Stepped-Care Approaches to Posttraumatic Stress Disorder: Sharpening Tools for the Clinician’s Toolbox

Abstract

Austern (2017) presents three composite Veteran case studies using Written Exposure Therapy (WET; Sloan, Lee, Litwack, Sawyer, & Marx, 2013) as a first-level intervention in a larger stepped-care model for PTSD.  The relatively minimalist WET intervention may be appealing to Veterans with PTSD who have opted not to seek out more time and therapist-intensive treatments.  In addition, writing has been used effectively in other protocols as a method of achieving exposure to memories of traumatic experiences.  Austern’s three cases demonstrate a range of success in using WET to engage Veterans in evidence-based treatment and reduce suffering associated with PTSD.  We comment on the current status of the research literature on stepped-care models for PTSD, the potential value of incorporating Motivational Interviewing principles and specific homework tasks into these efforts, and the promise that abbreviated interventions and stepped-care approaches may hold for helping clinicians manage their clinical caseloads and avoid burnout.