Virtual Trauma Support for Autistic Adults with PTSD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Waitlist Available

Sponsor: University of Wyoming

No Placebo Group

Trial Summary

What is the purpose of this trial?

The goal of this single-group clinical trial is to learn about the initial efficacy and feasibility of telehealth-delivered Written Exposure Therapy (WET) for autistic adults with traumatic stress symptoms. The main questions the investigators aim to answer are: * Do symptoms of posttraumatic stress disorder (PTSD) and co-occurring mental health concerns decrease after receiving WET? * Do biobehavioral health outcomes, including objective (Fitbit indicators of activity, sleep, and heart rate) and subjectively-reported health variables (e.g., sleep, pain, health-related quality of life), improve after receiving WET? * How do autistic adults experience WET, and how can this program be modified and enhance in the future in collaboration with autistic adults? Participants will complete the following as part of the study, which is completed entirely over telehealth. * Participants will first complete an initial assessment, involving brief measures of cognition and autistic traits, as well as interviews and questionnaires about PTSD, mental health, and physical health. If eligible, participants will proceed to the following steps: * Eligible participants will then start wearing a Fitbit, to be used for the duration of the study. * Participants will then participate in 5 weekly virtual visits involving the WET protocol, including weekly brief assessment of PTSD and mental and physical health. * Then, participants will complete a sixth virtual visit the following week where PTSD, mental and physical health, and treatment feedback are assessed. * Lastly, participants will complete virtual visits 1 and 6 months later involving re-assessment of PTSD and mental and physical health. Therefore, this is a pre-post single group design, where all participants will receive WET to establish initial efficacy and feasibility. Investigators will also consult with an autistic advisory board throughout the project, and make adaptations as recommended in consultation with autistic adults. The goal is to better understand the initial efficacy and feasibility of WET for supporting autistic adults who have experienced trauma.

Do I have to stop taking my current medications to join the trial?

The trial protocol does not specify whether you need to stop taking your current medications. However, it does exclude participants who are currently receiving trauma-focused therapeutic services.

What data supports the idea that Virtual Trauma Support for Autistic Adults with PTSD is an effective treatment?

The available research shows that Written Exposure Therapy (WET) is effective for treating PTSD. One study found that WET, which involves only five sessions, led to significant improvements in PTSD symptoms, depressive symptoms, and overall functioning in patients. This suggests that WET can be a quick and efficient treatment option. Although the study was conducted in Korea, it highlights the potential benefits of WET for individuals with PTSD, including autistic adults. Compared to other treatments, WET requires less time and effort, making it a practical choice for many. ^{1 2 3 4 5}

What safety data exists for Written Exposure Therapy (WET) for PTSD?

Written Exposure Therapy (WET) is a 5-session treatment for PTSD that has been shown to be non-inferior to Cognitive Processing Therapy (CPT) in terms of outcomes through 36 weeks, with gains maintained through 60 weeks. It is considered brief and tolerable, requiring limited patient and therapist time and no between-session assignments. Studies have demonstrated its efficacy in reducing PTSD symptoms, depressive symptoms, and improving global functioning levels, including among veterans and Korean patients with PTSD. These findings suggest that WET is a safe and effective treatment option for PTSD. ^{4 5 6 7 8}

Is Written Exposure Therapy (WET) a promising treatment for autistic adults with PTSD?

Yes, Written Exposure Therapy (WET) is a promising treatment for PTSD. It is a short, 5-session therapy that has shown significant improvements in PTSD symptoms. It is efficient, requiring less time from both patients and therapists, and has been effective in various studies, including those involving veterans. ^{2 3 4 5 8}

Research Team

Eligibility Criteria

This trial is for autistic adults over 18 who have experienced trauma and show significant traumatic stress symptoms. They must be comfortable with English, have basic internet access for telehealth visits, and score at least 65 on an intelligence test (WASI-2). Those not meeting these criteria or posing a safety risk are excluded.

Inclusion Criteria

I have experienced trauma and suffer from significant stress symptoms because of it.

Autistic

Comfortable speaking and writing in English

Exclusion Criteria

Participant does not have access to internet connected device for telehealth visits

Participant receives Full Scale Intelligence Quotient (FSIQ) score < 65 on the Wechsler Abbreviated Scale of Intelligence-Second Edition (WASI-2)

I cannot understand English.

Treatment Details

Interventions

• Written Exposure Therapy (WET) (Behavioral Intervention)

Trial Overview The study tests the effectiveness of Written Exposure Therapy (WET) delivered via telehealth to reduce PTSD symptoms in autistic adults. It's a pre-post single group design where participants wear Fitbits and attend virtual sessions to assess changes in mental health, physical health, and biobehavioral indicators.

Participant Groups

Group I: Written Exposure Therapy Experimental Treatment 1 Intervention

Behavioral therapy: Written Exposure Therapy via telehealth

Who Is Running the Clinical Trial?

University of Wyoming

Lead Sponsor

Trials

20

Recruited

1,600+

Findings from Research

In a study of 148 autistic youth aged 7-13 with anxiety disorders, the exposure phase of cognitive-behavioral therapy (CBT) led to significantly faster symptom reduction compared to the cognitive and psychoeducation phases, highlighting the effectiveness of exposure techniques in treating anxiety.

