Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia.
Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, LondonW12 7RH, UK.
Behav Cogn Psychother. 2022 Nov;50(6):649-655. doi: 10.1017/S1352465822000285. Epub 2022 Aug 4.
Despite its potential scalability, little is known about the outcomes of internet-based cognitive behaviour therapy (iCBT) for post-traumatic stress disorder (PTSD) when it is provided with minimal guidance from a clinician.
To evaluate the outcomes of minimally guided iCBT for PTSD in a randomised control trial (RCT, Study 1) and in an open trial in routine community care (Study 2).
A RCT compared the iCBT course (=21) to a waitlist control (WLC, =19) among participants diagnosed with PTSD. The iCBT group was followed up 3 months post-treatment. In Study 2, treatment outcomes were evaluated among 117 adults in routine community care. PTSD symptom severity was the primary outcome in both studies, with psychological distress and co-morbid anxiety and depressive symptoms providing secondary outcomes.
iCBT participants in both studies experienced significant reductions in PTSD symptom severity from pre- to post-treatment treatment (within-group Hedges' =.72-1.02), with RCT findings showing maintenance of gains at 3-month follow-up. The WLC group in the RCT also significantly improved, but Study 1 was under-powered and the medium between-group effect favouring iCBT did not reach significance (=0.64; 95% CI, -0.10-1.38).
This research provides preliminary support for the utility of iCBT for PTSD when provided with minimal clinician guidance. Future studies are needed to clarify the effect of differing levels of clinician support on PTSD iCBT outcomes, as well as exploring how best to integrate iCBT into large-scale, routine clinical care of PTSD.
尽管基于互联网的认知行为疗法（iCBT）在治疗创伤后应激障碍（PTSD）方面具有潜在的可扩展性，但当它仅得到临床医生的最低限度指导时，其治疗效果知之甚少。
在随机对照试验（RCT，研究 1）和常规社区护理中的开放试验（研究 2）中，评估最小程度指导的 iCBT 治疗 PTSD 的效果。
RCT 将 iCBT 课程（n=21）与等待名单对照（WLC，n=19）进行比较，参与者均被诊断为 PTSD。iCBT 组在治疗后 3 个月进行随访。在研究 2 中，对常规社区护理中的 117 名成年人进行了治疗效果评估。两项研究的主要结局均为 PTSD 症状严重程度，次要结局包括心理困扰和共病焦虑和抑郁症状。
两项研究中的 iCBT 参与者在治疗前后均显著降低了 PTSD 症状严重程度（组内 Hedges'=.72-1.02），RCT 结果显示在 3 个月随访时仍保持了疗效。RCT 中的 WLC 组也显著改善，但研究 1 统计效能不足，且有利于 iCBT 的中等组间效应未达到显著性水平（=0.64；95%CI，-0.10-1.38）。
这项研究初步支持了在最低限度的临床医生指导下，iCBT 在治疗 PTSD 方面的有效性。未来的研究需要阐明不同水平的临床医生支持对 PTSD iCBT 治疗效果的影响，以及探索如何将 iCBT 最佳地整合到 PTSD 的大规模常规临床护理中。
