A brief integrated therapy combining trauma writing exercises with cannabis coping skills showed promising results in three young women after recent sexual assault—but this is very early-stage evidence.
Trauma therapists interested in integrated approaches, and researchers studying the PTSD-cannabis use disorder overlap.
What the researchers found
This case series describes STEPS (Skills Training and Exposure for PTSD and Substance Misuse), a new therapy that combines Written Exposure Therapy for PTSD with cognitive-behavioral skills training for cannabis use disorder. It was delivered to three women ages 19–25 who experienced recent sexual assault and were using cannabis problematically.
The approach is notable for two reasons. First, it treats both conditions simultaneously rather than the traditional sequential approach (stabilize substance use first, then address trauma). Second, it targets people soon after the traumatic event, when early intervention might prevent both conditions from becoming entrenched.
Existing integrated trauma-and-substance-use protocols tend to be lengthy, which creates barriers to completion. STEPS was designed to be briefer and more accessible. The three cases showed improvements in both PTSD symptoms and cannabis use, though with only three participants and no control group, these results are purely descriptive.
The rationale for targeting cannabis specifically (rather than alcohol or other substances) reflects the reality that cannabis use disorder is increasingly common among young trauma survivors—a population that often self-medicates with cannabis to manage PTSD symptoms like hyperarousal and intrusive memories.
Why it matters
Sexual assault is one of the most common causes of PTSD, and cannabis use disorder frequently co-occurs with trauma in young adults. Most treatment protocols require addressing one condition before the other, which means patients often fall through the cracks. An integrated, brief approach that works soon after trauma could fill a significant gap—but this case series is only the very first step toward testing that idea.
The numbers in context
3 participants, ages 19–25. All experienced recent sexual assault. All showed improvements in PTSD severity and cannabis use by end of treatment.
How the study worked
Case series of three emerging adult women (ages 19–25) who experienced recent sexual assault and met criteria for PTSD and problematic cannabis use. Treatment: STEPS protocol combining Written Exposure Therapy with cognitive-behavioral substance use skills training. No control group or comparison condition.
Who was studied
3 emerging adult women aged 19-25 who experienced recent sexual assault (1-12 weeks post-assault)
What this study cannot tell us
Three participants with no control group—this is hypothesis-generating, not evidence of efficacy. No long-term follow-up reported. All participants were young women after sexual assault; results may not generalize to other trauma types, demographics, or genders. The improvements could reflect natural recovery, placebo effects, or regression to the mean.
How to read the evidence
Case series with three participants and no control group—the lowest tier of clinical evidence, useful only for generating hypotheses for future testing.
When this study was published
Published in 2025, describing a novel intervention protocol.
The bigger picture
This sits within the broader PTSD-cannabis literature that includes RTHC-00125 (cannabis and trauma exposure in veterans) and RTHC-00127 (PTSD as a predictor of cannabis use disorder). The self-medication hypothesis—that people use cannabis to manage trauma symptoms—is well-documented but creates a clinical paradox: the substance that provides short-term relief may worsen long-term outcomes. Integrated treatments that address both simultaneously could break this cycle.
Replication
Not stated in abstract.
Funding
Not reported in abstract.
Conflicts of interest
Not reported in abstract.
Questions still open
- Will STEPS show efficacy in a randomized controlled trial? Does the timing of intervention (soon after trauma) matter for outcomes? Would this approach work for other trauma types beyond sexual assault?
Read the original research
Written Exposure Therapy for PTSD Integrated with Cognitive Behavioral Coping Skills for Cannabis Use Disorder After Recent Sexual Assault: A Case Series.
Behavioral sciences (Basel, Switzerland), 15(7)
Behavioral Sciences is a peer-reviewed journal known for publishing research on mental health and behavioral interventions.
Citation
Hahn, Christine K; Salim, Selime R; Tilstra-Ferrell, Emily L; Brady, Kathleen T; Marx, Brian P; Rothbaum, Barbara O; Saladin, Michael E; Guille, Constance; Gilmore, Amanda K; Back, Sudie E. (2025). Written Exposure Therapy for PTSD Integrated with Cognitive Behavioral Coping Skills for Cannabis Use Disorder After Recent Sexual Assault: A Case Series.. Behavioral sciences (Basel, Switzerland), 15(7). https://doi.org/10.3390/bs15070877
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