Written Exposure Therapy-High Retention Rates in Group Therapy for Israel Defense Forces Combatants With...

This study aimed to compare written exposure therapy (WET) using the group therapy method for post-traumatic stress disorder (PTSD) in reserve combatants who participated in the October 7th War with other group therapies: psychoeducational group therapy, stress inoculation training (SIT), and cognitive processing treatment (CPT).

This retrospective observational cohort study analyzed the records of 133 Israeli army reservists who took part in the war and filled out questionnaires upon admission for evaluation at the Israel Defense Forces Combat Stress Reaction Unit (94.7% combatants, of whom 98.5% males; mean age = 29.03, SD = 6.28). The dependent variable was dropout. The independent variables included exposure to combat events and PTSD for DSM-5 (PCL-5) self-report questionnaires. Both dependent and independent variables were compared between different therapeutic approaches: WET, psychoeducational group therapy, SIT, and CPT.

Independent samples t-tests indicated that dropout was not significantly associated with age, PTSD symptom severity, or level of combat exposure. Cox proportional hazards regression revealed significantly higher treatment retention in the WET group-based interventions compared with other group-based treatments. Participants in -non-WET group therapies showed significantly increased dropout hazard (B = 1.70, SE = 0.79, Wald = 4.65, P = .031), with a hazard ratio of 5.49 (95% CI, 1.17-25.79).

Group-based WET was associated with higher treatment retention compared with other group-based therapies, highlighting substantial potential in ensuring therapeutic continuity and treatment engagement. However, it remains unclear if this translates into better clinical outcomes.