None listed
Conditions
Brief summary
Background: The present study is designed to validate the efficacy of an Internet-based therapy (Interapy) for Posttraumatic Stress Disorder (PTSD) in a German speaking population. Also, the quality of the online therapeutic relationship, its development and its relevance as potential moderator of the treatment effects was investigated. Method: Ninety-six patients with posttraumatic stress reactions were allocated at random to ten sessions of Internet-based cognitive behavioral therapy (CBT) conducted over a 5-week period or a wait list control group. Severity of PTSD was the primary outcome. Additional measures were depression, anxiety, dissociation and physical health. Follow-up assessments were conducted at the end of treatment and 3 month after treatment. Results: From baseline to post-treatment assessment, PTSD severity and other psychopathological symptoms were significantly improved for the treatment group (intent-to-treat group x time interaction effect size d= 1.40). Additionally, patients of the treatment condition showed significantly greater reduction in co-morbid depression and anxiety as compared to the wait list condition. These effects were sustained during the 3-month follow-up period. High ratings of the therapeutic alliance and low drop-out rates indicated that a positive and stable therapeutic relationship could be established online. Significant improvement of the online working alliance in the course of treatment and a substantial association between the quality of the online relationship at the end of treatment and treatment outcome emerged. Conclusion: Interapy proved to be a viable treatment alternative for PTSD with large effect sizes and time stable treatment effects. A stable and positive online therapeutic relationship can be established through the Internet which improved during the treatment process.
Interventions
10-sessionof 45 minutes (1 week assessment & 5 weeks treatment) cognitive-behavioral internet-based treatment for posttraumatic stress versus wait list control group.
The treatment consisted of three phases: 1) self-confrontation, 2) cognitive reconstruction, and 3) social sharing. In the first phase, patients focused on the most painful images and thoughts and described them in all emotional and sensory detail. The goal of the second phase was to form a new perspective on the traumatic event a
10-sessionof 45 minutes (1 week assessment & 5 weeks treatment) cognitive-behavioral internet-based treatment for posttraumatic stress versus wait list control group. The treatment consisted of three phases: 1) self-confrontation, 2) cognitive reconstruction, and 3) social sharing. In the first phase, patients focused on the most painful images and thoughts and described them in all emotional and sensory detail. The goal of the second phase was to form a new perspective on the traumatic event and to regain a sense of control by challenge dysfunctional automatic thinking and behavior patterns, and correct unrealistic assumptions. During the third phase, patients received psycho-education about the positive effects of social sharing. In a final letter, they then took symbolic leave of the traumatic event. At the beginning of each writing phase, patients proposed individual timetables as to when they planned to write. Halfway through and at the end of each treatment phase, patients received feedback and further writing instructions, which were based on the treatment manual but tailored to patients’ specific needs.
Sponsors
Prof. Dr. Dr. Andreas Maercker, University of Zurich
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Traumatic event according to the DSM IV (Diagnostic & Statistical Manual of Mental Disorders. The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is a handbook used frequently in diagnosing mental disorders.)- Posttraumatic stress symptoms- fluent in German.
Exclusion criteria
Pronounced dissociative tendenicies- risk of psychosis- severely depressed mood- suicidal intentions- substance abuse- currently receiving psychotherapeutic treatment elsewhere.
Outcome results
None listed