Guided internet-delivered cognitive behavior therapy for post-traumatic stress disorder: A randomized controlled trial

Abstract

The aim of this randomized controlled trial was to investigate the effects of guided internet-based cognitive behavior therapy (ICBT) for posttraumatic stress disorder (PTSD). Sixty-two participants with chronic PTSD, as assessed by the Clinician-administered PTSD Scale, were recruited via nationwide advertising and randomized to either treatment (n= 31) or delayed treatment attention control (n= 31). The ICBT treatment consisted of 8 weekly text-based modules containing psychoeducation, breathing retraining, imaginal and in vivo exposure, cognitive restructuring, and relapse prevention. Therapist support and feedback on homework assignment were given weekly via an online contact handling system. Assessments were made at baseline, post-treatment, and at 1-year follow-up. Main outcome measures were the Impact of Events Scale - Revised (IES-R) and the Posttraumatic Stress Diagnostic Scale (PDS). Results showed significant reductions of PTSD symptoms (between group effect on the IES-R Cohens d= 1.25, and d= 1.24 for the PDS) compared to the control group. There were also effects on depression symptoms, anxiety symptoms, and quality of life. The results at one-year follow-up showed that treatment gains were maintained. In sum, these results suggest that ICBT with therapist support can reduce PTSD symptoms significantly. © 2014 The Authors

Internet-based guided self-help for posttraumatic stress disorder (PTSD): Randomized controlled trial

“…Dropout rates from the study were comparable to previous trials of internet-based guided self-help for PTSD (Spence 2011, Ivarsson, Blom et al 2014) and other mental disorders (Spek, Cuijpers et al 2007). They were also of a similar magnitude to dropout from therapist-administered therapy ).…”

“…In agreement with the findings of recent meta-analyses of internet-based self-help for PTSD, the intervention was found to be effective in comparison to waitlist (Kuester, Niemeyer et al 2016, Sijbrandij, Kunovski et al 2016, with the magnitude of effect lying at the higher end of the effect sizes reported by these reviews. The effect size was larger than that reported previously for internet-based CBT for clinical populations of PTSD sufferers (Spence 2011, Ivarsson, Blom et al 2014), which may be influenced by the fact that the intervention was systematically developed through an iterative process of modelling and pilot testing intended to create an optimally effective programme . The programme had a greater trauma-focus and emphasis on imaginal exposure work via writing and reading a narrative, than other internet-based CBT programmes for PTSD.…”

“…The first found a large within-group effect size in the treatment group from pre to post treatment, but a smaller between-groups effect size was found, due to symptom improvement in the control group (Spence 2011). The second RCT compared internet-based guided self-help to delayed treatment minimal attention and a larger between-group effect-size was found (Ivarsson, Blom et al 2014). …”

Clinical aspects of childbirth-related anxiety

“…The components were inspired and partly derived from previous Internet interventions for PTSD (Ivarsson et al 2014), based on prolonged exposure (Foa Frances & Davidson 1999) in combination with ideas from narrative exposure (Robjant & Fazel 2010). During a period of four weeks between the beginning of February and the beginning of March 2014, 56 women were self-recruited directly on the project-specific website (laura.iterapi.se).…”

“…We developed and tested a trauma-focused ICBT program focusing on childbirth as the traumatic event. The modules were built on evidence-based principles from trauma-focused CBT therapies (Foa, Frances & Davidson 1999;Robjant & Fazel 2010) and inspired and partly derived from previous ICBT projects for treatment of PTSD (Ivarsson et al 2014). …”