Written Exposure Therapy (WET) is a brief, evidence-based five-session treatment for Post-Traumatic Stress Disorder (PTSD) that uses structured writing about a single traumatic event to reduce symptoms and improve functioning. This article explains how WET works, what to expect across the five-session protocol, and the clinical evidence supporting its use for veterans and civilians. Many people with PTSD face barriers to lengthy therapy or feel uncomfortable with prolonged verbal disclosure; WET provides a concise, focused alternative that leverages narrative organization and repeated exposure to the memory. Readers will learn session-by-session details, practical preparation steps, comparisons with Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE), and guidance on who is most likely to benefit. The sections that follow define WET, map its psychological mechanisms, present a session-by-session protocol with a handy reference table, summarize benefits and research findings, compare WET to CPT and PE, and outline preparation, delivery modes, and contraindications. This guide integrates current research context and practical tips so clinicians and patients can decide whether WET fits their needs.
What Is Written Exposure Therapy for PTSD?
Written Exposure Therapy for PTSD is a trauma-focused exposure therapy in which the patient repeatedly writes about a single traumatic event across multiple clinician-guided sessions to reduce distress and change memory meaning. The mechanism combines repeated exposure (desensitization) with narrative structuring that fosters cognitive reappraisal, and the primary benefit is measurable symptom reduction including fewer intrusive memories and avoidance behaviors. Clinicians present WET as a structured, brief protocol—typically five sessions with 30–45 minute writing periods—where the therapist provides psychoeducation and brief check-ins rather than extensive verbal processing. This focused format makes WET an efficient option for patients who prefer writing or who need time-limited interventions, and it sets the stage for the session-by-session breakdown that follows.
How Does WET Help Process Trauma Through Writing?
WET helps process trauma through writing by repeatedly activating the traumatic memory in a controlled setting, which reduces its emotional intensity and allows cognitive reorganization. Writing requires the patient to sequence sensory details and meaning, so trauma memories become less fragmented and more integrated into a coherent narrative. This process supports desensitization and cognitive restructuring; in semantic-triple form: Written Exposure Therapy → reduces → emotional reactivity to trauma memories. For many patients, writing is a tolerable medium that reduces shame or verbal avoidance and enables deeper focus on specific moments. The next section explains the signature features that operationalize this mechanism into a brief clinical protocol.
What Are the Key Features of WET?
WET’s signature features include brevity, structured in-session writing, and a minimal homework requirement, all delivered within a trauma-focused exposure framework. The protocol commonly uses five sessions with an extended writing period each session, during which the patient writes the trauma narrative uninterrupted while the therapist monitors safety and provides brief feedback. Therapist activity centers on psychoeducation, clear instructions, and brief check-ins rather than extensive cognitive restructuring or repeated in-session imaginal exposure. These features make WET scalable for telehealth and practical for settings with limited treatment slots. Understanding these features clarifies why WET can achieve outcomes comparable to longer therapies while reducing time and logistical barriers.
Who Is WET Designed For?
WET is designed for individuals with PTSD who can tolerate brief, focused exposure through writing and who seek a time-limited, evidence-based option for trauma processing. Research and clinical practice commonly include veterans and civilians exposed to diverse traumas, and ideal candidates are those who prefer structured tasks, have the literacy and concentration to write about distressing memories, and do not require immediate stabilization for acute suicidality or severe dissociation. WET is also suited to people facing constraints that make longer therapies impractical, such as work or caregiving responsibilities. Later sections address contraindications and necessary pre-treatment assessment to determine whether WET is appropriate for a given patient.
How Many Sessions Does Written Exposure Therapy Involve and What Happens in Each?
Written Exposure Therapy typically involves five sessions that progress from orientation and the first trauma narrative to repeated processing and a final review focused on consolidation and relapse prevention. Each session lasts roughly 30–60 minutes with a continuously timed writing period of about 30 minutes in sessions that include writing. The therapist provides psychoeducation and safety planning in session one, monitors distress across sessions two to four while the patient repeatedly writes about the same trauma, and in session five reviews symptom change and coping strategies. Below is a concise session-by-session protocol reference to use in clinical planning or for patient expectations.
