Importance Evidence-based treatments for posttraumatic stress disorder (PTSD) exist, but all require 8 to 15 sessions and thus are less likely to be completed than brief treatments. Written exposure therapy (WET) is a brief and efficacious treatment that has not been directly compared with prolonged exposure therapy (PE), a more time-intensive, exposure-based treatment. Objective To determine whether WET is noninferior to PE in treating PTSD among veterans. Design, Setting, and Participants A randomized noninferiority clinical trial was conducted between September 9, 2019, and April 30, 2022. Participants were 178 veterans with PTSD presenting to 1 of 3 Veterans Affairs medical centers. Inclusion criteria consisted of a primary diagnosis of PTSD and stable medication. Exclusion criteria included current psychotherapy for PTSD, high suicide risk, active psychosis, unstable bipolar disorder, and severe cognitive impairment. Independent evaluations were conducted at baseline and 10, 20, and 30 weeks after the first treatment session. Data were analyzed from January 1 to March 31, 2023. Interventions Participants assigned to WET (n = 88) received five to seven 45- to 60-minute sessions. Participants assigned to PE (n = 90) received eight to fifteen 90-minute sessions. The WET sessions included 30 minutes of writing-based imaginal exposure conducted in session, whereas PE sessions included 40 minutes of in-session imaginal exposure and between-session in vivo exposures. Main Outcomes and Measures The primary outcome was change in PTSD symptom severity measured with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) from baseline to the 20-week assessment; noninferiority was defined as a less than 10-point difference between the 2 treatment groups. Difference in treatment dropout was also examined. Results Of the 178 participants, 134 (75.3%) were men, and the mean (SD) age was 44.97 (13.66) years. In terms of race, 37 participants (20.8%) were Black, 112 (62.9%) were White, 11 (6.2%) were more than 1 race, and 18 (10.1%) were of other race (including American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander [some participants did not specify their race when selecting the category "other"]); in terms of ethnicity, 19 participants (10.7%) were Hispanic. Changes in PTSD symptom severity from baseline to all subsequent assessments among individuals randomized to WET were noninferior relative to individuals randomized to PE. The largest difference between treatments was observed at 10 weeks and was in favor of WET (mean difference, 2.42 [95% CI, 0.35-1.46] points). Participants were significantly less likely to drop out of WET compared with PE (11 [12.5%] vs 32 [35.6%]; χ2 = 12.91; Cramer V = 0.27). Conclusions and Relevance In this study, WET was noninferior to PE in PTSD symptom change and was associated with significantly less attrition. Findings suggest that WET may transcend previously observed barriers to PTSD treatment for both patients and clinicians. Trial Registration ClinicalTrials.gov Identifier: NCT03962504.

中文翻译：

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书面暴露疗法与长期暴露疗法治疗创伤后应激障碍：随机临床试验。

重要性 针对创伤后应激障碍 (PTSD) 的循证治疗方法是存在的，但都需要 8 至 15 个疗程，因此比短期治疗更不可能完成。书面暴露疗法（WET）是一种简短而有效的治疗方法，尚未与长期暴露疗法（PE）进行直接比较，后者是一种时间更密集、基于暴露的治疗方法。目的 确定 WET 在治疗退伍军人 PTSD 方面是否不劣于 PE。设计、设置和参与者 2019 年 9 月 9 日至 2022 年 4 月 30 日期间进行了一项随机非劣效性临床试验。参与者是 178 名患有 PTSD 的退伍军人，他们就诊于 3 个退伍军人事务部医疗中心之一。纳入标准包括 PTSD 的初步诊断和稳定药物治疗。排除标准包括目前针对 PTSD 的心理治疗、高自杀风险、活动性精神病、不稳定双相情感障碍和严重认知障碍。在基线以及第一次治疗后 10、20 和 30 周进行独立评估。数据分析时间为 2023 年 1 月 1 日至 3 月 31 日。 干预措施 分配至 WET 的参与者 (n = 88) 接受五至七次 45 至 60 分钟的课程。分配到体育项目的参与者 (n = 90) 接受了 8 到 15 次 90 分钟的课程。WET 课程包括 30 分钟的基于写作的想象暴露，而 PE 课程包括 40 分钟的会话中想象暴露和会话间体内暴露。主要结果和措施 主要结果是使用 DSM-5 临床医生管理的 PTSD 量表 (CAPS-5) 测量的 PTSD 症状严重程度从基线到 20 周评估的变化；非劣效性定义为2个治疗组之间的差异小于10分。还检查了治疗退出的差异。结果 178 名参与者中，134 名（75.3%）为男性，平均（SD）年龄为 44.97（13.66）岁。就种族而言，37 名参与者（20.8%）为黑人，112 名参与者（62.9%）为白人，11 名参与者（6.2%）为 1 个以上种族，18 名参与者（10.1%）为其他种族（包括美洲印第安人或阿拉斯加原住民） 、亚洲人、夏威夷原住民或其他太平洋岛民[一些参与者在选择“其他”类别时没有具体说明他们的种族]）；就种族而言，19 名参与者（10.7%）是西班牙裔。随机分配至 WET 的个体的 PTSD 症状严重程度从基线到所有后续评估的变化相对于随机分配至 PE 的个体而言并不差。治疗之间的最大差异出现在第 10 周时，并且有利于 WET（平均差异，2.42 [95% CI，0.35-1.46] 点）。与 PE 相比，参与者退出 WET 的可能性显着降低（11 [12.5%] vs 32 [35.6%]；χ2 = 12.91；Cramer V = 0.27）。结论和相关性 在本研究中，WET 在 PTSD 症状变化方面不劣于 PE，并且与显着减少的人员流失相关。研究结果表明，WET 可能超越之前观察到的患者和临床医生治疗 PTSD 的障碍。试验注册 ClinicalTrials.gov 标识符：NCT03962504。