Internet-Based Cognitive and Behavioral Therapies for PTSD in Adults

Peter M. Yellowlees, MBBS, MD


May 09, 2019

This transcript has been edited for clarity.

This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees. Therapist-delivered, trauma-focused, psychological therapies are the accepted first-line treatments for posttraumatic stress disorder (PTSD). However, they are not easily available or accessible for many patients. Delivering cognitive and behavioral therapy on the Internet (I-CBT) is an acceptable alternative, but is it effective?

A team of investigators from Cardiff University, Wales, has performed a Cochrane review to assess the effects of I-CBT for PTSD in adults.[1] The researchers found 10 studies with 720 participants and concluded that although there were some beneficial effects of I-CBT for PTSD, the overall quality of evidence was very low owing to the small number of included trials.

The researchers noted that further work is required to establish noninferiority to current first-line interventions, explore mechanisms of change, establish optimal levels of guidance, explore cost-effectiveness, measure adverse events, and determine predictors of efficacy and dropout.

As clinicians, where does this leave us? We are at the stage where I-CBT can be called, at best, a promising but unproven technique to help our patients with PTSD, despite the increasingly large number of programs available, especially in the form of apps on our mobile devices. We need more high-quality research in this area, especially to demonstrate that I-CBT is not inferior to current first-line, in-person interventions.

There is substantial evidence supporting I-CBT for other disorders, such as anxiety and depression, and there is no reason to suspect that online treatment for patients with PTSD should not be successful. Please talk to your research colleagues, and ask them to produce the evidence we need.

Thank you for listening to this Medscape Psychiatry Minute. Do continue to enjoy your practice.

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