Written Exposure Therapy: A Brief PTSD Treatment

Written Exposure Therapy: A Brief PTSD Treatment
Author(s): Denise M. Sloan, PhDBrian P. Marx, PhD


Written Exposure Therapy (WET) is a brief, 5-session exposure-based psychotherapy for PTSD that is recommended by the VA/DoD Clinical Practice Guideline. WET differs from other trauma-focused psychotherapies in its cost-efficiency and low treatment drop out.

This course reviews the theoretical mechanisms and development of WET, presenting the supporting and on-going research for WET as an evidence-based treatment for PTSD. The authors provide a comprehensive description of the WET protocol and its delivery and describe the type of patient who would be a good candidate.

Goals and Objectives

  • Describe PTSD treatment
  • Discuss WET development
  • Describe on-going and future-planned WET studies
  • Identify appropriate patients for WET

Find a Therapist

Available en Español

Good treatments for PTSD are available. Here are some suggestions for finding a therapist, counselor, or mental health care provider who can help your recovery.

Things to Consider

  • If you are a Veteran, see Help for Veterans.
  • Make sure the provider has experience treating people who have been through a trauma.
  • Try to find a provider who focuses on evidence-based medications for PTSD or effective talk therapy for PTSD, such as Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) or Eye Movement Desensitization and Reprocessing (EMDR).
  • Find out what type(s) of insurance the provider accepts and what you will have to pay (out-of-pocket costs) for care.
  • You may find more than one therapist. Learn about Types of Therapists.

First steps

  • Contact your family doctor to ask for a recommendation. Or, ask friends and family if they can recommend a therapist.
  • If you have health insurance, call to find out which mental health providers your insurance company will cover. Your insurance company may require that you choose a provider from among a list they maintain.

Finding a Provider Using the Internet

These resources can help you locate a therapist, counselor, or mental health provider who is right for you. Note: These resources can be used by anyone, and if you are a Veteran, see the “Help for Veterans” section below.


If you need help right away:

Resource: https://www.ptsd.va.gov/gethelp/find_therapist.asp

June is PTSD Awareness Month

Learn. Connect. Share. Raise PTSD Awareness, June

Help Raise PTSD Awareness

There are currently about 8 million people in the United States with PTSD.

Even though PTSD treatments work, most people who have PTSD don’t get the help they need. June is PTSD Awareness Month. Help us spread the word that effective PTSD treatments are available. Everyone with PTSD—whether they are Veterans or civilian survivors of sexual assault, serious accidents, natural disasters, or other traumatic events—needs to know that treatments really do work and can lead to a better quality of life.

What are the symptoms of PTSD?
There are 4 types of PTSD symptoms, but they may not be exactly the same for
everyone. Each person experiences symptoms in their own way.

Reliving the event
Unwelcome memories about the trauma can come up at any time. They can
feel very real and scary, as if the event is happening again. This is called a
flashback. You may also have nightmares.
Memories of the trauma can happen because of a trigger — something that
reminds you of the event. For example, seeing a news report about a disaster
may trigger someone who lived through a hurricane. Or hearing a car backfire
might bring back memories of gunfire for a combat Veteran.

Avoiding things that remind you of the event
You may try to avoid certain people or situations that remind you of the event.
For example, someone who was assaulted on the bus might avoid taking
public transportation. Or a combat Veteran may avoid crowded places like
shopping malls because it feels dangerous to be around so many people.
You may also try to stay busy all the time so you don’t have to talk or think
about the event.

Having more negative thoughts and feelings than before
You may feel more negative than you did before the trauma. You might be
sad or numb — and lose interest in things you used to enjoy, like spending
time with friends. You may feel that the world is dangerous and you can’t trust
anyone. It may be hard for you to feel or express happiness, or other positive
emotions. You might also feel guilt or shame about the traumatic event itself. For example, you may wish you had done more to keep it from happening.