WET session-by-session protocol:
| Session | Activity / Prompt | Typical Duration / Outcome |
|---|---|---|
| Session 1 | Psychoeducation; rationale; select trauma target; first trauma narrative writing prompt (description of the event, sensory details) | 45–60 min total; first 30-min writing; establish safety plan and expectations |
| Session 2 | Repeat writing on same trauma with prompts to clarify context and feelings (sensory details, timeline) | ~45 min; continued exposure and habituation; therapist checks for distress |
| Session 3 | Deeper focus on emotional responses and meaning; prompts explore thoughts about causes and consequences | ~45 min; cognitive reappraisal begins through organized narrative |
| Session 4 | Continued repeated writing emphasizing changes in perspective and reduced avoidance | ~45 min; consolidation of processing and monitoring of symptom shifts |
| Session 5 | Review progress, integrate coping strategies, relapse prevention, referrals if needed | 30–60 min; summarize gains and plan follow-up or additional care if required |
This session table provides a compact roadmap clinicians can follow and patients can use to anticipate structure and milestones in therapy. The next subsections expand on what clinicians do in the first session, the progression through sessions two to four, and the focus of the final session.
What Occurs in Session 1: Introduction and Initial Trauma Narrative?
Session 1 establishes the therapeutic rationale, selects a specific trauma memory to target, and completes the initial extended writing period while ensuring patient safety and containment. The therapist delivers psychoeducation about PTSD, explains how repeated writing reduces emotional intensity, and offers a clear script for the first 30-minute writing prompt focused on describing the event in detail. Safety planning is established by identifying coping strategies, support contacts, and procedures if the patient becomes highly distressed during or after writing. This initial orientation builds trust and sets measurable expectations, which leads naturally into the repeated processing that occurs in sessions two through four.
What Happens During Sessions 2 to 4: Deepening Trauma Processing?
Sessions two to four continue the core activity of repeated, focused writing about the same trauma memory while gradually shifting prompts to probe emotions, beliefs, and meanings tied to the event. Prompts progress from sensory details and chronology to questions about the worst moments, emotional reactions, and interpretations that maintain distress, enabling cognitive reappraisal within the written narrative. The therapist’s role is to monitor safety, provide brief feedback, and ensure the writing time remains uninterrupted; therapist intervention is limited to containment and clarification rather than long verbal processing. By the end of this phase, patients often report reduced vividness and distress associated with the memory, which prepares them for the final consolidation session.
What Is Covered in Session 5: Review and Coping Strategies?
Session 5 focuses on reviewing symptom change, integrating gains, teaching or refreshing coping strategies, and discussing next steps if additional care is needed. The clinician and patient compare baseline symptoms and current status, identify helpful self-management techniques (grounding, sleep hygiene, activity scheduling), and plan for relapse prevention if symptoms re-emerge. If progress is incomplete or comorbid conditions require further treatment, the therapist discusses referrals to longer trauma-focused therapies or adjunctive services. This consolidation session ensures the patient leaves with practical tools and a clear follow-up plan, which serves as a bridge to ongoing recovery or stepped care.
What Are the Benefits of Written Exposure Therapy for PTSD Recovery?
Written Exposure Therapy delivers several evidence-backed benefits: effective PTSD symptom reduction, a brief protocol that improves accessibility, and generally lower dropout rates compared with longer therapies in some studies. Mechanistically, WET reduces avoidance and emotional reactivity through repeated memory activation while promoting narrative integration that supports cognitive change. Clinically, the brief five-session format reduces logistical barriers and can be delivered in person or via telehealth, expanding access in diverse settings. The paragraphs that follow unpack how WET maps onto specific symptom targets, why it is considered efficient and accessible, and how it compares to established therapies like CPT and PE.
WET outcomes comparison (symptom reduction, dropout, session count):
| Therapy | Key Outcome | Typical Implication |
|---|---|---|
| Written Exposure Therapy (WET) | Symptom reduction with brief protocol; reported lower dropout in some RCTs | Efficient treatment for many patients; suitable when rapid access is needed |
| Cognitive Processing Therapy (CPT) | Strong evidence for cognitive restructuring with homework requirements | Better for patients who want active cognitive work and homework-based changes |
| Prolonged Exposure (PE) | Robust symptom reduction via imaginal and in vivo exposure; longer protocol | Preferred when imaginal and behavioral exposures are clinically indicated |
This comparison table highlights how WET balances efficacy with brevity, which is particularly valuable for patients and systems needing efficient, effective PTSD care. Next, we examine symptom-specific mechanisms and practical advantages in more detail.
Research has demonstrated that WET is a highly effective treatment, often showing comparable results to more intensive therapies with fewer dropouts.