The findings suggest that cognitive strategies alone may slow down symptom improvement, indicating that therapists should prioritize moving quickly to exposure practices to enhance treatment efficacy for autistic youth.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Change during cognitive and exposure phases of cognitive-behavioral therapy for autistic youth with anxiety disorders. Guzick, AG., Schneider, SC., Kendall, PC., et al.[2023]

Children with autism spectrum disorder (ASD) who also have post-traumatic stress disorder (PTSD) are at a higher risk for suicidal thoughts and behaviors, highlighting the need for effective trauma treatments.

The paper presents adaptations for Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) specifically for children with ASD, including strategies for teletherapy that address both trauma and ASD behaviors, ensuring safety and flexibility in treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

TF-CBT Informed Teletherapy for Children with Autism and their Families. Romney, JS., Garcia, M.[2022]

In a study of 59 adults with autistic spectrum disorder (ASD), over 40% reported probable PTSD symptoms after experiencing both DSM-5 and non-DSM-5 traumatic events, indicating a heightened risk for PTSD in this population.

The findings suggest that a broader range of life events are perceived as traumatic by individuals with ASD, highlighting the need for mental health assessments to include non-DSM-5 traumas to ensure appropriate diagnosis and treatment for PTSD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Experience of Trauma and PTSD Symptoms in Autistic Adults: Risk of PTSD Development Following DSM-5 and Non-DSM-5 Traumatic Life Events. Rumball, F., Happé, F., Grey, N.[2021]

Written exposure therapy (WET) significantly reduced PTSD symptoms in Korean patients, with 60.9% of participants no longer meeting PTSD criteria at 6 weeks, increasing to 77.8% at 24 weeks, demonstrating its efficacy.

The therapy also improved depressive symptoms and global functioning, with a low dropout rate of 8%, indicating that WET is a feasible and effective treatment option for PTSD in diverse populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Open Pilot Trial of Written Exposure Therapy for Patients With Post-Traumatic Stress Disorder in Korea. Park, JE., Choi, KS., Han, YR., et al.[2021]

Written Exposure Therapy (WET) is an effective 5-session treatment for PTSD that shows significant symptom improvement and requires less time from both patients and therapists compared to traditional therapies.

WET has similar efficacy to Cognitive Processing Therapy (CPT) but with a much lower dropout rate (6% for WET vs. 39% for CPT), making it a promising option for diverse populations, including veterans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Brief novel therapies for PTSD: Written Exposure Therapy. Thompson-Hollands, J., Marx, BP., Sloan, DM.[2022]

EMDR therapy, when added to standard treatment, significantly reduced symptoms of PTSD, psychological distress, and autistic features in adults with Autism Spectrum Disorder (ASD) who experienced adverse events, with effect sizes indicating strong improvements.

The positive effects of EMDR therapy were maintained even after a follow-up period of 6-8 weeks, suggesting its feasibility and potential effectiveness as a treatment for this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Eye Movement Desensitization and Reprocessing (EMDR) Therapy as a Feasible and Potential Effective Treatment for Adults with Autism Spectrum Disorder (ASD) and a History of Adverse Events. Lobregt-van Buuren, E., Sizoo, B., Mevissen, L., et al.[2021]

Modified written exposure therapy (m-WET) was found to significantly reduce PTSD symptoms in Afghan adolescent girls after a terrorist attack, showing promise as an effective treatment in humanitarian settings.

The study involved 120 participants and demonstrated high acceptability for m-WET, with a low dropout rate of 15%, and no significant difference in outcomes compared to trauma-focused cognitive behavior therapy (TF-CBT).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Investigating the Feasibility, Acceptability and Efficacy of Using Modified-Written Exposure Therapy in the Aftermath of a Terrorist Attack on Symptoms of Posttraumatic Stress Disorder Among Afghan Adolescent Girls. Ahmadi, SJ., Musavi, Z., Samim, N., et al.[2022]

Written Exposure Therapy (WET) is as effective as Cognitive Processing Therapy (CPT) for treating PTSD, maintaining similar outcomes even 60 weeks after treatment, with large effects on PTSD symptoms for both therapies.

Both WET and CPT significantly reduced depressive symptoms over the study period, although CPT showed a quicker reduction; however, the overall difference in effectiveness for depression was small.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-term treatment gains of a brief exposure-based treatment for PTSD. Thompson-Hollands, J., Marx, BP., Lee, DJ., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Change during cognitive and exposure phases of cognitive-behavioral therapy for autistic youth with anxiety disorders. [2023]

2. Switzerland pubmed.ncbi.nlm.nih.gov

TF-CBT Informed Teletherapy for Children with Autism and their Families. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Experience of Trauma and PTSD Symptoms in Autistic Adults: Risk of PTSD Development Following DSM-5 and Non-DSM-5 Traumatic Life Events. [2021]

4. Korea (South) pubmed.ncbi.nlm.nih.gov

An Open Pilot Trial of Written Exposure Therapy for Patients With Post-Traumatic Stress Disorder in Korea. [2021]

5. Switzerland pubmed.ncbi.nlm.nih.gov

Brief novel therapies for PTSD: Written Exposure Therapy. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Eye Movement Desensitization and Reprocessing (EMDR) Therapy as a Feasible and Potential Effective Treatment for Adults with Autism Spectrum Disorder (ASD) and a History of Adverse Events. [2021]

7. Switzerland pubmed.ncbi.nlm.nih.gov

Investigating the Feasibility, Acceptability and Efficacy of Using Modified-Written Exposure Therapy in the Aftermath of a Terrorist Attack on Symptoms of Posttraumatic Stress Disorder Among Afghan Adolescent Girls. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Long-term treatment gains of a brief exposure-based treatment for PTSD. [2022]