STOP-PTSD
Research type
Research Study
Full title
A randomised controlled clinical trial of therapist-assisted online psychological therapies for post-traumatic stress disorder (STOP-PTSD)
IRAS ID
224759
Contact name
Anke Ehlers
Contact email
Sponsor organisation
University of Oxford
ISRCTN Number
ISRCTN16806208
Duration of Study in the UK
3 years, 11 months, 30 days
Research summary
Summary of Research
Posttraumatic stress disorder (PTSD) is a common and disabling disorder. Over the last two decades, significant advances in the understanding and treatment of PTSD have been made, and several versions of cognitive behavioural therapies have been shown to be effective. NICE (2005) currently recommends face-to-face trauma-focused cognitive behavioural therapies such as cognitive therapy as first-line treatments for PTSD, but a recent Cochrane review of psychological therapies for PTSD suggested that nontrauma-focused cognitive behavioural therapies such as stress management may achieve similar outcomes, at least in the short-term.Despite these advances, many people with PTSD are currently unable to access psychological treatments due to a range of factors, such as shortage of therapists, living too far away from treatment centres, or being unable to attend therapy during usual working hours. Given the large number of people suffering from PTSD, it is therefore desirable to develop more efficient forms of treatment delivery that can be widely accessed. There is some evidence that therapist-assisted online psychological treatments are effective in PTSD and may be a promising alternative to face-to-face therapy, however, further studies are needed to investigate which online treatments work best.
The present study will compare a trauma-focused (internet-delivered Cognitive Therapy for PTSD, iCT-PTSD) and a nontrauma-focused therapist-assisted online psychological therapy (internet-based stress management therapy, iStress-PTSD). Both treatments will be compared with a waitlist to control for the natural recovery that is sometimes seen in PTSD samples.
Adult patients with PTSD (N = 175) will be randomly allocated to iCT-PTSD, iStress-PTSD or a 13-week wait list. Symptoms of PTSD, depression, anxiety, disability, sleep problems and health economic measures will be assessed at regular intervals over 15 months. The study will also investigate psychological mechanisms of change in the treatment groups.
Summary of Results
Post-traumatic stress disorder (PTSD) is caused by very stressful, frightening or distressing events. Research shows that PTSD can be treated effectively with psychological treatments. However, many patients with PTSD are currently unable to access effective psychological treatments for a range of reasons, such as shortage of therapists, living too far away from treatment centres, or being unable to attend therapy during usual working hours. Given the large number of people suffering from PTSD, it is desirable to develop more efficient forms of treatment delivery that can be widely accessed, and online treatment delivery appears to be a promising alternative to face-to-face therapy. There is already some evidence that therapist-assisted online psychological treatments are effective in PTSD.
The aim of this study was to compare two forms of therapist-supported internet-based psychological therapy for PTSD. The online therapies are based on effective face-to-face therapies (cognitive therapy, stress management therapy). Both treatments are compared with a 3-month wait-list to control for the natural recovery that is sometimes seen in PTSD.
Participants were 217 people with PTSD following a wide range of traumas in adolescence or adulthood. Both treatments were effective and led to much larger improvement than occurred during the wait-list. Both treatments were well accepted by participants (with low drop-out rates below 10%) and high satisfaction with treatment. Participants reported that they highly valued the support of their therapist, The cognitive therapy internet-based treatment led to greater improvement in PTSD symptoms, symptoms of depression and anxiety, quality of life, but not sleep problems. The advantages in outcome for the cognitive therapy condition were greater for participants with high dissociation (feelings of unreality or depersonalisation) or complex PTSD symptoms (problems with emotion regulation and maintaining interpersonal relationships, seeing the self as diminished, defeated or worthless). Both treatments worked by changing negative meanings of the trauma (about the self, other people and the world), unhelpful ways of coping, and flashback memories. No serious adverse events were reported.REC name
West Midlands - Black Country Research Ethics Committee
REC reference
17/WM/0441
Date of REC Opinion
4 Jan 2018
REC opinion
Further Information Favourable Opinion