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

Abstract

BackgroundTherapist-delivered trauma-focused psychological therapies are an effective treatment for post-traumatic stress disorder (PTSD). These have become the accepted first-line treatments for the disorder. Despite the established evidence-base for these therapies, they are not always widely available or accessible. Many barriers limit treatment uptake, such as the limited number of qualified therapists to deliver the interventions, cost, and compliance issues, such as time off work, childcare, and transportation, associated with the need to attend weekly appointments. Delivering cognitive behavioural therapy (CBT) on the Internet is an effective and acceptable alternative to therapist-delivered treatments for anxiety and depression. However, fewer Internet-based therapies have been developed and evaluated for PTSD, and uncertainty surrounds the efficacy of Internet-based cognitive and behavioural therapy (I-C/BT) for PTSD. ObjectivesTo assess the effects of I-C/BT for PTSD in adults. Search methodsWe searched the Cochrane Common Mental Disorders Group's Specialised Register (CCMDCTR) to June 2016 and identified four studies meeting the inclusion criteria. The CCMDCTR includes relevant randomised controlled trials (RCT) from MEDLINE, Embase, and PsycINFO. We also searched online clinical trial registries and reference lists of included studies, and contacted researchers in the field to identify additional and ongoing studies. We ran an update search on 1 March 2018, and identified four additional completed studies, which we added to the analyses along with two that were previously awaiting classification. Selection criteriaWe searched for RCTs of I-C/BT compared to face-to-face or Internet-based psychological treatment, psychoeducation, wait list or care as usual. We included studies of adults (aged over 16 years or over), in which at least 70% of the participants met the diagnostic criteria for PTSD, according to the Diagnostic and Statistical Manual (DSM) or the International Classification of Diseases (ICD). 1 Internet-based cognitive and behavioural therapies for post-traumatic stress disorder (PTSD) in adults (Review)

Guided, internet based, cognitive behavioural therapy for post-traumatic stress disorder: pragmatic, multicentre, randomised controlled non-inferiority trial (RAPID)

“…The results consolidate previous work that has shown the efficacy of guided internet based CBT-TF for the treatment of PTSD 171819. Meta-analyses of face-to-face CBT-TF for PTSD found lower mean levels of improvement than our results for face-to-face CBT-TF and guided internet based CBT-TF,50 although participants could have had more severe PTSD, given the focus on mild to moderate PTSD to one event in our trial.…”

“…To the best of our knowledge, this is the largest study of guided internet based CBT-TF for PTSD so far and the only study of guided internet based CBT-TF compared with a manual based gold standard treatment. Previous studies have usually compared guided internet based CBT-TF for PTSD with wait list controls, and major concerns have been raised about the various approaches used, overall quality of the methodology used, absence of follow-up, and higher dropout rates than found in our trial 1954…”

“…Previous studies of guided internet based CBT-TF for PTSD have shown smaller effect sizes compared with wait list than guided internet based CBT-TF with the Spring programme1819. This finding might be because more guidance was included in the Spring programme than in most other web assisted interventions for PTSD, the programme was co-produced with people with lived experience of PTSD, it adhered to a CBT-TF approach, and was compliant with NICE’s minimum recommended standards for guided internet based CBT-TF for PTSD 9.…”

Ambulante Rehabilitative Versorgung von Patienten mit Long-COVID – eine leitlinienorientierte klinisch-praktische Handlungsempfehlung

“…Nach Entfernung von Duplikaten und Prüfung der Einschlusskriterien verblieben 61 Artikel, die für die folgende Arbeit als Basis dienten ( Abb. 1 ) 2 3 4 5 7 9 10 11 12 13 15 16 17 18 20 22 24 25 28 29 30 31 33 34 37 38 41 42 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 . Sie werden als Grundlage der Empfehlungen in den einzelnen Unterkapiteln des Abschnitts 3 verwendet und dort zitiert.…”

Internet-Based Prevention Program of Victimization for Youth in Care and Care Leavers (EMPOWER YOUTH): Protocol for a Randomized Controlled Trial

“…A meta-analysis [ 23 ] found an overall pooled effect size with d =0.85 for internet-delivered cognitive behavioral therapy in youth, with a large effect for psychiatric conditions ( d =1.27) and a lower treatment effect for somatic conditions ( d =0.49). Systematic reviews and meta-analyses showed that cognitive behavioral web-based interventions for individuals with PTSD symptoms [ 24 ] and youth with neurodevelopmental disorders, anxiety, depression, and even suicidal ideation had high efficacy [ 25 - 27 ] comparable to traditional face-to-face settings [ 28 , 29 ].…”