Written Exposure Therapy (WET): A 5-Session PTSD Treatment Written exposure therapy (WET) is a five-session exposure-based intervention for the treatment of post-traumatic stress disorder (PTSD). WET was developed through a series of systematic evaluations of the expressive writing procedure. It is an efficient intervention, requiring limited patient and therapist time, and no between-session assignments. The treatment results in statistically and clinically significant symptom change among individuals, including veterans, with PTSD. WET has been shown to be non-inferior to cognitive processing therapy (CPT), a more intensive form of PTSD treatment. Additionally, WET resulted in substantially lower rates of treatment dropout compared with CPT (6% versus 39%). Moderator analyses of the rate of symptom change during treatment indicated that WET performed equally well for participants regardless of age, gender, comorbid depression, or estimated full scale IQ. WET represents a viable option for the efficacious, brief treatment of PTSD and may have significant strengths compared with other manualized psychotherapeutic approaches. Brief novel therapies for PTSD: written exposure therapy, J Thompson-Hollands, 2019
How Does WET Reduce PTSD Symptoms Like Flashbacks and Nightmares?
WET reduces flashbacks and nightmares by decreasing the emotional charge of traumatic memories and promoting more coherent cognitive representations of the event. Repeated written exposure engages desensitization: memories are reactivated and then processed in a safe context, leading to reduced physiological arousal over time. Narrative organization through writing diminishes intrusive imagery by placing sensory fragments into a timeline, reducing rumination and spontaneous recall. Improved emotional regulation and updated meaning-making often translate into fewer intrusive symptoms and better sleep, illustrating how mechanism-driven change maps onto common PTSD complaints.
Why Is WET Considered Efficient and Accessible?
WET’s efficiency stems from a short, manualized five-session course, minimal between-session homework, and straightforward training for clinicians to deliver the protocol safely. These features lower scheduling and adherence barriers, and evidence indicates dropout rates in some trials are lower than for longer therapies, improving real-world reach. Telehealth delivery maps well to the WET structure because writing tasks and brief clinician check-ins translate cleanly to remote formats, increasing geographic and scheduling accessibility. For systems and patients needing time-limited treatment, WET’s design supports rapid, scalable care.
How Does WET Compare to Other Evidence-Based PTSD Treatments?
WET differs from CPT and PE primarily in modality and logistics: WET uses structured writing within sessions, CPT emphasizes cognitive restructuring with homework, and PE relies on imaginal and in vivo exposure with more therapist-led exercises. Efficacy comparisons from randomized controlled trials often show non-inferiority of WET on primary PTSD outcomes for many patients, while differences emerge in homework expectations and session length. When choosing a therapy, consider patient preference for writing versus talking, available time, and comorbidities that may require longer attention or stabilization. The comparative table above provides a quick reference to match patient needs to treatment attributes.
Discussions around the comparative efficacy of WET and other treatments, like CPT, highlight important nuances in study design and outcomes.
Written Exposure Therapy vs. Cognitive Processing Therapy for PTSD To the Editor Sloan and colleagues1 reported noninferiority of 5-session written exposure therapy (WET) to 12-session cognitive processing therapy (CPT) in patients with posttraumatic stress disorder (PTSD). However, several aspects of the study require some clarification. First, was researcher allegiance controlled for? Written exposure therapy and CPT were carried out by the same therapists who were supervised by 2 of the authors. Second, the value of a noninferiority or equivalence study depends on how well the Written exposure therapy vs cognitive processing therapy, CM Monson, 2018
How Does Written Exposure Therapy Compare to Other PTSD Treatments Like CPT and Prolonged Exposure?
Comparing WET to Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) clarifies which patients may benefit most from each approach and how mechanisms and logistics differ across modalities. All three are trauma-focused and evidence-based, but they vary in primary technique (writing, cognitive restructuring, imaginal/in vivo exposure), session number and length, and homework demands. Understanding these distinctions helps clinicians recommend the best fit based on symptom profile, patient preference, and resource constraints. The next subsections break down similarities and differences with CPT and PE and provide decision guidance for selecting WET.
What Are the Similarities and Differences Between WET and Cognitive Processing Therapy?