Feeling on edge
It’s common to feel jittery or “keyed up” — like it’s hard to relax. This is called
hyperarousal. You might have trouble sleeping or concentrating, or feel like
you’re always on the lookout for danger. You may suddenly get angry and
irritable — and if someone surprises you, you might startle easily.
You may also act in unhealthy ways, like smoking, abusing drugs and alcohol, or driving aggressively.

Why get treatment for PTSD?
Treatment works.
There are many treatment options for PTSD.
For many people, these treatments can get rid of symptoms altogether. Others find they have fewer symptoms or feel that their symptoms are less intense.
After treatment, most people feel they have a better quality of life.

Common questions about treatment
Can a therapist really understand what I’ve been through?
Therapists can treat your PTSD whether or not they have been through trauma
themselves. What’s important is that your therapist understands how you think about your experience, so she can teach you the skills you need to manage your symptoms.

Is it ever too late to get treatment for PTSD?
It’s never too late. Treatment can help even if your trauma happened years ago. And treatment for PTSD has gotten much better over the years. If you tried treatment before and you’re still having symptoms, it’s a good idea to try again.

There is a wealth of information available in the booklet that I have linked to below. If you think you may have symptoms of PTSD, there is a questionaire to fill out. Also, a description of what PTSD therapy is and how it can help you manage your stress. Please have a look. Do it today. And remember, you are not alone !


After a Trauma: Take Time to Heal



When you go through a trauma, it’s understandable that you might either feel numb or have strong feelings, including fear, guilt, confusion, or anger. It’s also common to be hard on yourself if you’re not getting better. Healing from trauma is a process that doesn’t happen overnight, or even—for many—in a few days or weeks.

Reach Out

It’s easy to avoid people and become isolated, but when you make an effort to connect with others, especially those who have been through similar experiences or who help you to continue on a positive path, the weight of the trauma might start to feel lighter.

Practice Relaxation Methods

You can sometimes feel anxious after a trauma, and calming activities can help. What activities put your body and mind at ease, even for just a little while? Is it swimming, reading, meditating? Do you enjoy creating art or playing music? Spending time with a pet? All these relaxation methods are worth a try.

What to Watch Out For

Don’t get caught up in negative ways of coping. Using alcohol, for example, may help you to get to sleep and forget, but it also interferes with deeper sleep cycle. In the long run, that can interfere with your health and your ability to heal. In order to feel better, it’s important to find strategies that make you feel better and help you be healthy and strong.

When You Need Extra Help

If it’s been more than a couple of months since the trauma, and your symptoms are still interfering with your life, you may need extra help. There are plenty of treatment options  that can help. You can explore effective treatments online,  or talk with a medical provider about the ones that are best for you.

Each person is different, so allow yourself time to process the pain, and begin to find the best ways for you to manage your reactions.



PTSD and Sleep: Rest Easier with Treatment

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Many who are diagnosed with PTSD also have sleep problems. And when sleep problems last, they can have a negative impact on many parts of your life. The good news is, treatment can help!

Recognize Sleep Concerns

Ask yourself the following questions:

  • Have I had difficulty sleeping (getting to sleep, staying asleep, waking up too early) several nights a week for several months?
  • Do I feel sluggish or have low energy?
  • Have I noticed changes in my concentration or mood?
  • Do I dread the idea of trying to sleep, instead of looking forward to it?
  • Have I woken up gasping for air?

If you answered yes to any of the questions, then talk with your provider about getting a sleep assessment and discuss sleep treatment options.

Seek Treatment

If you have PTSD and sleep problems, ask your provider about evidence-based treatment options. Treating your PTSD can help improve your sleep problems. If your sleep problems continue after you complete a front-line treatment for PTSD, talk to your provider about options for sleep-related treatments.

If you have been diagnosed with insomnia, consider Cognitive Behavioral Therapy for Insomnia (CBT-I). CBT-I is a talk therapy that is the most effective treatment for insomnia. CBT-I does not require medication either. For people who are doing CBT-I, the National Center for PTSD has a free treatment companion mobile CBT-I Coach. Also, VA has a free Veteran online training called Path to Better Sleep to help address insomnia symptoms.

