A randomised controlled trial of therapist-assisted online psychological therapies for posttraumatic stress disorder (STOP-PTSD): trial protocol

Ehlers, Anke; Wild, Jennifer; Warnock-Parkes, Emma; Grey, Nick; Murray, Hannah; Kerr, Alice; Beierl, Esther T.; Tsiachristas, Apostolos; Perera, Rafael; Andersson, Gerhard; Clark, David M.

doi:10.1186/s13063-020-4176-8

Cited by 21 publications

(24 citation statements)

References 42 publications

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“…Participants rated each life domain using a 10-point Likert-scale ranging from 0 = not at all to 10 = very much. The life domains were inspired by the type of value measures often used in Acceptance and Commitment Therapy ( Reilly et al, 2019 ), and are commonly employed in many clinical trials (e.g., Buhrman et al, 2020 ; Ehlers et al, 2020 ).…”

Section: Methodsmentioning

confidence: 99%

Procrastination Among University Students: Differentiating Severe Cases in Need of Support From Less Severe Cases

2022

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Procrastination refers to voluntarily postponing an intended course of action despite expecting to be worse off for this delay, and students are considered to be especially negatively affected. According to estimates in the literature, at least half of the students believe procrastination impacts their academic achievements and well-being. As of yet, evidence-based ideas on how to differentiate severe from less severe cases of procrastination in this population do not exist, but are important in order to identify those students in need of support. The current study recruited participants from different universities in Sweden to participate in an anonymous online survey investigating self-rated levels of procrastination, impulsivity, perfectionism, anxiety, depression, stress, and quality of life. Furthermore, diagnostic criteria for pathological delay (PDC) as well as self-report items and open-ended questions were used to determine the severity of their procrastination and its associated physical and psychological issues. In total, 732 participants completed the survey. A median-split on the Pure Procrastination Scale (PPS) and the responses to the PDC were used to differentiate two groups; “less severe procrastination” (PPS ≤ 2.99; n = 344; 67.7% female; M age = 30.03; SD age = 9.35), and “severe procrastination” (PPS ≥ 3.00; n = 388; 66.2% female; M age = 27.76; SD age = 7.08). For participants in the severe group, 96–97% considered procrastination to a problem, compared to 42–48% in the less severe group. The two groups also differed with regard to considering seeking help for procrastination, 35–38% compared to 5–7%. Participants in the severe group also reported more problems of procrastination in different life domains, greater symptoms of psychological issues, and lower quality of life. A thematic analysis of the responses on what physical issues were related to procrastination revealed that these were characterized by stress and anxiety, e.g., tension, pain, and sleep and rest, while the psychological issues were related to stress and anxiety, but also depression, e.g., self-criticism, remorse, and self-esteem. The current study recommends the PPS to be used as an initial screening tool, while the PDC can more accurately determine the severity level of procrastination for a specific individual.

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Section: Methodsmentioning

confidence: 99%

Procrastination Among University Students: Differentiating Severe Cases in Need of Support From Less Severe Cases

2022

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“…CT-PTSD has been delivered to patients experiencing a range of trauma, including traumatic loss, and has been evaluated in several RCTs (Ehlers et al ., 2003; Ehlers et al ., 2005; Ehlers et al ., 2014; Ehlers et al ., 2020) as well as in routine clinical practice (Duffy, Gillespie and Clark, 2007; Ehlers et al ., 2013; Ehlers et al ., 2023) and is associated with high rates of recovery. However, to determine the efficacy associated with the different components of CT-PTSD as delivered for traumatic bereavement, a dismantling study is required or a study of an experimental design in which the procedures are evaluated in isolation.…”

Section: Discussionmentioning

confidence: 99%

Moving forward with the loss of a loved one: treating PTSD following traumatic bereavement with cognitive therapy

Wild

Duffy

Ehlers

2023

tCBT

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Traumatic loss is associated with high rates of post-traumatic stress disorder (PTSD) and appears to inhibit the natural process of grieving, meaning that patients who develop PTSD after loss trauma are also at risk of experiencing enduring grief. Here we present how to treat PTSD arising from traumatic bereavement with cognitive therapy (CT-PTSD; Ehlers et al., 2005). The paper describes the core components of CT-PTSD for bereavement trauma with illustrative examples, and clarifies how the therapy differs from treating PTSD associated with trauma where there is no loss of a significant other. A core aim of the treatment is to help the patient to shift their focus from loss to what has not been lost, from a focus on their loved one being gone to considering how they may take their loved one forward in an abstract, meaningful way to achieve a sense of continuity in the present with what has been lost in the past. This is often achieved with imagery transformation, a significant component of the memory updating procedure in CT-PTSD for bereavement trauma. We also consider how to approach complexities, such as suicide trauma, loss of a loved one in a conflicted relationship, pregnancy loss and loss of life caused by the patient. Key learning aims (1) To be able to apply Ehlers and Clark’s (2000) cognitive model to PTSD arising from bereavement trauma. (2) To recognise how the core treatment components differ for PTSD associated with traumatic bereavement than for PTSD linked to trauma where there is no loss of life. (3) To discover how to conduct imagery transformation for the memory updating procedure in CT-PTSD for loss trauma.

