Stuart Johnson was skeptical about the writing therapy his psychologist recommended to treat his post-traumatic stress disorder. Writing, the Persian Gulf War veteran said, was not his forte. But the retired U.S. airman had reached a low point in his life and was willing to give something else a try after seeking help for many years at the U.S. Department of Veterans Affairs.
The process of writing about his experiences was intense at first, he said, but he “fought through it.” That hard work he did a few years ago restored his courage. It gave him a new outlook. And it helped him clear his mind so he could continue working in the transportation industry.
“I had control of my life again,” said Johnson, 56, a husband and father who lives in the Atlanta area.
Typically consisting of five sessions of about 50 minutes each, the therapy for PTSD patients involves writing narratively about their traumatic experiences. Therapists supervise the sessions — online or in person — and give their patients feedback about their writing. The process helps patients realize that memories of their troubling experiences are not dangerous and that it is possible to think about traumatic events and their meaning in new ways.
Published last year and in 2018, a pair of studies concluded written exposure therapy for U.S. military veterans with PTSD is just as effective as other treatments recommended by the VA, including forms of talk therapy. The studies also determined fewer patients drop out of the writing therapy, which can require less time than other treatments.
In 2019, the VA began a program that trains therapists nationwide on how to use written exposure therapy. Eighteen in Georgia have been trained and more than 650 of their patients in the state have chosen to use it.
Researchers are now poised to study how it helps others, including those grappling with addiction and sexual trauma. Another study will evaluate how it works when combined with a treatment for depression called repetitive transcranial magnetic stimulation, which uses magnetic fields to stimulate nerve cells in the brain.
Brian Marx has spent many years developing written exposure therapy with Denise Sloan, a colleague at the VA’s National Center for PTSD.
“We know this is helping a lot of people, so we are really grateful for that,” Marx said.
Marx and Sloan, both psychiatry professors at Boston University’s Chobanian & Avedisian School of Medicine, are about to do a follow-up study of how the therapy works in preventing suicides among active-duty service members.
Reducing the high suicide rate among veterans is a top priority for the VA. The rate rose slightly between 2020 to 2021 — the most recent data available — from 32.6 to 33.9 per 100,000. In contrast, the rate for non-veteran adults was 16.7 per 100,000 in 2021. In all, 6,392 veterans took their own lives in 2021, up by 114 from the year before.
Sheila Rauch, director of mental health research and program evaluation for the Atlanta VA Health Care System, is optimistic about the therapy’s effectiveness and wants to study it further, adding she has seen a similar writing treatment work in conjunction with talk therapy for PTSD patients in primary care.
“There is a lot of enthusiasm in the Atlanta area for written exposure therapy and for other models that are getting treatments out to patients where they are,” said Rauch, deputy director of the Emory Healthcare Veterans Program.
Written exposure therapy was inspired by pioneering research done by James Pennebaker, a psychology emeritus professor at the University of Texas at Austin. Pennebaker found that people who write about emotionally difficult events experienced long-term decreases in health problems and visited doctors less often. Such writing forces people to acknowledge traumatic events happened and seek to understand them, Pennebaker said, and that can help them derive meaning from, even discoveries about, their experiences.
“By translating an experience into language, it changes the way it is represented in our minds — the way it is represented in our brains for that matter,” he said. “It simplifies it and organizes it.”
At first, some patients are reluctant because they worry about their writing skills, so psychologists seek to reassure them.
“It’s not connected to writing ability. That is one of the questions that we often get,” said Courtney Worley, a clinical psychologist and training program coordinator for the VA. “Your therapist in this treatment is not judging your spelling or your grammar.”
The feedback therapists give patients as part of the therapy, she added, focuses on “helping them to go deeper into their thoughts and feelings around the trauma that they are writing about.”
Kelci Flowers, a clinical psychologist, has used the therapy with many VA patients in the Atlanta area since 2019. She said it has helped reduce their depression and anxiety and has aided them in getting better sleep and an “overall better quality of life.”
“At the end of therapy,” she said, “people usually experience a lot of a decrease in intrusive thoughts and memories about the trauma, a decrease in nightmares about the trauma. They are able to talk about the trauma and think about it without having a lot of distress associated with the memory.”
Among Flowers’ patients is Johnson, the retired airman. Johnson said he would recommend the writing therapy to others, adding that he credits it with giving him the confidence to “face the world that we deal with today. It gave me that sense to be part of society again and not deal with unnecessary pressures I was putting on myself.”
“Life,” he said, “is good right now.”
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