Manage Sleep Difficulties

Treatment is the best option if you have lasting sleep problems. But these tips can also help temporarily:

  • Have a 30-minute wind down time before bed.
  • Go to bed when sleepy.
  • Get out of bed if you find yourself “trying” to sleep. Engage in a relaxation activity until you feel sleepy and then go back into bed.
  • Have a consistent wake time.
  • Make your bed and sleeping environment comfortable.
  • Avoid alcohol and drugs before bed.
  • Limit your caffeine use.

Visit the National Center for PTSD’s website to learn more about the relationship between PTSD and sleep problems.


Do I Have PTSD?


The only way to know for sure if you have PTSD is to talk to a mental health care provider. The provider will ask you about your trauma, your symptoms and any other problems you have.

Talk to Someone You Trust

After a traumatic event, it’s normal to think, act, and feel differently than usual. Most people will start to feel better after a few weeks. If your symptoms last longer than a few months, are very upsetting, and disrupt your daily life, you should get help. Whether or not you have PTSD, treatment can help if thoughts and feelings from the trauma are bothering you. Talk to:

  • Talk to your family doctor.
  • A mental health professional, such as a therapist.
  • Your local VA facility or Vet Center, if you are a Veteran
  • A close friend or family member who can support you while finding help
  • A clergy member
  • Fill out a PTSD questionnaire  (see below).


Take a Self-Screen for PTSD

A screen is a brief set of questions to tell you if it is likely you might have PTSD. Below is the Primary Care PTSD Checklist for DSM-5, or the PC-PTSD-5 screen.

Sometimes things happen to people that are unusually or especially frightening, horrible, or traumatic. For example:

  • a serious accident or fire
  • a physical or sexual assault or abuse
  • an earthquake or flood
  • a war
  • seeing someone be killed or seriously injured
  • having a loved one die through homicide or suicide

Have you ever experienced this kind of event? YES / NO
If no, screen total = 0. Please stop here.

If yes, please answer the questions below:
In the past month, have you …

  • had nightmares about the event(s) or thought about the event(s) when you did not want to? YES / NO
  • tried hard not to think about the event(s) or went out of your way to avoid situations that reminded you of the event(s)? YES / NO
  • been constantly on guard, watchful, or easily startled? YES / NO
  • felt numb or detached from people, activities, or your surroundings? YES / NO
  • felt guilty or unable to stop blaming yourself or others for the event(s) or any problems the event(s) may have caused? YES / NO

If you answer “yes” to any three items (items 1 to 5 above), you should talk to a mental health care provider to learn more about PTSD and PTSD treatment.

Answering “yes” to 3 or more questions on the PC-PTSD-5 does not mean you have PTSD. Only a mental health care provider can tell you for sure. And, if you do not answer “yes” to 3 or more questions, you may still want to talk to a mental health care provider. If you have symptoms that last following a trauma, treatment can help – whether or not you have PTSD.

Seek Help

It’s common to think that your PTSD symptoms will just go away over time. But this is unlikely, especially if you’ve had symptoms for longer than a year. Here are some of the reasons why you should seek help.

Early treatment is better

Symptoms of PTSD may get worse. Dealing with them now might help stop symptoms from getting worse in the future and lead to a better quality of life for you.

It’s never too late to get PTSD treatment

Treatment can help even if your trauma happened years ago. And treatment for PTSD has gotten much better over the years. If you tried treatment before and you’re still having symptoms, it’s a good idea to try again.

PTSD symptoms can affect those you love

PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help improve your relationships.

PTSD can be related to other health problems

PTSD symptoms can affect physical health problems. For example, a few studies have shown a relationship between PTSD and heart trouble. By getting help for your PTSD, you could also improve your physical health.