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“…CT-PTSD is a highly effective treatment for PTSD that in our experience can be delivered remotely over video conferencing facility or the telephone, using the same treatment components as in face-to-face delivery and in their typical order, with some adjustments. A trial is currently underway evaluating therapist-supported internet-delivered cognitive therapy for PTSD (Ehlers et al, 2020b ), a remote version of CT-PTSD that is acceptable to patients, includes modules for the patient to complete and shows promising preliminary results (Wild et al, 2016 ). However, this and other web-based versions of trauma-focused CBT are not yet routinely available in clinical services in the UK.…”

Section: Discussionmentioning

confidence: 99%

“…CT-PTSD is based on Ehlers and Clark ( 2000 ) cognitive model of PTSD and is recommended as a first-line treatment in international clinical guidelines (APA, 2017 ; International Society of Traumatic Stress Studies, 2019 ; National Institute of Health and Clinical Excellence, 2018 ). Several randomised controlled trials have demonstrated that face-to-face CT-PTSD is effective and acceptable to patients who have experienced a wide range of traumatic events, with low drop-out rates (3% on average in randomised trials) and high patient satisfaction scores in adults (Ehlers, Clark, Hackmann, McManus, & Fennell, 2005 ; Ehlers et al, 2003 , 2014 , 2020b ) and children and adolescents (Meiser-Stedman et al, 2017 ; Smith et al, 2007 ). In these trials, CT-PTSD led to large improvements in PTSD symptoms, disability, depression, anxiety, and quality of life, and over 70% of patients (intent-to-treat) recovered from PTSD, i.e.…”

Section: Introductionmentioning

confidence: 99%

Treating posttraumatic stress disorder remotely with cognitive therapy for PTSD

Wild

Warnock-Parkes

Murray

et al. 2020

European Journal of Psychotraumatology

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Delivering trauma-focused cognitive behavioural therapy to patients with PTSD during the COVID-19 pandemic poses challenges. The therapist cannot meet with the patient in person to guide them through trauma-focused work and other treatment components, and patients are restricted in carrying out treatment-related activities and behavioural experiments that involve contact with other people. Whilst online trauma-focused CBT treatments for PTSD have been developed, which overcome some of these barriers in that they can be delivered remotely, they are not yet routinely available in clinical services in countries, such as the UK. Cognitive therapy for PTSD (CT-PTSD) is a trauma-focused cognitive behavioural therapy that is acceptable to patients, leads to high rates of recovery and is recommended as a first-line treatment for the disorder by international clinical practice guidelines. Here we describe how to deliver CT-PTSD remotely so that patients presenting with PTSD during the COVID-19 pandemic can still benefit from this evidence-based treatment. Tratamiento remoto del trastorno de estrés postraumático con terapia cognitiva para el TEPT Brindar terapia cognitivo conductual (TCC) centrada en el trauma a pacientes con Trastorno de Estrés Postraumático (TEPT) durante la pandemia de COVID-19 plantea desafíos. El terapeuta no puede reunirse con el paciente en persona para guiarlo a través del trabajo centrado en el trauma y apoyarlo con otros componentes del tratamiento; y por otra parte, los pacientes tienen restricciones para llevar a cabo las actividades relacionadas con el tratamiento y los experimentos de comportamiento que impliquen contacto con otras personas. Si bien se han desarrollado tratamientos de TCC centrados en el trauma en línea para el TEPT, que superan algunas de estas barreras en el sentido de que pueden administrarse de forma remota, todavía no están disponibles de forma rutinaria en los servicios clínicos de los países, como en el Reino Unido. La terapia cognitiva para el TEPT (TC-TEPT) es una terapia cognitiva conductual centrada en el trauma que es aceptable para los pacientes, conduce a altas tasas de recuperación y se recomienda como tratamiento de primera línea para el trastorno según las pautas internacionales de práctica clínica (APA, 2017; International Society of Traumatic Stress Studies, 2019; National Institute of Health and Clinical Excellence, 2018). Aquí describimos cómo administrar TC-TEPT de forma remota para que los pacientes que se presentan con TEPT durante la pandemia de COVID-19 aún puedan beneficiarse de este tratamiento basado en la evidencia.

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A randomised controlled trial of therapist-assisted online psychological therapies for posttraumatic stress disorder (STOP-PTSD): trial protocol

Cited by 21 publications

References 42 publications

Procrastination Among University Students: Differentiating Severe Cases in Need of Support From Less Severe Cases

Procrastination Among University Students: Differentiating Severe Cases in Need of Support From Less Severe Cases

Moving forward with the loss of a loved one: treating PTSD following traumatic bereavement with cognitive therapy

Treating posttraumatic stress disorder remotely with cognitive therapy for PTSD

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