Internet-based cognitive and behavioural therapies for post-traumatic stress disorder (PTSD) in adults

Internet-delivered cognitive behavioural therapy for post-traumatic stress disorder: systematic review and meta-analysis.Objective: To determine whether Internet-delivered cognitive behavioural therapy (i-CBT) is an effective treatment for those who meet diagnostic criteria for post-traumatic stress disorder (PTSD). Method: A systematic review was undertaken according to Cochrane Collaboration Guidelines. The primary outcome measures were reduction in PTSD symptoms and drop-out. Categorical outcomes were meta-analysed as risk ratios (RRs) and continuous outcomes as mean differences (MDs) or standardised mean differences (SMDs). Results: Ten studies with 720 participants were included. Evidence showed that i-CBT may be associated with a clinically important reduction in post-treatment PTSD symptoms compared with wait list (SMD À0.60, 95% confidence interval À0.97 to À0.24; N = 560); however, only three studies reported follow-up data, and there was no evidence to support the maintenance of symptom improvement at follow-up of 3-6 months. There was no evidence of a difference in PTSD symptoms between i-CBT and Internet-delivered non-CBT posttreatment. There was evidence of greater treatment effect from traumafocused i-CBT than i-CBT without a trauma focus, as well as evidence that treatment effect was increased by the provision of guidance. Conclusions: While the review found some beneficial effects of i-CBT for PTSD post-treatment, the quality of the evidence was very low because of the small number of included trials and there was insufficient evidence to support the maintenance of improvement at follow-up of 3-6 months. Further work is required to establish non-inferiority to current first-line interventions; to determine long-term efficacy; to explore mechanisms of effect; and to establish optimal levels of guidance. Summations• i-CBT may be associated with a clinically important reduction in PTSD symptoms post-treatment, but there is currently a lack of evidence to support maintenance of the effect at follow-up.• There was evidence of greater treatment effect from trauma-focused i-CBT than i-CBT without a trauma focus, as well as evidence that treatment effect was increased by the provision of guidance.• Further work is required to establish non-inferiority to current first-line interventions. Limitations• Only ten studies were eligible for inclusion, and sample sizes were often small. • Participants included in the ten studies were predominantly from the United States and Western Europe, employed and had relatively high levels of education. It is not possible to determine whether similar results would have been obtained from participants with more representative demographic characteristics.• There was a lack of independent evaluation. All but one of the programmes were evaluated by the programme developers themselves.

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“…A systematic review and meta‐analyses were undertaken according to a protocol prospectively registered with the Cochrane Collaboration .…”

Section: Methodsmentioning

confidence: 99%

Internet‐delivered cognitive behavioural therapy for post‐traumatic stress disorder: systematic review and meta‐analysis

Lewis

Roberts

Simon

et al. 2019

Acta Psychiatr Scand

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“…Included studies were RCTs; randomised cross-over trials; and cluster-randomised trials of i-CBT for PTSD, for optimal confidence interpreting findings, given the rigorous methodology/reporting expected of these designs. For consistency with other reviews of psychological therapies for PTSD (Lewis et al, 2018), studies were eligible if at least 70% of participants were diagnosed with PTSD according to DSM/ ICD criteria, and if participants were aged 16 years or older. There was no restriction on the index trauma; severity or duration of symptoms; or length of time since trauma.…”

Section: Selection Criteriamentioning

confidence: 99%

“…The search strategy used for a review of the efficacy of i-CBT for PTSD (Lewis et al, 2018), was adopted for the current review. Search terms were identified and a systematic search of the Cochrane Common Mental Disorders Group (CCMDG) clinical trials registers databases was performed for studies published up to 2 March 2018 (see Appendix A for full search strategy terms).…”

Section: Search Strategymentioning

confidence: 99%

“…I-CBT interventions for PTSD generally offer less therapist contact than in traditional face-to-face TF-CBT, and guidance varies across i-CBT interventions, for example a higher level of therapist involvement, feedback and encouragement, week-to-week, is required in the PTSD i-CBT intervention, Interapy (Lange, Rietdijk, Hudcovicova, van de Ven, J.-P.,Schrieken, B., & Emmelkamp, 2003), compared with the intervention, PTSD Online (Klein et al, 2010), which does not require weekly feedback from therapists. Effective across a range of mental health problems, including anxiety disorders and depression (Lewis, Pearce, & Bisson, 2012), i-CBT interventions have also been tested for PTSD, and found to be superior to waitlist and treatment-asusual, in reducing symptoms of depression and PTSD, with greater effect when guided by a therapist (Lewis, Roberts, Bethell, Robertson, & Bisson, 2018). In recognition of the developing evidence base, guided i-CBT with a trauma-focus has featured amongst treatment recommendations in recent treatment guidelines for PTSD (ISTSS, 2018).…”

