Internet-based PTSD Therapy May Help Overcome Barriers to Care
• Science Update
NIMH-funded researchers recently completed a pilot study showing that an Internet-based, self-managed cognitive behavioral therapy (CBT) can help reduce symptoms of post-traumatic stress disorder (PTSD) and depression, with effects that last after treatment has ended. This study supports further development of PTSD therapies that focus on self-management and innovative methods of providing care to large numbers of people who do not have access to mental health care or who may be reluctant to seek care due to stigma. The researchers published their study in the November 2007 issue of the American Journal of Psychiatry.
Brett Litz, Ph.D., of the National Center for PTSD at the VA Boston Healthcare System and Boston University, and colleagues recruited service members from the Department of Defense who had developed PTSD following the September 11, 2001, attack on the Pentagon or from recent combat exposure. Forty-five participants first met with a therapist to determine their baseline PTSD and depression symptoms, and then were randomly assigned to one of two 8-week long, therapist-assisted, Internet-based treatments.
One treatment used strategies from CBT, which previous research has shown to be effective in relieving symptoms of PTSD. This CBT-based therapy aimed to first help participants identify situations that triggered their PTSD symptoms by working with a therapist and then improve their ability to manage those symptoms through on-line homework assignments. The other therapy, called supportive counseling, asked participants to monitor their own current, non-trauma-related problems, and then write about those experiences online. These participants also received periodic phone calls or emails from their therapist, who provided supportive but non-directed counseling. Participants in both groups were asked to log on daily to a Web site specific to their assigned treatment. After rating their PTSD and depression symptoms using a checklist, participants were allowed access to the Web site where they could find information about PTSD, stress, trauma, and other related health topics; communicate with their therapist; or complete treatment-specific activities.
After eight weeks of treatment, participants in both groups had fewer or less severe PTSD and depression symptoms, but those in CBT-based therapy showed greater improvements than those in supportive counseling therapy. Six months after their first meeting with a study therapist, participants who received CBT-based therapy showed continued improvements, while those in the supportive therapy group experienced an increase in PTSD and depression symptoms.
These findings suggest the CBT-based online therapy may be an efficient, effective, and low-cost method of providing PTSD treatment following a traumatic event to a large number of people. The researchers noted that fewer people completed the CBT-based therapy than the supportive counseling therapy. However, regardless of therapy group, the discontinuation rate among study participants was similar to the 30 percent discontinuation rate reported in studies of face-to-face treatment. Further study is needed to improve treatment use and completion and to test Internet-based PTSD therapies in a larger study population.
Litz BT, Engel CC, Bryant R, Papa A. A Randomized Controlled Proof-of-Concept Trial of an Internet-Based, Therapist-Assisted Self-Management Treatment for Posttraumatic Stress Disorder. Am J Psychiatry. 2007 Nov;164(11):1676-84.