It may not be PTSD

Having some symptoms of PTSD does not always mean you have PTSD. Some of the symptoms of PTSD are also symptoms of other mental health problems. For example, trouble concentrating or feeling less interested in things you used to enjoy can be symptoms of both depression and PTSD. And, different problems have different treatments.

When you seek help, your mental health care provider can determine whether you need treatment for PTSD, or another type of treatment.

Find the Best Treatment for You

Today, there are several treatment options for PTSD. For some people, these treatments can get rid of symptoms altogether. Others find they have fewer symptoms or feel that their symptoms are less intense.

If you think you might be suffering from PTSD, please don’t delay speaking to a mental health caregiver.  It is their job to help you find relief.


VA recognizes September as Suicide Prevention Month

#BeThere campaign urges communities nationwide to support Veterans

Suicide is a complex, national, public health issue that affects communities nationwide, with more than 45,000 Americans, including more than 6,000 Veterans, dying by suicide every year.
Suicide is preventable, and special training is not needed to prevent suicide. Everyone can play a role by learning to recognize warning signs, showing compassion to Veterans in need and offering support. Listed are actions anyone can take to Be There:
Reach out to Veterans to show them you care. Send a check-in text, cook them dinner or simply ask, “How are you?”
Learn the warning signs of suicide, found on the Veterans Crisis Line website.
Watch the free S.A.V.E. training video to equip yourself to respond with care and compassion if someone you know indicates they are having thoughts of suicide.
Check out VA’s Social Media Safety Toolkit to learn how to recognize and respond to social media posts that may indicate emotional distress, feelings of crisis or thoughts of suicide.
Contact VA’s Coaching Into Care program when worried about a Veteran or loved one. A licensed psychologist or social worker will provide guidance on motivating your loved one to seek support.
Learn more about the #BeThere campaign and access resources to help support Veterans at BeThereForVeterans.com.
Veterans who are in crisis or having thoughts of suicide, and those who know a Veteran in crisis, can call the Veterans Crisis Line. Confidential support is available 24 hours a day, seven days a week, 365 days a year. Call 800-273-8255 and Press 1, text to 838255 or chat online at VeteransCrisisLine.net/Chat.





PTSD: The Best Medicine? Focus on What’s Bothering You

Treatment Can Help You Heal

It’s common to hope that PTSD symptoms will just go away over time, but this is unlikely if you’ve had symptoms for longer than a year. Even if you feel like you can handle your symptoms now, they may get worse over time. Seeking treatment and talking about a traumatic event may seem hard, but confronting difficult memories can help you heal and move forward.

Trauma-Focused Psychotherapies

With trauma-focused psychotherapy you work with a trained provider to face exactly what is bothering you.

There are three specific treatments that have the strongest scientific evidence showing they are safe and proven to work. These therapies are:

·         Cognitive Processing Therapy

·         Prolonged Exposure

·         Eye Movement Desensitization and Reprocessing

Each therapy is different, but they all teach you how to process your trauma-related thoughts, memories, and feelings so that you can move on. For more on how these therapies work and evidence based treatment watch our short, informative videos.

Treatment: What to Expect

Cognitive Processing Therapy (CPT)

After a trauma, it’s common to have negative thoughts — like thinking what happened is your fault or that the world is very dangerous. CPT helps you learn to identify and change these thoughts. Changing how you think about the trauma can help change how you feel.

“Before, I had my blinders on and I’d see all the things I had [done] wrong. And now, when I go through it, I see the experience as a whole… The way I think about this completely changed.”

– Christopher J. Tyler, US Army (1996-2004)

Prolonged Exposure Therapy (PE)

People with PTSD often work hard to avoid traumatic memories and things that remind them of the trauma. This can help you feel better in the moment, but in the long term it can keep you from recovering from PTSD by preventing you from processing what happened to you. In PE, you expose yourself to the memories, feelings, and situations that you’ve been avoiding. It sounds scary, but facing things you’re afraid of in a safe way can help you learn that you don’t need to avoid reminders of the trauma.

