Evaluation of an internet-based intervention for service members of the German armed forces with deployment-related posttraumatic stress symptoms

Abstract

Background: The present study was designed to evaluate the efficacy of a therapist-guided internet-based cognitive-behavioral therapy (iCBT) intervention for service members of the German Armed Forces with posttraumatic stress disorder (PTSD). The iCBT was adapted from Interapy, a trauma-focused evidence-based treatment based on prolonged exposure and cognitive restructuring. It lasted for 5 weeks and included 10 writing assignments (twice a week). The program included a reminder function if assignments were overdue, but no multimedia elements. Therapeutic written feedback was provided asynchronously within one working day. Methods: Male active and former military service members were recruited from the German Armed Forces. Diagnoses were assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the Mini-International Neuropsychiatric Interview. Psychopathology was assessed at pre-treatment, post-treatment, and 3-month followup. Severity of PTSD was the primary outcome and anxiety was the secondary outcome. Participants were randomly allocated to a treatment group that received iCBT immediately or to a waitlist group that received iCBT after 6 weeks. Due to the overall small sample size (n = 37), the two groups were collapsed for the statistical analyses. Change during the intervention period was investigated using latent-change score models. Results: Improvements in the CAPS-5 were small and not statistically significant. For anxiety, small significant improvements were observed from pre-to follow-up assessment. The dropout rate was 32.3%. Conclusions: The low treatment utilization and the high dropout rate are in line with previous findings on treatment of service members. The interpretation of the current null results for the efficacy of iCBT is limited due to the small sample size, however for military samples effect estimates were also smaller in other recent studies. Our results demonstrate the need to identify factors influencing treatment engagement and efficacy in veterans. Trial registration: Australian Clinical Trials Registry ACTRN12616000956404.

Associations between oxytocin and vasopressin concentrations, traumatic event exposure and posttraumatic stress disorder symptoms: group comparisons, correlations, and courses during an internet-based cognitive-behavioural treatment

“…future. For an even more detailed description of the treatment manual (Niemeyer et al, 2020). Before assignment to the trial, PTSD patients were -based on a computer-generated randomization list -assigned to the waitlist or non-waitlist condition.…”

“…This study is part of a randomized waitlist-controlled trial investigating the feasibility, acceptability and efficacy of a 5-week internet-based TF-CBT in German Armed Forces service members (Niemeyer et al, 2020 ). The study design is explained and illustrated in Table 1 .…”

“…Concerning the analyses in the context of the internet-based TF-CBT, all results that are presented in the manuscript are based on data of those PTSD patients with available PTSD symptoms, oxytocin and vasopressin data at pre-treatment, post-treatment and follow-up (complete cases, n = 16). This comparatively low number of cases is mainly due to the high dropout rate (as explained in Niemeyer et al, 2020). In order to test the robustness of our results, descriptive and correlational analyses were also conducted in all cases with available data in the respective parameter per assessment (n = 17-37).…”

Associations Between Difficulties in Emotion Regulation and Post-Traumatic Stress Disorder in Deployed Service Members of the German Armed Forces

“…Participants without deployment and those with incomplete CAPS-5 scores were excluded. Accordingly, n = 39 treatment-seeking GAF service members and n = 33 GAF service members from the control group of the original RCT ( 60 ) were pooled ( n = 72) and subsequently allocated to either the PTSD or the non-PTSD group according to their CAPS-5 PTSD diagnosis. Ultimately, a total of n = 25 participants fulfilled the PTSD criteria (PTSD group), while n = 47 participants experienced a traumatic event but did not fulfill the PTSD criteria (non-PTSD group).…”

“…The time since deployment varied between six weeks and 26 years ( M = 7.0, SD = 5.4) and did not differ significantly between groups [ U ( N PTSD = 20, N non-PTSD = 45) = 320.0, z = −1.848, p = 0.065]. A detailed description of the procedure of the initial study is available elsewhere ( 60 ).The traumatic events experienced by both groups were measured with the Life Events Checklist for DSM-5 ( 61 ). As shown in Table 3 , the frequencies of traumatic events did not differ significantly between groups.…”