3 - (SYM 82) Addressing Dropout with Brief, Evidence-based Intervention: Outcomes of Written Exposure Therapy in Department of Veterans Affairs Clinics

Trauma-focused cognitive behavioral therapies are the first line, most supported treatments for posttraumatic stress disorder (PTSD); however, up to 69% of patients drop out prematurely, limiting their effectiveness potential. One solution to high patient dropout is implementation of treatment models that are briefer and more efficient, which may increase receipt of an adequate dose. Written Exposure Therapy (WET) is an evidence-based therapy for PTSD consisting of five sessions with no formal between-session practice. In clinical trials, WET has typically had dropout rates between 6-14% (Sloan et al., 2012; 2013; 2018), and participants have evidenced less dropout from WET than other first line treatments including Cognitive Processing Therapy (CPT; Sloan et al., 2018) and Prolonged Exposure (PE; Sloan et al., 2022a). While these efficacy data are extremely promising, more data are needed from routine care settings. In this presentation, we will discuss dropout from WET delivered by Department of Veterans Affairs clinicians trained as part of a national pilot implementation program (5 cohorts) and official VA rollout of WET (3 cohorts). Results from the first six cohorts indicate that WET was associated with large reductions in PTSD symptoms, and 24.6% of patients dropped out. These rates were higher than most clinical trials of WET but slightly lower than PE training program rates (30%; Eftekhari et al., 2020) and much lower than PE and CPT rates in routine care (69%; Hale et al., 2019). Dropout was highest for the cohort coinciding with the onset of COVID-19-related impacts to in-person care. Dropout was lowest when WET was delivered via telehealth rather than in person (21.3% vs. 34.0%; χ2 (1, N = 228) = 3.97, p = .046). Dropout was unrelated to age, gender, race/ethnicity, trauma type, baseline symptom severity, or presence of psychiatric comorbidity, indicating that WET was tolerated similarly across patients. We will also discuss reasons for dropout, when in the protocol dropout occurred, and symptom trajectories for those completing versus not completing WET. Overall, WET is a promising treatment to increase retention in evidence-based treatment.