BN 64_Internet-based Cognitive Behavioral

Internet-based Cognitive Behavioral
Therapy for Adults with Post Traumatic
Stress Disorder: A Systematic Review
Post traumatic stress disorder
(PTSD) results from exposure to a
traumatic event that poses actual or
threatened death or injury and
produces intense fear, helplessness,
or horror. Dissemination and
effective delivery of short-term,
evidence-based treatments for PTSD
is an urgent priority to address this
growing public health problem and
to prevent the development of costly
chronic mental health disorders.
Recent findings suggest that CBTbased online therapy may be an
effective method of providing PTSD
Julie Fricke
Brunel University, London
Olu Onyimadu
Brunel University, London
David Humphreys
University of Oxford
Catherine Meads
Brunel University, London
9 RCTs were included (n=626), and six were meta-analysed (n=501). A separate analysis was conducted for each of the
subscales of the IES-R to obtain the average mean differences (intrusion (n=501, -6.4 [-8.5-4.2]), avoidance (n=501, -7.0
[-9.4-4.7]), and hyper-arousal (n=389, -4.7 [-6.1-3.3]). Sizeable reductions of symptoms in the experimental group were
found (including secondary outcomes, such as depression, mood, anxiety, and overall mental and physical health).
Analysis 1.1: Internet-based CBT for PTSD - Intrusion
Analysis 1.2: Internet-based CBT for PTSD - Avoidance
To systematically review the
effectiveness of internet-based
cognitive behavioral therapy
(CBT) interventions for adults with
Analysis 1.3: Internet-based CBT for PTSD - Hyper-Arousal
•  A systematic search for relevant
studies was conducted through 9
databases between February and
March 2015 – e.g Cochrane,
Campbell, Medline, Embase, Web of
Science (Science Citation Index)
•  Inclusion criteria were an internetbased CBT intervention (RCT) for
adults with PTSD with a primary
outcome of decreasing or improving
post traumatic stress symptoms.
Comparators were no intervention
(e.g. wait-list control) or therapistassisted internet-based CBT versus
therapist alone
•  Studies were excluded if they
compared specific variations of CBT
treatment (e.g. exposure vs. nonexposure CBT), if participants were
clinically diagnosed with other
personality or mental health
disorders, abused drugs or alcohol, or
had suicidal intentions
•  The Cochrane risk of bias tool was
used to assess bias and the RevMan
software to conduct meta-analyses
Evidence Live Oxford, April 2015
All included studies reported a high level of
clinically relevant change in experimental group
vs. control group: participants had either changed
diagnostic category or no longer met any PTSD
criteria altogether
•  More empirical studies to further substantiate
•  More diverse trial locations (e.g. low socioeconomic status) to see if it affects change
•  Trials that include an equal number of men
and women
•  An attempt to standardize PTSD treatment
(helps adaptations and scale-ups)
•  Research on whether or not treatment should
differ between trauma type
•  Translate programmes to different languages;
international options
Web-based cognitive behavioral therapy seems
to be a promising and innovative treatment for
reducing the severity and frequency of PTSD
symptoms, but because of the lack of clinical
trials, more need to be conducted to
substantiate effectiveness
•  A lack of published research / available RCTs
•  Heterogeneity; various components
•  Small sample sizes; generalizability and power
•  Unclear outcome assessment bias; reporting bias
•  Primarily self-report outcome measures
•  Implementation fidelity is not addressed – Result
of intervention? What works?
•  Missing data; intention-to-treat; drop-outs
•  Modern limitations: user engagement, digital
Contact: [email protected]