Internet-delivered cognitive therapy for PTSD: a development pilot series

Abstract

BackgroundRandomised controlled trials have established that face-to-face cognitive therapy for posttraumatic stress disorder (CT-PTSD) based on Ehlers and Clark's cognitive model of PTSD is highly effective and feasible with low rates of dropout. Access to evidence-based psychological treatments for PTSD is insufficient. Several studies have shown that therapist-assisted treatment delivery over the Internet is a promising way of improving access to cognitive behavioural therapy interventions.ObjectiveTo develop an Internet version of CT-PTSD that significantly reduces therapist contact time without compromising treatment integrity or retention rates.MethodsWe describe the development of an Internet version of CT-PTSD. It implements all the key procedures of face-to-face CT-PTSD, including techniques that focus on the trauma memory, such as memory updating, stimulus discrimination and revisiting the trauma site, as well as restructuring individually relevant appraisals relating to overgeneralisation of danger, guilt, shame or anger, behavioural experiments and planning activities to reclaim quality of life. A cohort of 10 patients meeting DSM-IV criteria for PTSD worked through the programme, with remote guidance from a therapist, and they were assessed at pre- and post-treatment on PTSD outcome, mood, work and social adjustment and process measures.ResultsNo patients dropped out. Therapists facilitated the treatment with 192 min of contact time per patient, plus 57 min for reviewing the patient's progress and messages. Internet-delivered CT-PTSD was associated with very large improvements on all outcome and process measures, with 80% of patients achieving clinically significant change and remission from PTSD.ConclusionsInternet-delivered cognitive therapy for PTSD (iCT-PTSD) appears to be an acceptable and efficacious treatment. Therapist time was reduced to less than 25% of time in face-to-face CT-PTSD. Randomised controlled trials are required to evaluate systematically the acceptability and efficacy of iCT-PTSD.Highlights of the articleiCT-PTSD was acceptable to patients and associated with very large improvements on PTSD outcome and process measures.iCT-PTSD required substantially less therapist time than CT-PTSD.iCT-PTSD may be associated with changes in employment status.Randomised controlled trials are required to systematically evaluate the acceptability and efficacy of iCT-PTSD.

A decennial review of psychotraumatology: what did we learn and where are we going?

“…(Cernvall, Sveen, Bergh Johannesson, & Arnberg, 2018;Ruzek et al, 2011). Over the past 10 years researchers have been increasingly exploring the delivery of therapy via the internet (Wild et al, 2016). Researchers have begun to demonstrate the feasibility and acceptability of delivering established treatments online (Simon et al, 2019;Wild et al, 2016) and via Skype (Ashwick, Turgoose, & Murphy, 2019).…”

“…Over the past 10 years researchers have been increasingly exploring the delivery of therapy via the internet (Wild et al, 2016). Researchers have begun to demonstrate the feasibility and acceptability of delivering established treatments online (Simon et al, 2019;Wild et al, 2016) and via Skype (Ashwick, Turgoose, & Murphy, 2019). Several studies are also underway to explore the possible efficacy of new technologies such as internetbased virtual reality (Freedman, Dayan, Kimelman, Weissman, & Eitan, 2015), digital reappraisal training (Beer, Neerincx, Morina, & Brinkman, 2017) and novel game-based interventions (Asselbergs et al, 2018) as early interventions.…”

The Impact of Digital Technology on Psychological Treatments and Their Dissemination

“…More attention is being given to their appearance, appeal and ease of navigation, and the interventions may include features such as learning exercises, self-monitoring tools, progress reports, downloadable documents, audio-and video-files, audio-and video-feedback, avatars, quizzes and games. Examples of multifaceted and technologically sophisticated interventions are recent ones for social anxiety disorder (Stott et al, 2013) and post-traumatic disorder (Wild et al, 2016). A few interventions have been delivered entirely in the form of a game (Merry et al, 2012), a modality that may especially suit younger users and is attracting considerable interest.…”

“…This role requires that the clinician be intimately familiar with the digital intervention and the treatment upon which it is based. Preliminary evidence suggests that supervised digital treatment may dramatically reduce the amount of clinician time needed without sacrificing effectiveness (Stott et al, 2013;Wild et al, 2016).…”

Back to Basics: Integrating Clinical and Scientific Knowledge to Advance the Field of Trauma—Highlights of the ISTSS-2015

“…She described how systematic observations of re-experiencing in PTSD led to hypotheses about possible cognitive mechanisms that may explain core characteristics of these symptoms and their persistence, and how trauma-focused CBT addresses these mechanisms. In her contribution in this special issue, Anke Ehlers and colleagues describe a promising series of pilot studies on Internet-delivered versions of cognitive therapy for PTSD (Wild et al, 2016). The third keynote speaker, Regina Sullivan, treated us with a comprehensive overview of her fascinating work in rodents on the regulation of the infant brain by a caretaker to alter behavior and facilitate attachment to the caregiver.…”