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Written Exposure Therapy as Step One in Reducing the Burden of PTSD: The Composite Cases of "Alex," "Bruno," and "Charles"

David J. Austern

Abstract


The purpose of this study is to explore the effects of a stepped-care model of treatment on Posttraumatic Stress Disorder (PTSD) symptomatology and sequelae in United States' Veterans. The study provides a literature review of the burden of PTSD, describes current best treatment practices, and illustrates key processes in the service-delivery of these treatments. Treatment considerations are demonstrated via three hybrid case examples, which serve as vivid portrayals of Veteran clients who struggle with research-consistent PTSD symptomatology and difficulties engaging in psychotherapy. In addition to being informed by clinical examples in relevant psychological literature, these composite cases, "Alex," "Bruno," and "Charles," contain disguised aspects drawn from psychotherapy clients who have been in my caseload in a PTSD clinic. Demonstrating these clients’ courses of treatment provides an avenue for describing key clinical issues related to Veteran engagement in evidence-based PTSD therapy. By adopting a qualitative, disciplined inquiry approach, treatment is tailored to the client’s unique psychological struggles within the context of historical, contextual, and cultural factors. Using a pragmatic case study research format (Fishman, 2013), case material is analyzed both qualitatively and quantitatively. The cases illustrate how a stepped-care model of treatment, beginning with Written Exposure Therapy (WET; Sloan, Lee, Litwack, Sawyer, & Marx, 2013) and culminating in Prolonged Exposure Therapy (PE; Foa,  Hembree, & Rothbaum, 2007), has the potential to be distinctively helpful in the treatment of Veterans suffering from PTSD. These case studies are designed to be a resource for therapists who seek to gain additional understanding of how to provide efficient and effective treatment to Veterans.


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