# Written Exposure Therapy (WET) as a brief trauma treatment for Veterans with Co-occurring Substance Use Disorders and PTSD

> **NIH VA I01** · VA CONNECTICUT HEALTHCARE SYSTEM · 2023 · —

## Abstract

There are high rates of trauma exposure and posttraumatic stress disorder (PTSD) among treatment-
seeking veterans with substance use disorders (SUD). Comorbid PTSD among veterans with SUD contributes
to poor treatment outcomes and is associated with worse overall mental and physical health. While addiction
programs traditionally do not address PTSD, increasing evidence suggests that trauma treatments not only
treat PTSD, but may even improve SUD treatment retention and outcomes among those with comorbidity.
Veterans with SUD are usually treated in SUD specialty clinics, where staff are not trained in trauma, and thus
do not offer PTSD treatment. So, although the Department of Veterans Affairs (VA) prioritizes the
administration of effective evidence-based psychotherapies for PTSD, only a small percentage of veterans with
SUD receive this treatment. Written exposure therapy (WET) is a brief trauma-focused intervention shown to
effectively treat PTSD. WET has several advantages over traditional therapies; it can be delivered in 5 sessions,
has lower dropout compared to other PTSD treatments, has high patient satisfaction, and can be easily
delivered with minimal therapist training requirements making it cost efficient and therefore an ideal
intervention for administration in a busy outpatient SUD clinic. A previous study suggested written exposure is
feasible and effective in decreasing symptoms of PTSD among women in residential SUD treatment. In a recent
acceptability and feasibility pilot study, SUD treatment-seeking veterans (N=12) with comorbid PTSD were
randomized to WET plus treatment as usual (TAU) or TAU augmented by a neutral writing condition. Results
showed this writing-based intervention was feasible and acceptable. WET was associated with a greater
decrease in PTSD symptoms at 8-week post-baseline follow-up and a greater decrease in the average number of
days of alcohol and drug use at follow-up compared to controls.
 The proposed study is a randomized clinical trial within a SUD specialty clinic to evaluate whether TAU
plus WET is superior to TAU augmented by neutral topic writing on both PTSD and addiction outcomes for
veterans in SUD treatment. The proposed study will also examine a biological marker of autonomic arousal,
heart rate variability (HRV), in order to determine whether it might be a potential objective measure of
treatment efficacy. Emerging evidence suggests high-frequency HRV may be sensitive to SUD and PTSD
symptom improvement and a possible mechanism underlying the connection between stress and substance
use. [This study will examine the association between HRV and treatment outcomes. We will also examine
whether change in HRV scores over time correlates with treatment outcomes (PTSD symptoms and days of
substance use).]
 The specific aims of the project are to examine whether WET augmentation of TAU: a) improves trauma
symptoms for veterans with SUD and PTSD who are receiving outpatient SUD treatment compared to T...

## Key facts

- **NIH application ID:** 10657576
- **Project number:** 5I01CX002271-02
- **Recipient organization:** VA CONNECTICUT HEALTHCARE SYSTEM
- **Principal Investigator:** Sarah Meshberg-Cohen
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2023
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-07-01 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10657576

## Citation

> US National Institutes of Health, RePORTER application 10657576, Written Exposure Therapy (WET) as a brief trauma treatment for Veterans with Co-occurring Substance Use Disorders and PTSD (5I01CX002271-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10657576. Licensed CC0.

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