Examining written exposure therapy for the treatment of posttraumatic stress disorder in Azerbaijan: A pilot study

Written exposure therapy (WET) is a brief, evidence-based treatment for posttraumatic stress disorder (PTSD) that has demonstrated effectiveness in a variety of settings, mostly within the United States. The pilot study described here examined the feasibility, acceptability, and effectiveness of WET in Azerbaijan, where access to evidence-based trauma-focused treatments is limited. Patients diagnosed with PTSD (N = 62) received five weekly sessions of WET delivered by trained clinicians. Self-report measures were used to assess PTSD and depressive symptoms, as well as maladaptive beliefs, at pre- and posttreatment. Working alliance was also assessed using the patient version of the Brief Revised Working Alliance Inventory (BR-WAI). Treatment dropout was low, with only four participants (6.4%) dropping out. Treatment outcome findings indicated that there were significant decreases in PTSD symptoms, d = 1.84; depressive symptoms, d = 1.43; and maladaptive beliefs, d = 0.85. At posttreatment, most (87.1%) participants showed a reliable reduction in PTSD symptoms, and 71.0% met the criteria for clinical recovery. Working alliance moderated PTSD symptom reductions, with stronger agreement on goals and tasks associated with larger reductions in PTSD symptoms, B = -0.18, p = .049. Exploratory analyses revealed that reductions in maladaptive trauma-related beliefs were significantly associated with reductions in PTSD symptoms, B = -0.46, p < .001. Overall, the findings suggest that WET is both feasible and acceptable to implement in Azerbaijan. Moreover, WET was effective, with large treatment effects observed. These findings support the broader implementation of WET in low-resource settings.