Guided Written Exposure Therapy for Posttraumatic Stress Disorders in China: Protocol for a Randomized Controlled Trial

Background: Posttraumatic stress disorder (PTSD) is prevalent in China, yet access to evidence-based treatments remains limited. Written Exposure Therapy (WET) offers a brief intervention option but shows high dropout rates among Chinese patients and a need for culturally informed adaptations. Guided Written Exposure (GWE) builds on WET by integrating elements from Narrative Exposure Therapy (NET) and specialized components tailored for Chinese patients to enhance trauma processing and treatment engagement. This study presents the protocol for a randomized controlled trial examining the effectiveness of GWE in reducing PTSD symptoms in Chinese patients. Methods: Ninety adults aged 18–65 with PTSD or subthreshold PTSD will be randomly assigned to either GWE or minimal contact control (MCC) in a 2:1 ratio. GWE includes 5–8 online sessions over three weeks, incorporating enhanced psychoeducation, increased session frequency, and structured guidance on emotional expression to improve treatment acceptance. Primary outcomes are clinician-rated and self-reported PTSD severity, with secondary outcomes including depression and insomnia. All participants will be assessed at baseline, post-treatment, and 1-month follow-up assessments, with the GWE group undergoing additional follow-ups at 3 and 6 months. Group differences over time will be analyzed using multilevel modeling. Discussion: This study evaluates GWE's effectiveness as a culturally adapted PTSD treatment for Chinese patients, expanding the evidence base for PTSD therapies in diverse populations. By addressing barriers to treatment engagement, GWE may serve as a scalable and acceptable intervention for PTSD in China, offering insights for adapting exposure therapies cross-culturally.