A Therapist‐Assisted Internet‐Based CBT Intervention for Posttraumatic Stress Disorder: Preliminary Results

Faculty of Life and Social Sciences, National eTherapy Centre, Swinburne University, Hawthorn, Victoria 3122, Australia.
Cognitive behaviour therapy 06/2009; 38(2):121-31. DOI: 10.1080/16506070902803483
Source: PubMed


Posttraumatic stress disorder (PTSD) is a debilitating mental health condition frequently associated with psychiatric comorbidity and diminished quality of life, and it typically follows a chronic, often lifelong, course. Previous research has shown that trauma-related psychopathology (but not necessarily clinical PTSD) can be effectively treated via the Internet. This study is the first of its kind to report on the online treatment of patients with a Diagnostic and Statistical Manual of Mental Disorders (fourth edition) clinical diagnosis of PTSD with therapist support by e-mail only. Preliminary findings are presented of an open trial involving a 10-week Internet-based therapist-assisted cognitive behavioural treatment for PTSD (PTSD Online). Pre and posttreatment measures of PTSD and related symptomatology were compared for 16 participants with a variety of trauma experiences. Participants showed clinically significant reductions in PTSD severity and symptomatology, moderate tolerance of the program content, and high therapeutic alliance ratings. No significant change was found on measures of more general psychological symptoms. The results suggest that PTSD Online appears to be an effective and accessible clinical treatment for people with a confirmed PTSD diagnosis.

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    • "The results indicated a clinical reduction of PTSD symptoms, and high ratings of therapeutic alliance, but there were no effects on other more general psychological problems (Klein et al., 2009). The most recent controlled study conducted within this field, is that of Spence et al. (2011) who included individuals with an established primary diagnosis of PTSD. "
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    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 Cohen's 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.
    Full-text · Article · Mar 2014 · Internet Interventions
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    • "The results of a recent review indicated that a positive alliance can be formed over the Internet (Sucala et al., 2012). High alliance ratings were reported for online interventions regarding posttraumatic stress disorder (PTSD; Knaevelsrud and Maercker, 2006; Knaevelsrud and Maercker, 2007; Wagner et al., 2012; Klein et al., 2009a), depression (Andersson et al., 2012; Preschl et al., 2011; Ruwaard et al., 2009), anxiety disorders (Kiropoulos et al., 2008; Andersson et al., 2012; Klein et al., 2009b; Bergman Nordgren et al., 2013), and recurrent headache (Trautmann and Kröner-Herwig, 2010). Furthermore, there is evidence that the strength of the therapeutic alliance in online and face-to-face therapy is comparable (Sucala et al., 2012). "
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    ABSTRACT: Objective This study (ID: NCT01205906) compared the impact of the working alliance between the therapist and the client on treatment outcome in a group and an Internet-based cognitive behavior therapy (GCBT vs. ICBT) for chronic tinnitus. Methods The Working Alliance Inventory — Short Revised (WAI-SR, scale range: 1–5) was administered to 26 GCBT and 38 ICBT participants after treatment weeks 2, 5, and 9, and the Tinnitus Handicap Inventory (THI) before and after the treatment. Results High alliance ratings were found in both ICBT (WAI-SR total scores at week 9: M = 3.59, SD = 0.72) and GCBT (WAI-SR total scores at week 9: M = 4.20, SD = 0.49), but significantly higher ratings occurred in GCBT on most WAI-SR scales (ps < .01). Significant time × group interactions for most WAI-SR scales indicated differences in alliance growth patterns between the treatments (ps < .001). Residual gain scores for the therapy outcome measure ‘tinnitus distress’ were significantly correlated with the agreement on treatment tasks between therapist and client in ICBT (r = .40, p = .014) and with the affective therapeutic bond in GCBT (r = .40, p = .043) at mid-treatment (week 5). Conclusion More time was needed to build a strong alliance in ICBT although GCBT yielded generally higher alliance ratings. Moreover, different aspects of the therapeutic alliance might be important for treatment success in ICBT versus GCBT.
    Full-text · Article · Jan 2014
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    • "Klein et al. (2009, (2010) have evaluated a 10-week Internet intervention that is delivered entirely online with email support from a psychologist. The intervention includes education, anxiety management instruction, cognitive restructuring, and imaginal and in vivo exposure. "
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    ABSTRACT: Internet-facilitated interventions may offer numerous advantages in reaching the large numbers of military service men and women exposed to traumatic events. The Internet is now a primary source of health-related information for consumers and research has shown the effectiveness of web-based interventions in addressing a range of mental health problems. Clinicians can learn how to bring Internet education and intervention into routine care, to help clients better understand mental health issues and learn skills for self-management of problems. The (AD) Internet site can be used by health care professionals serving U.S. military personnel returning from Iraq and Afghanistan, and their families. The site currently addresses 18 key domains of functioning, including post-traumatic stress, sleep, anger, alcohol and drugs, and military sexual trauma. It provides an extensive amount of client and family education that is suitable for immediate use by clients and providers, as well as the kinds of interactive workshop content and self-assessment tools that have been shown to be helpful in other treatment contexts. AD CAN BE UTILIZED IN CLINICAL PRACTICE IN A VARIETY OF WAYS: as an adjunct to treatment for PTSD, to supplement existing treatments for a range of post-deployment problems, or as the primary focus of treatment for a client. AD represents a kind of service that is likely to become increasingly available in coming years and that is important for mental health providers to actively explore as a tool for extending their reach, improving their efficiency, and improving quality of care.
    Full-text · Article · Nov 2011 · European Journal of Psychotraumatology
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