Written Exposure Therapy for Posttraumatic Stress Disorder and Integration of a Mindfulness Based App in China: A Pilot Randomized Controlled Trial

Objective: This pilot randomized controlled trial examined the feasibility, acceptability, and preliminary effectiveness of Written Exposure Therapy (WET) for post-traumatic stress disorder (PTSD) in China and explored whether adding a mindfulness-based app (MBA) could improve associated insomnia outcomes. Method: Forty-six adults meeting DSM-5 criteria for PTSD or subthreshold PTSD with associated insomnia were randomly assigned to WET (n =15), WET+MBA (n = 15), or minimal contact control (MCC, n = 16). PTSD severity was assessed by the PTSD Symptom Scale Interview (PSSI-5) and the PTSD Checklist (PCL-5), and insomnia with the Insomnia Severity Index (ISI). Assessments occurred at baseline and post-treatment for all groups, with a 3-month follow-up for WET and WET+MBA participants. Results: Completion rates were 50% for WET. Treatment satisfaction was high in WET and moderate in WET+MBA. WET showed significantly greater reductions in PCL-5 (p = .022, d = -.68) and marginally greater reductions in PSSI-5 (p = .053, d = -.68) than MCC at post-treatment, with these reductions maintained during follow-up. ISI scores were significantly higher in the WET+MBA group compared to the WET group at post-treatment and follow-up. Conclusions: WET demonstrated preliminary effectiveness for PTSD treatment in Chinese patients but requires adaptation to improve feasibility and acceptability. Adding an MBA did not improve insomnia outcomes and may have negatively impacted satisfaction and effectiveness.