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

Guided internet-delivered cognitive behavior therapy for post-traumatic stress disorder: a b s t r a c t a r t i c l e i n f o Keywords: PTSD Treatment Cognitive behavior therapy Internet-based treatment Self-help Randomized controlled trial 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 Post-traumatic 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. Lifetime prevalence of posttraumatic stress disorder (PTSD) in the general population has been estimated to range from 5.6% to 8.3% (Frans et al., 2005; Kessler et al., 1995), indicating that PTSD is a common problem after experiencing traumatic events. While there are effective treatments for PTSD, like cognitive behavior therapy (CBT; Bisson et al., 2007), a substantial proportion of individuals with PTSD do not seek professional help or do not have access to effective help (Gavrilovic et al., 2005). Internet-based CBT (ICBT) could be a possible way to increase access to psychological treatment for a review see Amstadter et al., 2009). There is also a related literature on the broader concept of telehealth interventions (Sloan et al., 2011). Lange et al. from The Netherlands were probably the first to develop and test a therapist-guided internet-based treatment protocol for PTSD symptoms in controlled studies (Lange et al., 2001, 2003). They named their protocol Interapy, and the program has since then been translated and tested in studies conducted in …