needed?
0
5
10
15
20
25
30
PSS-
SR S
core
Sessions
60-minute 30-minute
60 min = 6.8 sessions 30 min = 7.2 sessions
van Minnen & Foa (2006). 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