(PS13-83) Comparing Patients’ Experiences Receiving Written Exposure Therapy versus Antidepressant Medications for Post-traumatic Stress Disorder in Primary Care

Offering post-traumatic stress disorder (PTSD) treatments in primary care makes this care more accessible. However, patients’ experiences with different types of treatments that are feasible for primary care are not well understood. Available treatments include antidepressant pharmacotherapy and brief exposure-based psychotherapies, such as Written Exposure Therapy (WET), in which patients write about a traumatic experience in detail. As part of a comparative effectiveness trial conducted in Federally Qualified Health Centers (FQHCs) and the Veterans Health Administration (VA), we qualitatively examined similarities and differences in patients’ experiences with WET vs. antidepressant medications delivered in primary care. We conducted semi-structured interviews with 65 patients (30 FQHC; 35 VA); 27 received WET, 22 received medication, and 16 received both. Interviews were audio recorded, transcribed, and analyzed using inductive thematic analysis. All transcripts were independently analyzed by a primary and secondary coder, with any discrepancies reconciled by consensus. The full investigative team and an advisory board comprising healthcare leaders and individuals with lived PTSD experience iteratively reviewed themes. Overall, most patients reported positive changes for both treatments, such as improved symptoms and feeling empowered. Patients said that talking to clinicians about PTSD was a helpful part of both treatments, though this is a more explicit component of WET than antidepressants. Patients found writing to be a helpful aspect of WET, though some felt WET focused too much on only one traumatic event. Some patients experienced limited or negative changes. For WET, some patients described worsened anxiety or panic attacks, a delay in positive changes until later in/after treatment, or not maintaining positive changes after treatment. Patients generally reported similar barriers (e.g., fear, stigma) and facilitators (e.g., family/friend support, virtual care) of treatment engagement, regardless of treatment received. Achieving an adequate therapeutic dose was discussed for both treatments (adjusting medication; desiring more WET sessions). Financial barriers and confidentiality concerns were more commonly reported for WET. Additional WET-specific barriers included disliking writing, wishing to devote time with the therapist to other things, and a preference for a female therapist. Patients receiving antidepressants addressed logistical barriers, such as remembering to take medication and refilling prescriptions. Moreover, patients discussed dealing with medication side effects and the temporary worsening of negative emotions during WET. Findings highlight similarities and differences in patients' experiences with WET vs. antidepressants for PTSD in primary care. These findings can inform treatment delivery. Primary care clinics should be prepared to support patients in engaging in treatment, which may look similar and different across treatment types (e.g., addressing stigma; addressing medication side effects vs. preparing patients for short-term exposure therapy effects; adjusting medication dose vs. connecting patients to more intensive psychotherapy as needed).