BackgroundRandomised controlled trials have established that face-to-face cognitive therapy for posttraumatic stress disorder (CT-PTSD) based on Ehlers and Clark's cognitive model of PTSD is highly effective and feasible with low rates of dropout. Access to evidence-based psychological treatments for PTSD is insufficient. Several studies have shown that therapist-assisted treatment delivery over the Internet is a promising way of improving access to cognitive behavioural therapy interventions.ObjectiveTo develop an Internet version of CT-PTSD that significantly reduces therapist contact time without compromising treatment integrity or retention rates.MethodsWe describe the development of an Internet version of CT-PTSD. It implements all the key procedures of face-to-face CT-PTSD, including techniques that focus on the trauma memory, such as memory updating, stimulus discrimination and revisiting the trauma site, as well as restructuring individually relevant appraisals relating to overgeneralisation of danger, guilt, shame or anger, behavioural experiments and planning activities to reclaim quality of life. A cohort of 10 patients meeting DSM-IV criteria for PTSD worked through the programme, with remote guidance from a therapist, and they were assessed at pre- and post-treatment on PTSD outcome, mood, work and social adjustment and process measures.ResultsNo patients dropped out. Therapists facilitated the treatment with 192 min of contact time per patient, plus 57 min for reviewing the patient's progress and messages. Internet-delivered CT-PTSD was associated with very large improvements on all outcome and process measures, with 80% of patients achieving clinically significant change and remission from PTSD.ConclusionsInternet-delivered cognitive therapy for PTSD (iCT-PTSD) appears to be an acceptable and efficacious treatment. Therapist time was reduced to less than 25% of time in face-to-face CT-PTSD. Randomised controlled trials are required to evaluate systematically the acceptability and efficacy of iCT-PTSD.Highlights of the articleiCT-PTSD was acceptable to patients and associated with very large improvements on PTSD outcome and process measures.iCT-PTSD required substantially less therapist time than CT-PTSD.iCT-PTSD may be associated with changes in employment status.Randomised controlled trials are required to systematically evaluate the acceptability and efficacy of iCT-PTSD.

Background: Negative beliefs about the self, including low self-compassion, have been identified as a putative causal factor in the occurrence of paranoia. Therefore, improving self-compassion may be one route to reduce paranoia. Aims: To assess the feasibility, acceptability, and potential clinical effects of a brief compassionate imagery intervention for patients with persecutory delusions. Method: Twelve patients with persecutory delusions received an individual four-session compassionate imagery intervention. Assessments of self-concept and paranoia were completed before treatment, immediately after treatment, and at 1-month follow-up. A qualitative study exploring participants’ experiences of the treatment was also completed. Results: Twelve out of 14 eligible patients referred to the study agreed to take part. All participants completed all therapy sessions and assessments. Post-treatment, there were improvements in self-compassion (change score –0.64, 95% CI –1.04, –0.24, d = –1.78), negative beliefs about the self (change score 2.42, 95% CI –0.37, 5.20, d = 0.51), and paranoia (change score 10.08, 95% CI 3.47, 16.69, d = 0.61). There were no serious adverse events. Three themes emerged from the qualitative analysis: ‘effortful learning’, ‘seeing change’ and ‘taking it forward’. Participants described a process of active and effortful engagement in therapy which was rewarded with positive changes, including feeling calmer, gaining clarity, and developing acceptance. Conclusion: This uncontrolled feasibility study indicates that a brief compassionate imagery intervention for patients with persecutory delusions is feasible, acceptable, and may lead to clinical benefits.

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