WET and CPT share a trauma-focus and empirical support for reducing PTSD symptoms, but they emphasize different change mechanisms: WET uses repeated narrative writing to desensitize and restructure memory, whereas CPT targets maladaptive beliefs through cognitive techniques and active homework. CPT typically involves more sessions and structured cognitive exercises outside of sessions, while WET concentrates change inside brief sessions with minimal homework. Both can be effective, and patient preference—writing comfort versus engaging in structured cognitive homework—often determines the better match. Clinicians should consider literacy, motivation for homework, and comorbid issues when recommending one over the other.
How Does WET Differ from Prolonged Exposure Therapy?
WET differs from Prolonged Exposure in modality and exposure components: PE uses therapist-guided imaginal exposure plus in vivo homework to confront avoided situations, while WET relies primarily on in-session written narratives. PE protocols frequently require more sessions and more between-session assignments, increasing time and logistical demands. Both therapies aim to reduce avoidance and emotional reactivity and can produce similar outcomes for many patients, but PE may be preferable when behavioral avoidance patterns must be addressed through in vivo practice. The choice depends on what form of exposure the patient can engage with most effectively.
Direct comparisons between WET and Prolonged Exposure Therapy (PE) are crucial for understanding their respective roles in PTSD treatment.
Written Exposure Therapy vs. Prolonged Exposure Therapy for PTSD ABSTRACT: RCT: Written Exposure Therapy vs Prolonged Exposure Therapy in the Treatment of PTSDVisual Abstract.View LargeDownload(opens in new tab)Go to Figure in Article Written exposure therapy vs prolonged exposure therapy in the treatment of posttraumatic stress disorder: A randomized clinical trial, DM Sloan, 2023
When Is WET Preferred Over Other Trauma-Focused Therapies?
WET is preferred when patients need a brief, structured approach, prefer writing over prolonged verbal disclosure, or when system constraints favor shorter protocols for rapid access to care. It is also a strong option when telehealth delivery is required and when lower homework burden will improve adherence. Clinicians should avoid WET when immediate stabilization is necessary (e.g., active suicidality or severe dissociation) or when the clinical picture requires integrated interventions for comorbid conditions. Use a decision-style approach: if time-limited, writing-preferred, and clinically stable → consider WET; if intensive behavioral exposure or extensive cognitive work is needed → consider PE or CPT.
How Can You Prepare for Written Exposure Therapy and What Should You Expect?
Preparing for WET includes clinical screening, practical scheduling, and establishing safety measures so patients can engage in focused writing with support. Before starting, clinicians assess symptom severity, suicide risk, dissociation, and substance use to determine stability and need for stabilization first. Patients should arrange a private, uninterrupted environment for sessions, plan for brief emotional after-effects, and ensure social supports are available if needed. The following subsections provide concrete pre-treatment guidance, clarify the therapist’s role, and describe differences between in-person and online delivery to help patients and clinicians prepare.
What Should Patients Know Before Starting WET?
Patients should expect emotional activation during writing sessions but also measurable symptom improvements across the five-session course. There is typically no extensive homework, but patients must be prepared for transient distress immediately after writing and follow the therapist’s safety plan if reactivity increases. Practical preparation includes scheduling sessions at times with minimal interruptions, arranging a private space for telehealth, and having grounding strategies ready. Clear expectations about outcome timelines and honest discussions about comfort with writing help optimize engagement and therapeutic success.
What Is the Therapist’s Role During WET?
The therapist’s role in WET is to provide psychoeducation, deliver clear instructions for writing periods, monitor patient safety and distress, and facilitate brief integration without extended processing. Clinicians must be competent in trauma-focused therapies, able to assess risk, and trained in WET protocols to maintain fidelity and safety. Specific tasks include selecting the trauma target collaboratively, timing and supervising writing periods, offering brief containment interventions when needed, and conducting the final review and referral planning. This focused role preserves efficiency while ensuring clinical oversight.
How Is WET Delivered: In-Person and Online Options?
WET translates well to both in-person and telehealth formats because the core activity—timed, uninterrupted writing—can be conducted in either modality with appropriate privacy and technology. For telehealth, clinicians should confirm secure platforms, ensure patients have a private space, and clarify how writing will be documented or saved. In-person delivery allows direct observation of distress and easier immediate containment, while online delivery increases access for remote or rural patients. Training in telehealth adaptations and clear protocols for emergency situations are essential regardless of delivery mode.
What Does Current Research Say About the Effectiveness of Written Exposure Therapy?
