Guided Self-Help using Cognitive Processing Therapy for Posttraumatic Stress Disorder: A Randomized Controlled Trial

My study will test an online version of guided self-help cognitive processing therapy (from here on labelled CPT-GSH) with modest therapist input for monitoring and support for treating posttraumatic stress disorder in adults. This will be the first study to assess the CPT-GSH in a stepped care model. The participants who meet the eligibility criteria will be randomly allocated to either a standard CPT or stepped care (CPT-GSH) group. Standard CPT: CPT is an evidence-based treatment for PTSD. It helps clients to challenge and modify their distressing thoughts relating to the traumatic event. CPT session begins with psychoeducation about PTSD symptoms and overall treatment goals. In the subsequent sessions, the participant will be taught to identify stuck points related to their thoughts and feelings and complete worksheets weekly. In addition, the therapist will also focus on specific topics such as safety, trust, power or control, esteem, and intimacy which are drastically affected for a trauma survivor. Typically, standard CPT comprises of 60-min weekly session which could be tailored to 8 to 18 sessions based on participant’s progress, which is determined by the therapist and client (taking into account consultation with the supervisor). In this study, CPT will be delivered one-on-one via video call. All therapy sessions will be videotaped for the purpose of the study. Stepped care : In the stepped care condition, participants will be enrolled into CPT-GSH and can be stepped up to a standard CPT. CPT-GSH is an adapted and modified version of self-help manual created by Resick et al. (in prep). CPT-GSH follows the same protocol of standard CPT (including the content) mentioned above except that the therapist input will be minimal. Participants will be required to read one module every week (for up to 12 sessions) sent by the study team and complete worksheets (e.g. challenging thoughts, challenging beliefs, problematic thinking worksheets, etc.) on their own. Approximately, participants need to spend about an hour to complete their modules. If participants show significant improvement in their PTSD scores, then two modules will be sent weekly. Completed assignments will be sent back to the therapist for review. Therapists will engage with clients for a maximum of 15 minutes weekly to provide support and feedback to monitor adherence and maintain their engagement in therapy. Participants can be stepped up to a standard CPT if a) there is minimal improvement; b) they are at risk of dropout; c) they demonstrate lack of engagement early in therapy; d) they show significant increase in symptom manifestation that requires more intensive therapy. Decision to be stepped up is determined by the therapist and client (after consultation with the supervisor). All therapy sessions in both groups will be conducted by registered/ provisional psychologists. The total number of sessions in both groups is flexible based on participants’ progress in the study, although it is capped at 18 sessions. Once the participants conclude the therapy, they will complete the post-treatment questionnaires two weeks after completion of the study . They will be assessed again in 3 months using the follow-up assessment batteries. Although subject to further funding, participants will be asked (in the Information and Consent forms) if they are willing to participate in 6 month- and 1-year follow-ups should funding/further resources become available