Lewis Catrin E, Farewell Daniel, Groves Vicky, Kitchiner Neil J, Roberts Neil P, Vick Tracey, Bisson Jonathan I
Cardiff University, Cardiff, UK.
Cardiff and Vale University Health Board, Cardiff, UK.
Depress Anxiety. 2017 Jun;34(6):555-565. doi: 10.1002/da.22645. Epub 2017 May 29.
There are numerous barriers that limit access to evidence-based treatment for posttraumatic stress disorder (PTSD). Internet-based guided self-help is a treatment option that may help widen access to effective intervention, but the approach has not been sufficiently explored for the treatment of PTSD.
Forty two adults with DSM-5 PTSD of mild to moderate severity were randomly allocated to internet-based self-help with up to 3 h of therapist assistance, or to a delayed treatment control group. The internet-based program included eight modules that focused on psychoeducation, grounding, relaxation, behavioural activation, real-life and imaginal exposure, cognitive therapy, and relapse prevention. The primary outcome measure was reduction in clinician-rated traumatic stress symptoms using the clinician administered PTSD scale for DSM-V (CAPS-5). Secondary outcomes were self-reported PTSD symptoms, depression, anxiety, alcohol use, perceived social support, and functional impairment.
Posttreatment, the internet-based guided self-help group had significantly lower clinician assessed PTSD symptoms than the delayed treatment control group (between-group effect size Cohen's d = 1.86). The difference was maintained at 1-month follow-up and dissipated once both groups had received treatment. Similar patterns of difference between the two groups were found for depression, anxiety, and functional impairment. The average contact with treating clinicians was 2½ h.
Internet-based trauma-focused guided self-help for PTSD is a promising treatment option that requires far less therapist time than current first line face-to-face psychological therapy.
存在众多障碍限制了创伤后应激障碍（PTSD）患者获得循证治疗。基于互联网的引导式自助是一种治疗选择，可能有助于扩大有效干预的可及性，但该方法在PTSD治疗中的应用尚未得到充分探索。
42名患有轻度至中度严重程度的DSM-5创伤后应激障碍的成年人被随机分配到接受长达3小时治疗师协助的基于互联网的自助组，或延迟治疗对照组。基于互联网的项目包括八个模块，重点是心理教育、扎根、放松、行为激活、现实生活和想象暴露、认知疗法以及复发预防。主要结局指标是使用临床医生评定的DSM-5创伤后应激障碍量表（CAPS-5）来评估创伤应激症状的减轻情况。次要结局包括自我报告的创伤后应激障碍症状、抑郁、焦虑、酒精使用、感知到的社会支持以及功能损害。
治疗后，基于互联网的引导式自助组的临床医生评定的创伤后应激障碍症状显著低于延迟治疗对照组（组间效应量Cohen's d = 1.86）。这种差异在1个月随访时得以维持，而当两组都接受治疗后差异消失。两组在抑郁、焦虑和功能损害方面也发现了类似的差异模式。与治疗临床医生的平均接触时间为2.5小时。
基于互联网的针对创伤后应激障碍的聚焦引导式自助是一种有前景的治疗选择，与当前一线面对面心理治疗相比，所需治疗师时间要少得多。
