Feasibility and acceptability of written exposure therapy group in a virtual outpatient setting

Abstract

Written exposure therapy (WET) has emerged as a promising treatment for posttraumatic stress disorder (PTSD) with the potential to overcome common barriers to engagement. Several facets of WET lend themselves particularly well for adaptation to a group setting, yet few studies have examined WET in such formats. The objective of the present study was to present preliminary feasibility, acceptability, and clinical outcome data from a quality improvement project conducted in an outpatient psychiatry clinic that included patients who engaged in a virtual WET group. Participants were 28 adults from six WET group cohorts that occurred between January 2024 and March 2025. Overall attendance was strong (78.2%), with 67.9% of participants completing at least five of the six weekly sessions. Patient satisfaction ratings were high (80.0%), and 86.7% of participants indicated that they would recommend the group to other individuals struggling with trauma symptoms. Acceptability ratings were also largely supportive of the virtual (vs. in-person) and group (vs. individual) formats. There were large effect sizes for pre-post improvement in PTSD symptoms (PCL-5: M = 52.6 vs. 33.0), d = 1.39, and depressive symptoms (PHQ-9: M = 14.2 vs. 9.9), d = 0.86, among participants who completed the group. Our study provides preliminary data suggesting the feasibility and acceptability of a virtual WET group delivered in a naturalistic community setting, with strong attendance and high patient satisfaction. There is significant benefit to standardizing a group-based WET protocol and substantiating clinical benefits through a fully powered randomized controlled clinical trial.