Section: Introductionmentioning

confidence: 99%

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Acceptability of internet-based cognitive behavioural therapy (i-CBT) for post-traumatic stress disorder (PTSD): a systematic review

Simon

McGillivray

Roberts

et al. 2019

European Journal of Psychotraumatology

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Background: Internet-delivered Cognitive Behavioural Therapy (i-CBT) offers potential as an alternative, accessible, clinically and cost-effective treatment for post-traumatic stress disorder (PTSD), but little is known about its acceptability. Objective: To review the available evidence to understand the acceptability of i-CBT for PTSD. Method: We undertook a mixed-methods systematic review according to Cochrane Collaboration Guidelines, of randomised controlled trials (RCTs) of i-CBT for adults with PTSD. We examined included studies for measures of acceptability, and possible proxy indicators of acceptability, including dropout rates, which were meta-analysed as risk ratios (RRs). Results: Ten studies with 720 participants were included. We found i-CBT to be acceptable according to specific acceptability measures, and suggestions for acceptability according to some proxy measures of i-CBT programme usage. There was, however, evidence of greater dropout from i-CBT than waitlist (RR 1.39, CI 1.03-1.88; 8 studies; participants = 585) and no evidence of a difference in dropout between i-CBT and i-non-CBT (RR 2.14, CI 0.97-4.73; participants = 132; 2 studies). Conclusion: i-CBT appears a potentially acceptable intervention for adults with PTSD. We identified clinical and research questions, including the status of proxy indicators, and call for standardised, consistent treatment acceptability measurement.

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“…In einem aktuellen Cochrane Review [16] wurde die Wirksamkeit verschiedener internetbasierter kognitiv-verhaltenstherapeutischer Therapieprogramme bei Patienten mit PTBS untersucht. Dabei wurden sowohl Computer-als auch Smartphone-basierte Anwendungen berücksichtigt (z. T. bereits oben vorgestellt, z.…”

Section: Cochrane Review: Internetbasierte Kognitive Verhaltenstherapunclassified

Digitale Medien in der Psychotherapie – Neue Ansätze und Perspektiven in der Behandlung von Traumafolgestörungen

Kessler

Dangellia

Herpertz

et al. 2020

Psychother Psychosom Med Psychol

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ZusammenfassungDieser Artikel gibt einen Einblick in neue Ansätze und Perspektiven bei der Behandlung von Traumafolgestörungen unter Einsatz digitaler Medien. Ausgangslage ist die unzureichende flächendeckende Versorgung bei Traumafolgestörungen und die Suche nach neuen, spezifischen Behandlungsstrategien. Zunächst werden exemplarisch digitale Ansätze vorgestellt, die bekannte analoge Therapien zur Grundlage haben und zu deren Verbreitung und Ökonomisierung beitragen. Der Fokus liegt jedoch auf digitalen Therapien, die neue – z. B. aus der Kognitionswissenschaft entwickelte – Ansätze zur gezielten Arbeit an Symptomen erstmals nach deren Entwicklung in Grundlagenstudien auch an klinischen Populationen anwenden. Beispiele hierfür sind visuospatiale Interventionen zur Reduktion von Intrusionen und Trainings zur Verbesserung der Interferenzkontrolle (um traumabezogene Stimuli zu kontrollieren) oder zur Veränderung automatischer dysfunktionaler Kognitionen. Diese werden mit dem theoretischen Hintergrund und ersten (z.T. klinischen) Studien näher dargestellt, welche bereits vielversprechende Ergebnisse bezüglich Akzeptanz, Anwendbarkeit und Effektivität zeigen.

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Internet-based cognitive and behavioural therapies for post-traumatic stress disorder (PTSD) in adults

Abstract: Internet-based cognitive and behavioural therapies for post-traumatic stress disorder (PTSD) in adults (Review)

Cited by 53 publications

References 74 publications

Internet‐delivered cognitive behavioural therapy for post‐traumatic stress disorder: systematic review and meta‐analysis

Internet‐delivered cognitive behavioural therapy for post‐traumatic stress disorder: systematic review and meta‐analysis

Acceptability of internet-based cognitive behavioural therapy (i-CBT) for post-traumatic stress disorder (PTSD): a systematic review

Digitale Medien in der Psychotherapie – Neue Ansätze und Perspektiven in der Behandlung von Traumafolgestörungen

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