Current research indicates that WET is an effective, evidence-based treatment for PTSD with randomized controlled trials showing meaningful symptom reduction and, in many analyses, non-inferiority to longer therapies such as CPT and PE. Recent studies report favorable outcomes and, in several samples, lower or comparable dropout rates relative to longer protocols, supporting WET as a pragmatic option for many patients. Guideline bodies include WET among recommended trauma-focused treatments, which has supported broader adoption and telehealth dissemination. The following subsections summarize efficacy and dropout findings, guideline placement, and trends in accessibility and use.
What Do Recent Studies Reveal About WET’s Efficacy and Dropout Rates?
Recent randomized controlled trials demonstrate that WET reduces PTSD symptom severity with effect sizes that compare favorably to other evidence-based therapies for many patients, and some studies have reported lower dropout percentages in WET arms. Findings emphasize that WET achieves clinically significant gains within five sessions, making it an efficient alternative when resources or time are limited. Researchers continue to examine moderators of outcome—such as trauma type and comorbidity—to refine indications. Clinicians are encouraged to review primary trial reports for exact statistics and to monitor emerging 2024–2025 evidence for updates.
How Do VA/DoD Guidelines Recommend WET for PTSD Treatment?
VA/DoD clinical practice guidance recognizes WET as an evidence-based option for PTSD, positioning it alongside other trauma-focused psychotherapies recommended for veterans and military personnel. This guideline endorsement supports clinical adoption within systems of care and informs training priorities and reimbursement considerations. The guideline placement signals that WET meets rigorous evidence criteria and can be offered as part of standard treatment options, particularly where brief, scalable interventions are needed. Facility-level implementation should align training and supervision with guideline expectations.
What Are the Latest Trends in WET Accessibility and Use?
Trends in WET usage include expanding telehealth delivery, increasing clinician training uptake, and broader application across civilian and veteran populations for diverse trauma types. Health systems seeking scalable PTSD care have piloted WET as a stepped-care option to rapidly reduce symptom burden while preserving resources for more intensive cases. Ongoing monitoring of outcomes in real-world settings and continued dissemination of clinician training will determine how widely WET integrates into routine practice. These trends suggest growing acceptance of brief, writing-based exposure as a mainstream PTSD treatment.
Who Can Benefit Most from Written Exposure Therapy for PTSD?
WET benefits many people with PTSD, with evidence particularly strong for veteran populations but also applicable to civilians exposed to sexual assault, accidents, disasters, and other traumas when adapted with appropriate safety planning. Best candidates are clinically stable individuals without active suicidality or severe dissociation, who can engage with writing and are seeking a brief, structured therapy. The following subsections describe veteran outcomes, applicability to sexual assault and other trauma survivors, and clinical contraindications or considerations that determine suitability.
How Does WET Support Veterans and Military Personnel?
Veterans and military personnel have been prominent in WET research, with trials showing symptom reductions and practical benefits in VA care settings where brief, guideline-endorsed treatments improve access. Military cultural competence and sensitivity to combat trauma content enhance engagement and outcomes, and VA/DoD guideline endorsement has facilitated training and implementation. WET offers a pragmatic option for veterans who may prefer structured, time-limited interventions, and programmatic adoption can support stepped-care models that expand treatment reach.
Can WET Help Survivors of Sexual Assault and Other Trauma Types?
WET has been studied across various trauma types and can help survivors of sexual assault and other traumas when delivered with tailored safety planning and trauma-specific sensitivity. For survivors of interpersonal trauma, ensuring a supportive therapeutic environment and addressing shame reactions are critical while using writing prompts that respect boundaries. Clinicians must individualize prompts and monitor dissociation or retraumatization risks. With appropriate adaptations, WET can be an effective option beyond veteran samples.
What Are Contraindications or Considerations for WET?
Contraindications and considerations for WET include active suicidal ideation, uncontrolled severe dissociation, unstable substance use, and situations requiring immediate stabilization before trauma-focused work. Clinicians should complete comprehensive assessments and prioritize safety planning or stabilization treatments when these conditions are present. When contraindications exist, referral to more intensive or integrated services is appropriate before initiating WET. Thoughtful case formulation ensures WET is used where it can be delivered safely and effectively.
This article has presented a structured, evidence-forward overview of Written Exposure Therapy for PTSD, including mechanisms, a session-by-session protocol, benefits and research context, comparisons with CPT and PE, preparation tips, delivery considerations, and population-specific guidance to support clinical decision-making and patient expectations.
