Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth—a randomized controlled trial

Abstract

The aim of this study was to analyse the effects of trauma-focused guided Internet-based cognitive behaviour therapy for relieving posttraumatic stress disorder (PTSD) symptoms following childbirth, a problem that about 3% women encounter postpartum. Following inclusion, 56 traumatized women were randomized to either treatment or to a waiting list control group. Primary outcome measures were the Traumatic Event Scale (TES) and Impact of Event Scale-Reversed (IES-R). Secondary measures were Beck depression inventory II, Patient Health Questionnaire (PHQ-9), Beck Anxiety Inventory, Quality Of Life Inventory and the EuroQol 5 Dimensions. The treatment was guided by a clinician and lasted eight weeks and comprised eight modules of written text. The between-group effect size (ES) was d = .82 (p < .0001) for the IES-R. The ES for the TES was small (d = .36) and not statistically significant (p = .09). A small between-group ES (d = .20; p = .02) was found for the PHQ-9. The results from pre- to post-treatment showed large within-group ESs for PTSD symptoms in the treatment group both on the TES (d = 1.42) and the IES-R (d = 1.30), but smaller ESs in the control group from inclusion to after deferred treatment (TES, d = .80; IES-R d = .45). In both groups, the treatment had positive effects on comorbid depression and anxiety, and in the treatment group also on quality of life. The results need to be verified in larger trials. Further studies are also needed to examine long-term effects.

Therapist-Supported Internet-Based Cognitive Behavior Therapy for Stress, Anxiety, and Depressive Symptoms Among Postpartum Women: A Systematic Review and Meta-Analysis

“…All of the studies were conducted between 2011 [47] and 2016 [31], with 2016 having the highest number of publications (38%, 3/8) [28,29,31]. …”

“…The mean age of the participants in the studies ranged from 31 [33] to 35 years [29]. Participants were postpartum women with 3 different health conditions, namely, depressive symptoms (63%, 5/8) [28,30-33], post-traumatic stress symptoms (13%, 1/8) [29], and pregnancy loss (25%, 2/8) [46,47].…”

“…Participants were postpartum women with 3 different health conditions, namely, depressive symptoms (63%, 5/8) [28,30-33], post-traumatic stress symptoms (13%, 1/8) [29], and pregnancy loss (25%, 2/8) [46,47]. The sample sizes were between 43 [28] and 910 [32].…”

“…The sample sizes were between 43 [28] and 910 [32]. Comparators were waitlist treatment (50%, 4/8) [29,31,46,47], usual care (38%, 3/8) [28,30,32], and waitlist or usual care (13%, 1/8) [33]. Six of the studies (75%, 6/8) assessed more than one target outcome.…”

“…They expressed interest in use of Web-based resources and greater engagement in ehealth behaviors related to mental health [27]. An increasing number of randomized controlled trials (RCTs) found that iCBT is effective for stress [28,29], anxiety [30,31], and depressive symptoms [32,33] among postpartum women. Given the burgeoning development of iCBT for a broad range of conditions [8] paralleled by the rapid increase in access to instant cyber connectivity, what is the effect of therapist-supported iCBT in improving stress, anxiety, and depressive symptoms among postpartum women?…”