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kelly-sikkema-f_aHTIof44U-unsplash.jpgThe gold-standard evidence-based treatments for PTSD (e.g., Prolonged Exposure [PE] therapy, Cognitive Processing Therapy) are typically implemented in 60- to 90-minute sessions for approximately 12 appointments. These treatments are considered highly effective, and it is often recognized that dropout rates (as well as waitlists for these services) are high. That said, advances in short-term, evidence-based PTSD treatments are helping to combat some of the potential barriers those with PTSD face in accessing and completing treatment. Specifically, this article highlights two brief PTSD treatments that can be implemented in primary care settings: Written Exposure Therapy (WET) and Prolonged Exposure Therapy for primary care (PE-PC). While the traditional model of outpatient PTSD treatment may be feasible for some, expanding the types of treatments and settings for treatment delivery without compromising on efficacy helps make PTSD treatment more widely accessible.
First, WET is a treatment protocol based on an emotional processing theory of PTSD (similar to other exposure therapies) that typically consists of five sessions that vary between 40-60 minutes in length (Sloan & Marx, 2019). The primary focus of these sessions is writing a trauma narrative and observing changes in subjective distress as exposure to the narrative increases. Multiple studies have explored the implementation of WET using shorter sessions, finding it feasible and effective to implement in sessions as brief as 30 minutes (Schumatcher et al., 2022; Tyler et al., 2022). More information on the specific treatment protocol for WET can be found in Written Exposure Therapy for PTSD: A brief treatment approach for mental health professionals (Sloan & Marx, 2019).
Second, PE, which is typically implemented in approximately twelve 90-minute sessions, has been adapted to four 30-minute sessions specifically designed for implementation in a primary care setting (PE-PC). The abridged protocol, similar to the standard course of PE, maintains focus on in-vivo exposure to trauma-related avoidance, imaginal exposure to the trauma memory, and emotional processing (Rauch et al., 2017). Authors that describe one of the PE-PC pilot studies note that PE-PC and WET are similar, but primary differences are that WET was developed for specialty mental health and does not involve specific emotional processing or in vivo exposure (Rauch et al., 2017).
Who might benefit from these approaches? Although the research is still emerging, it suggests that there are multiple scenarios in which a shorter-term PTSD treatment might be appropriate and beneficial. One study reported that military veterans above the age of 30 with PTSD were less likely to attend specialty mental health visits as compared to younger veterans, so it is possible that short-term treatment, integrated with primary care, might be more appealing or accessible for some individuals (Lu et al., 2012, as cited in Rauch et al., 2017). Additionally, as one aim of short-term PTSD treatments is to improve access to care, such treatments may be best suited for individuals who face barriers to accessing specialty mental health care, whether those barriers relate to physical injury or disability, parental status, employment, access to transportation, mental health stigma or other biopsychosocial-cultural factors. Although these short-term treatments have demonstrated clinically meaningful reductions in PTSD symptoms, they may be slightly better suited for individuals who are able to identify one index trauma that primarily drives symptoms (as opposed to a history of complex trauma), and who do not currently need management of additional mental health conditions.
About the Author

Sophie Oliver, MA, is a clinical psychology PhD candidate with an emphasis in trauma at the University of Colorado Colorado Springs. She is completing her pre-doctoral internship at the Rocky Mountain Regional VA Medical Center.  Her research and clinical interests include posttraumatic growth, trauma memory, and the role of creative writing in trauma healing. Please note that the opinions expressed in this piece are her own and do not necessarily reflect the position of the University of Colorado Colorado Springs nor the U.S. Department of Veterans Affairs.
Lu, M. W., Carlson, K. F., Duckart, J. P., & Dobscha, S. K. (2012). The effects of age on initiation of mental health treatment after positive PTSD screens among Veterans Affairs primary care patients. General hospital psychiatry, 34(6), 654–659. https://doi.org/10.1016/j.genhosppsych.2012.07.002
Rauch, S. A. M., Cigrang, J., Austern, D., Evans, A., & STRONG STAR Consortium (2017). Expanding the reach of effective PTSD treatment into primary care: Prolonged Exposure for Primary Care. Focus (American Psychiatric Publishing), 15(4), 406–410. https://doi.org/10.1176/appi.focus.20170021
Schumacher, J. A., Kinney, K. L., Morris, M. C., & McAfee, N. W. (2022). Biweekly delivery of a group-based adaptation of Written Exposure Therapy (WET) for PTSD in residential substance treatment. Cognitive Behavioral Practice, advance online publication. https://doi.org/10.1016/j.cbpra.2022.02.024
Sloan, D. M. & Marx, B. P. (2019). Written Exposure Therapy for PTSD: A brief treatment approach for mental health professionals. American Psychological Press. http://dx.doi.org/10.1037/0000139-001
Tyler, H., Fina, B. A., Marx, B. P., Young-McCaughan, S., Sloan, D. M., Kaplan, A. M., Green, V. R., Blankenship, A., Bryan, C. J., Peterson, A. L., & STRONG STAR Consortium. (2022). Written Exposure Therapy for suicide in a psychiatric inpatient unit: A case series. Cognitive and Behavioral Practice, 29(4), 924-937. https://doi.org/10.1016/j.cbpra.2021.06.011