A Therapist-Assisted Internet Self-Help Program for Traumatic Stress.

Abstract

The authors describe a therapist-assisted, Internet-based self-help intervention to treat posttraumatic stress disorder (PTSD) and discuss how it can be used as an efficient tool to treat large numbers of traumatized individuals. The intervention uses a modified form of stress inoculation training, promoted through daily homework assignments completed in vivo, using fewer therapist resources than standard face-to-face therapy. The process and structure of the treatment program (and structure of the Web site) and clinical and Internet security safeguards are described to introduce practitioners to a unique therapist-assisted self-management model of PTSD. It is hoped that the method described will lead to other novel, efficient methods of delivering interventions and treatment for PTSD in primary care and other outpatient and private practice settings.

Crisis interventions in online psychological counseling

“…Eleven models of online crisis intervention were found ( Table 2). These programs are still ongoing, since the websites were tested in randomized clinical trials and Bae et al 9 van Spijker et al 35 Hirai & Clum 46 van Spijker et al 32 Lange et al 38 van Spijker et al 43 Knaevelsrud & Maercker 47 Barak 34 Wagner et al 44 Gilat & Shahar 45 Litz et al 39 Christensen et al 42 Litz et al 11 Mouthaan et al 37 Mouthaan et al 40 Cox et al 41 Robinson et al Eight weeks of intervention comprising: 1) information, 2) relaxation training (including breathing techniques, PMR and IIR), 3) cognitive restructuring, and 4) exposure modules (written).…”

“…Eleven of these were randomized clinical trials or pilots for randomized clinical trials, 32,33,35,37-44 three of them were reports of experience 9,11,34 and the remaining three fell into other categories. [45][46][47] Several different crisis contexts were identified and so the articles were allocated to three categories to provide a framework for organizing the results, as follows (Table 1): interventions in disasters, interventions in suicide risk and suicide prevention, and interventions in traumas.…”

“…Countries such as the Netherlands With regard to who guides the therapy, all of the studies in this review included some degree of self-management from patients, either total or partial ( and face-to-face assessments before intervention. 11,33,39 However, in all cases the patient takes the major role in conducting the therapy.…”

“…17 Initially, DBT proved its efficacy with borderline personality disorder patients, but since it is focused on helping patients to reduce and tolerate stress, it has also shown promise for treating suicide risk in other disorders. 18 Litz et al 11 have stated that the limited abilities of therapists could be a barrier to optimum mental health care when a mass casualty incident occurs. In view of this, low-cost short-term interventions that can reach the largest number of victims ought to be designed.…”

“…In some interventions, the option of face-to-face treatment was included, either when a demand was identified 37,40 or as a constant part of the program. 9,11,33,34,39 This is the case of the Zahar Project, 34 in which, if a situation of imminent risk of suicide was detected, a specific team was activated to provide specialized face-to-face support. This kind of approach illustrates the point that online treatments are not being developed in order to replace or reject the traditional work of psychologists.…”