Evaluation of an Internet-based treatment of posttraumatic stress disorders (PTSD) and depression in Arabic-speaking countries: A randomized control trial

According to their symptoms, the participants will be assigned to the treatment of posttraumatic stress or depression after the screening. Treatment of Posttraumatic stress disorders: The treatment lasts five weeks. During that time-frame, participants write ten texts for approximately 45 minutes, twice a week (10 essays in total), whereas the participants decide when they want to write. Each time after having received two texts, the therapists provide feedback and further instructions, which are based upon the manual (compare to "Interapy" developed by Lange et al., 2003) and consider the patient´s specific needs. It is important to mention that all communication during the treatment occurs exclusively via E-mails. Before and after treatment (as well as 3 and 12 months later) the participants are asked to complete any questionnaires to gather information about health-related issues and individual well-being. The treatment of posttraumatic sress disorder can be divided into three phases. First phase - self-confrontation (4 essays) At the beginning the participants receive psychoeducation about the mechanisms of exposure before writing four essays about their emotionally most painful memories. In the meantime they receive feedback and support by their individual therapists. Second phase – cognitive restructuring (4 essays) First of all there is again psychoeducation about the principles of cognitive restructuring. Again the particpants write four texts, however, this time they go beyond mere descriptions and use their experiences to write a supportive letter to an imaginary friend who had been through the same experience. Thus, the victim turns into an adviser. Third phase - parting (2 essays) In the third phase, two texts are written in the form of a letter to document the past in a worthy document. Psychoeducation about the positive effects of social sharing is provided as well. Treatment of Depression: The treatment lasts six weeks and can be compared to the PTSD-Treatment concerning the basic conditions. The participants write as well texts for approximately 45 minutes, twice a week (11 essays in total), whereas the participants decide when they want to write. Each time after having received two texts, the therapists provide feedback and further instructions, which are based upon the manual (compare to "Interapy" developed by Lange et al., 2003) and consider the patient´s specific needs. It is important to mention that all communication during the treatment occurs exclusively via E-mails. Before and after treatment (as well as 3 and 12 months later) the participants are asked to complete any questionnaires to gather information about health-related issues and individual well-being. The treatment of depression can be divided into five steps: First of all the participants are asked whether there are special situations that cause depressive symptoms in particular and if there are any factors promoting them (step 1: behavior analysis; 3 essays). Afterwards there should be established a new daily structure, especially by planning positive activities (step 2: building up positive activities; 2 essays including homework). Furthermore depressive clients frequently suffering from negative thoughts and in the next step they are asked to evaluate things in a different way (step 3: cognitive restructuring; 3 essays). In addition to that the treatment focusses on social interaction (step 4; 2 essays including homework and exercises). Because depressive clients have difficulty establishing new contacts, setting limits or saying "no", the participants are asked to do any homework and practice these things. At the end the focus will be on the main results of the treatment, what the clients have learned and how to use this to prevent depression prospectively (step 5: relapse prevention; 1 essay). Psychoeducation is also provided during the whole treatment.