Internet-Based Early Intervention to Prevent Posttraumatic Stress Disorder in Injury Patients: Randomized Controlled Trial

Abstract

BackgroundPosttraumatic stress disorder (PTSD) develops in 10-20% of injury patients. We developed a novel, self-guided Internet-based intervention (called Trauma TIPS) based on techniques from cognitive behavioral therapy (CBT) to prevent the onset of PTSD symptoms.ObjectiveTo determine whether Trauma TIPS is effective in preventing the onset of PTSD symptoms in injury patients.MethodsAdult, level 1 trauma center patients were randomly assigned to receive the fully automated Trauma TIPS Internet intervention (n=151) or to receive no early intervention (n=149). Trauma TIPS consisted of psychoeducation, in vivo exposure, and stress management techniques. Both groups were free to use care as usual (nonprotocolized talks with hospital staff). PTSD symptom severity was assessed at 1, 3, 6, and 12 months post injury with a clinical interview (Clinician-Administered PTSD Scale) by blinded trained interviewers and self-report instrument (Impact of Event Scale—Revised). Secondary outcomes were acute anxiety and arousal (assessed online), self-reported depressive and anxiety symptoms (Hospital Anxiety and Depression Scale), and mental health care utilization. Intervention usage was documented.ResultsThe mean number of intervention logins was 1.7, SD 2.5, median 1, interquartile range (IQR) 1-2. Thirty-four patients in the intervention group did not log in (22.5%), 63 (41.7%) logged in once, and 54 (35.8%) logged in multiple times (mean 3.6, SD 3.5, median 3, IQR 2-4). On clinician-assessed and self-reported PTSD symptoms, both the intervention and control group showed a significant decrease over time (P<.001) without significant differences in trend. PTSD at 12 months was diagnosed in 4.7% of controls and 4.4% of intervention group patients. There were no group differences on anxiety or depressive symptoms over time. Post hoc analyses using latent growth mixture modeling showed a significant decrease in PTSD symptoms in a subgroup of patients with severe initial symptoms (n=20) (P<.001).ConclusionsOur results do not support the efficacy of the Trauma TIPS Internet-based early intervention in the prevention of PTSD symptoms for an unselected population of injury patients. Moreover, uptake was relatively low since one-fifth of individuals did not log in to the intervention. Future research should therefore focus on innovative strategies to increase intervention usage, for example, adding gameplay, embedding it in a blended care context, and targeting high-risk individuals who are more likely to benefit from the intervention.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 57754429; http://www.controlled-trials.com/ISRCTN57754429 (Archived by WebCite at http://webcitation.org/6FeJtJJyD).

Early interventions for the prevention of PTSD in adults: a systematic literature review

“…In the study by Mouthaan et al 24 , which did not report reductions in the occurrence of PTSD, the authors discuss the fact that one-fifth of the volunteers failed to adhere to the intervention program. Another possible explanation for these results could be related to the low level of PTSD symptoms in the sample, which may have hampered the detection of improvements in the group that received the intervention.…”

“…Some limitations related to follow-up assessments were pointed in the studies reviewed, such as excessively short intervals between assessments 17 and poor treatment adherence by participants during long follow-up periods 24 . Finally, one limitation described in some studies refers to the intrinsic difficulties of proving the efficacy of early interventions, since a significant part of volunteers may not be vulnerable to the development of PTSD.…”

Pszichológiai intervenciók traumatikus események után a poszttraumás stressz zavar megelőzésére. Szisztematikus irodalmi áttekintés

“…A vizsgálatok módszertani ér-tékelése alapján elmondható, hogy míg a többségük jó színvonalú, csupán 1 vizsgálat [33] felelt meg az összes, általunk állított módszertani szempontnak, illetve továb-bi 4 vizsgálat, egy feltétel kivételével, majdnem minden kritériumnak megfelelt [34,35,36,37]. A vizsgálatok jelentős részénél [35,36,38,39,40,41,42,43,44,45,46,47,48,49,50] a minta elemszáma kifogásolható, illetve a megfelelő statisztikai erőt nyújtó mintaelem-szá-mítás hiánya tapasztalható (n = 15).…”

“…[34,41,42,45,47,48,49,50,52]. A kezelési protokollok bemutatásra kerültek és az esetek nagy részében (n = 13) az ahhoz való adherenciát hangfelvételek segít-ségével független vizsgálók mérték [33,34,45,53].…”

“…Egy másik kutatásban a CBT egy speciális formáját vizsgálták, egy interneten keresztül elérhető önsegítő programot [33]. A program tartalmazott pszichoeduká-ciós és relaxációs elemeket, valamint in vivo expozíciós feladatot.…”