Decreasing Suicide Risk among Service Members with Posttraumatic Stress Using Written Exposure Therapy


Determine whether Written Exposure Therapy for Suicide reduces suicidal thoughts and behaviors and posttraumatic stress symptoms (PTSS); determine whether reductions in PTSS severity lead to fewer suicidal thoughts and behaviors.

Military service members and veterans have high rates of posttraumatic stress disorder (PTSD) and suicidal behavior. And PTSD more than doubles the likelihood that they will attempt suicide, researchers have reported.
Although evidence-based treatments for PTSD have been shown to reduce suicidal thinking, it is challenging to provide these therapies to high-risk patients hospitalized for acute care in military facilities. That is because the treatments require more time and resources than are typically afforded during inpatient stays.

Evaluating a therapy delivered in five sessions

A new STRONG STAR-affiliated study will test a therapy that the study team believes will reduce severity of posttraumatic stress symptoms and decrease suicide risk with only five sessions. They will evaluate an intervention called Written Exposure Therapy for Suicide (WET-S), which involves the patient writing about the same trauma experience during multiple sessions.

Brian P. Marx, PhD, deputy director of the Behavioral Science Division of the National Center for PTSD at the VA Boston Healthcare System, will lead the study at the Carl R. Darnall Army Medical Center at Fort Hood, Texas. His research team will work with consenting patients who are hospitalized for suicidal thoughts, suicide plan, or suicide attempt, who also have PTSD or symptoms of posttraumatic stress. A total of 124 patients will be randomly assigned either to “treatment as usual (TAU)” or WET-S plus TAU.

TAU consists of daily contact and patient-centered care by an acute psychiatric inpatient unit provider team that includes psychiatrists, therapists, case managers, and behavioral health technicians. TAU also involves initial psychiatric stabilization, nurse case management, medication management, psychoeducation groups, and discharge planning.

Writing about the “index trauma”

WET-S consists of five private treatment sessions, each lasting approximately one hour. During the first session, the therapist educates the patient about common reactions to trauma and the rationale for
WET-S as a treatment for PTSD. Then the patient receives instructions for completing the written trauma narratives and completes the first narrative writing session. For each of the five sessions, the patient writes about the “index trauma” – the traumatic event that is deemed to be the worst by the patient and an independent assessor. Patients will receive at least one session per day.

Benefits of the therapy and future impact

Previous research found Written Exposure Therapy (WET) for PTSD to be comparable to other evidence-based treatments, with data also indicating that it helped to reduce suicidal thinking. WET-S is a reformulation of WET that adds a suicide prevention strategy called Crisis Response Planning (CRS). WET-S addresses trauma-related symptoms that are both targets for PTSD treatment and warning signs for suicidal thoughts and behaviors.
The therapy is brief and easy to administer. It also requires fewer resources and less training for the mental health provider than treatments currently used with at-risk patients in military settings. If found to be effective, WET-S could be scaled up and disseminated easily across the Department of Defense to reduce suicidal behavior among service members and veterans.

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