What is Post-traumatic Stress Disorder (PTSD)?
Health is a state of complete physical, mental, and social well-being. Well-being exists when an individual realizes his or her potential, works productively, contributes to his or her community, and is able to cope with the normal life stresses (WHO, 2014). Post-traumatic stress disorder (PTSD) is a common disorder that involves upsetting thoughts, nightmares, or flashbacks of trauma or reminders of it, leading to negative changes in mood or cognition, anxiety, depression, hypervigilance, and sleep problems. It imposes a significant personal and societal burden. PTSD involves distressing psychological symptoms that develop after exposure to a traumatic event that may involve either a direct personal experience or the witnessing of a traumatic event happening to another person “of an exceptionally threatening or catastrophic nature, to cause pervasive distress” (American Psychiatry Association, 2013; WHO 1992).
Why consider internet-based rehabilitation?
PTSD can be treated effectively with talk therapy focusing on the trauma, cognitive restructuring of thoughts, and behavioural changes. Effective management of PSTD consists of cognitive behavioural therapy, behavioural therapy, and/or drug therapy (rarely). Internet-based rehabilitation (cognitive behavioural therapy or behavioural therapy) enables the remote delivery of healthcare services in patients’ homes or other environments, broadening treatment access and reducing cost (time and monetary).
Why was a Cochrane Review needed?
Internet-based therapies have been used routinely to treat depression and anxiety, but few studies have been conducted on their efficacy for PTSD. This Cochrane Review evaluates the effectiveness of online PTSD therapeutic approaches in adult patients. The analysis included 10 randomised controlled trials with 720 adult participants. Study participants were allocated randomly into one group receiving treatment under investigation and another as a control group receiving standard treatment/no treatment/waitlist. Reviewers discussed different types of strategies, such as (i) assistance by a highly engaged specialist, (ii) a program by a mental health professional, and/or (iii) a self-help approach. Common features of these internet-based therapies are psychoeducation, (negative) cognitive pattern identification and modification, behavioural changes, and self-help skill development.
Authors observed that after the internet-based therapies there was a reduction in signs of PTSD (anxiety and depression) compared to no therapy (waiting list) with very low-quality evidence. Out of 10, two studies reported no difference between internet-based therapies and another type of online psychological therapy. No evidence was observed in any study regarding the participants’ report of internet-based therapies as acceptable treatment or improved quality of life. None of the studies reported on the cost effectiveness.
Authors summarized that the beneficial effects of internet-based cognitive and/or behavioural therapies for PTSD have very low evidential value due to the small number of studies in literature. Internet-based therapies may be a potential alternative for direct psychological interventions, but future studies are needed surrounding optimal management of symptoms. These studies should include parameters like negative-signs reduction, adverse events, cost-effectiveness, and dropout rates.
Comment by Sunita Gudwani