“It unlocks the ugly stuff. It’s in there eating away at you anyway, so it’s better just to purge it in your therapist’s office. Honestly it felt like a weight off of my shoulders. It was phenomenal.”

– Sarah Humphries, US Army (1994-2012)

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR can help you process upsetting memories, thoughts and feelings by having you focus on images of the trauma. At the same time, the therapist introduces brief sets of back-and-forth eye movements, taps or tones. This helps your brain work through the traumatic memories. Over time, it changes how you react to memories of your trauma and how you feel about yourself.

“My traumatic thoughts don’t come to the forefront of my everyday life and consume my thoughts…they have been processed and placed into long- term memory, where they belong.”

– Rogelio “Roger” Rodriquez, Jr., US Navy (1987-1993), US Air Force (1993 – 2013)

AboutFace: Veterans Talk About Getting Help

To hear more about these and other Veterans’ experiences with trauma-focused psychotherapies visit AboutFace, where Veterans who have been through them, will tell you about their experience.

How Can You Decide Which Treatment is Right for You?

The online PTSD Treatment Decision Aid is a great way to learn about your options and consider which treatment is right for you. You can watch videos of providers explaining how treatments work, then build a personalized comparison chart of the treatments that appeal to you. You can share a printout of the chart with your provider as you decide together which treatment best meets your needs.

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Produced by VA’s National Center for PTSD

PTSD: National Center for PTSD

We are the world’s leading research and educational center of excellence on PTSD and traumatic stress.
PTSD is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault. It’s normal to have upsetting memories, feel on edge, or have trouble sleeping after this type of event. If symptoms last more than a few months, it may be PTSD. The good news is that there are effective treatments.

Inner demons fantasy picture

Get Help, NOW !

Ways to get help

  • Get Help in a Crisis
    The National Center for PTSD provides links and information to help you locate VA and other mental health services in your area.
  • Find a Therapist
    Describes types of professionals who provide therapy and medication for PTSD and trauma issues.
  • Self-Help and Coping
    Find out what to expect after a trauma and about self-help tools that can help you manage stress reactions.

Help for Veterans

  • Care for Women Veterans
    Describes VA services offered to women Veterans, including the Women Veterans Health Care Program.
  • PTSD Treatment Programs
    Information on specialized treatment for PTSD within VA Medical Centers.
  • VA Benefits and Claims
    Answers to some questions about PTSD and service-connected disability that are frequently asked by veterans. Provides information about resources for treatment.

Getting immediate help for PTSD:

If you need help right away:


June is PTSD Awareness Month


PTSD is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault. It’s normal to have upsetting memories, feel on edge, or have trouble sleeping after this type of event. If symptoms last more than a few months, it may be PTSD. The good news is that there are effective treatments.

It’s normal to have upsetting memories, feel on edge, or have trouble sleeping after a traumatic event. At first, it may be hard to do normal daily activities, like go to work, go to school, or spend time with people you care about. But most people start to feel better after a few weeks or months.
If it’s been longer than a few months and you’re still having symptoms, you may have PTSD. For some people, PTSD symptoms may start later on, or they may come and go over time.

Anyone can develop PTSD at any age. A number of factors can increase the chance that someone will have PTSD, many of which are not under that person’s control. For example, having a very intense or long-lasting traumatic event or getting injured during the event can make it more likely that a person will develop PTSD. PTSD is also more common after certain types of trauma, like combat and sexual assault.
Personal factors, like previous traumatic exposure, age, and gender, can affect whether or not a person will develop PTSD. What happens after the traumatic event is also important. Stress can make PTSD more likely, while social support can make it less likely.

There are many different treatment options for PTSD. For many people, these treatments can get rid of symptoms altogether. Others find they have fewer symptoms or feel that their symptoms are less intense. Your symptoms don’t have to interfere with your everyday activities, work, and relationships.  Get help, now !