C Lewis1, N P Roberts1,2, N Simon1, A Bethell3, J I Bisson1. 1. Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK. 2. Directorate of Psychology and Psychological Therapies, Cardiff & Vale University Health Board, Cardiff, UK. 3. Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.
Abstract
OBJECTIVE: To determine whether Internet-delivered cognitive behavioural therapy (i-CBT) is an effective treatment for those who meet diagnostic criteria for post-traumatic stress disorder (PTSD). METHOD: A systematic review was undertaken according to Cochrane Collaboration Guidelines. The primary outcome measures were reduction in PTSD symptoms and drop-out. Categorical outcomes were meta-analysed as risk ratios (RRs) and continuous outcomes as mean differences (MDs) or standardised mean differences (SMDs). RESULTS: Ten studies with 720 participants were included. Evidence showed that i-CBT may be associated with a clinically important reduction in post-treatment PTSD symptoms compared with wait list (SMD -0.60, 95% confidence interval -0.97 to -0.24; N = 560); however, only three studies reported follow-up data, and there was no evidence to support the maintenance of symptom improvement at follow-up of 3-6 months. There was no evidence of a difference in PTSD symptoms between i-CBT and Internet-delivered non-CBT post-treatment. There was evidence of greater treatment effect from trauma-focused i-CBT than i-CBT without a trauma focus, as well as evidence that treatment effect was increased by the provision of guidance. CONCLUSIONS: While the review found some beneficial effects of i-CBT for PTSD post-treatment, the quality of the evidence was very low because of the small number of included trials and there was insufficient evidence to support the maintenance of improvement at follow-up of 3-6 months. Further work is required to establish non-inferiority to current first-line interventions; to determine long-term efficacy; to explore mechanisms of effect; and to establish optimal levels of guidance.
OBJECTIVE: To determine whether Internet-delivered cognitive behavioural therapy (i-CBT) is an effective treatment for those who meet diagnostic criteria for post-traumatic stress disorder (PTSD). METHOD: A systematic review was undertaken according to Cochrane Collaboration Guidelines. The primary outcome measures were reduction in PTSD symptoms and drop-out. Categorical outcomes were meta-analysed as risk ratios (RRs) and continuous outcomes as mean differences (MDs) or standardised mean differences (SMDs). RESULTS: Ten studies with 720 participants were included. Evidence showed that i-CBT may be associated with a clinically important reduction in post-treatment PTSD symptoms compared with wait list (SMD -0.60, 95% confidence interval -0.97 to -0.24; N = 560); however, only three studies reported follow-up data, and there was no evidence to support the maintenance of symptom improvement at follow-up of 3-6 months. There was no evidence of a difference in PTSD symptoms between i-CBT and Internet-delivered non-CBT post-treatment. There was evidence of greater treatment effect from trauma-focused i-CBT than i-CBT without a trauma focus, as well as evidence that treatment effect was increased by the provision of guidance. CONCLUSIONS: While the review found some beneficial effects of i-CBT for PTSD post-treatment, the quality of the evidence was very low because of the small number of included trials and there was insufficient evidence to support the maintenance of improvement at follow-up of 3-6 months. Further work is required to establish non-inferiority to current first-line interventions; to determine long-term efficacy; to explore mechanisms of effect; and to establish optimal levels of guidance.
Authors: Jonathan I Bisson; Cono Ariti; Katherine Cullen; Neil Kitchiner; Catrin Lewis; Neil P Roberts; Natalie Simon; Kim Smallman; Katy Addison; Vicky Bell; Lucy Brookes-Howell; Sarah Cosgrove; Anke Ehlers; Deborah Fitzsimmons; Paula Foscarini-Craggs; Shaun R S Harris; Mark Kelson; Karina Lovell; Maureen McKenna; Rachel McNamara; Claire Nollett; Tim Pickles; Rhys Williams-Thomas Journal: BMJ Date: 2022-06-16
Authors: Leslie A Morland; Stephanie Y Wells; Lisa H Glassman; Carolyn J Greene; Julia E Hoffman; Craig S Rosen Journal: Curr Treat Options Psychiatry Date: 2020-05-30
Authors: Christian Rauschenberg; Anita Schick; Dusan Hirjak; Andreas Seidler; Isabell Paetzold; Christian Apfelbacher; Steffi G Riedel-Heller; Ulrich Reininghaus Journal: J Med Internet Res Date: 2021-03-10 Impact factor: 5.428