(PO-073) (PO-073) A one week course of in-hospital Written Exposure Therapy for otolaryngologic PTSD

Background/Significance:
There are multiple evidence based psychotherapeutic options for PTSD; Implementing these is challenging in the general hospital inpatient setting. Written Exposure Therapy (WET) is a brief and efficient 5-session intervention found noninferior to Cognitive Processing Therapy (Sloan et al 2018), with no in-between session assignments and metrically measured outcomes via PCL-5 and SUDS. WET has not been described in the literature as employed in medically hospitalized patients, and condensed in-hospital courses of WET have not been studied.

Case:
A 39 year old female with past psychiatric history of PTSD from childhood medical trauma of recurrent brachial cleft cysts was admitted to otolaryngology service for operative management of a neck abscess. For the first time in her life a nasogastric tube was placed, which would be required for the next week prior to surgery. That day, she suffered profound baseline anxiety, hypervigilance, flashbacks triggered by the feeling of the NG tube in her throat while speaking and swallowing. She soon experienced frequent and intense panic attacks and nightmares that night; psychiatry was consulted to evaluate for anxiety. Prazosin was started for nightmares and Zyprexa for fear response and nausea. She had never undergone trauma focused therapy for PTSD. We started a condensed 5-day course of written exposure therapy for PTSD (Friday, Tuesday, Wednesday, Thursday, Friday). Over the course of her stay, she felt better able to sit with her emotions and not let them upset her in regards to her previous trauma. Her PCL-5 scores showed improvement in autonomic arousal and subjective distress, allowing her to tolerate her stay and undergo her operation prior to discharge home.

Discussion:
Written Exposure Therapy is standardized currently as a 5-week course of 5-sessions of 40 minute duration, but can also be administered over consecutive days (Thompson-Hollands et al 2019). This in-hospital condensed 1-week 5-session course with a several-day interruption showed measured benefit when combined with medication in a patient with medical trauma which worsened while speaking. Benefits were conferred in hospital prior to an operative intervention which was at the core of the existing trauma.

Conclusion/Implications:
A condensed course of written exposure therapy can be effectively administered during a hospital admission course. There is a role for further investigation of condensed courses of WET for PTSD in the consultation psychiatry service in general hospital settings.

References:
Sloan DM, Marx BP, Lee DJ, Resick PA. A Brief Exposure-Based Treatment vs Cognitive Processing Therapy for Posttraumatic Stress Disorder, A Randomized Noninferiority Clinical Trial. JAMA Psychiatry. 2018 Mar 1; 75(3): 233–239. doi: 10.1001/jamapsychiatry.2017.4249

Thompson-Hollands J, Marx BP, Sloan DM. Brief novel therapies for PTSD: Written Exposure Therapy. Curr Treat Options Psychiatry. 2019 Jun;6(2):99-106. doi: 10.1007/s40501-019-00168-w. Epub 2019 Jun 5. PMID: 31245252; PMCID: PMC6594556.