Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled clinical trial

BMC Psychiatry. 2007 Apr 19;7:13. doi: 10.1186/1471-244X-7-13.

Abstract

Background: The present study was designed to evaluate the efficacy of an internet-based therapy (Interapy) for Posttraumatic Stress Disorder (PTSD) in a German speaking population. Also, the quality of the online therapeutic relationship, its development and its relevance as potential moderator of the treatment effects was investigated.

Method: Ninety-six patients with posttraumatic stress reactions were allocated at random to ten sessions of Internet-based cognitive behavioural therapy (CBT) conducted over a 5-week period or a waiting list control group. Severity of PTSD was the primary outcome. Secondary outcome variables were depression, anxiety, dissociation and physical health. Follow-up assessments were conducted at the end of treatment and 3 months after treatment.

Results: From baseline to post-treatment assessment, PTSD severity and other psychopathological symptoms were significantly improved for the treatment group (intent-to-treat group x time interaction effect size d = 1.40). Additionally, patients of the treatment condition showed significantly greater reduction of co-morbid depression and anxiety as compared to the waiting list condition. These effects were sustained during the 3-months follow-up period. High ratings of the therapeutic alliance and low drop-out rates indicated that a positive and stable therapeutic relationship could be established online. Significant improvement of the online working alliance in the course of treatment and a substantial correlation between the quality of the online relationship at the end of treatment and treatment outcome emerged.

Conclusion: Interapy proved to be a viable treatment alternative for PTSD with large effect sizes and sustained treatment effects. A stable and positive online therapeutic relationship can be established through the Internet which improved during the treatment process.

Trial registration: Australian Clinical Trials Registry ACTRN012606000401550.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anxiety / etiology
  • Anxiety / psychology
  • Anxiety / therapy
  • Cognitive Behavioral Therapy / methods*
  • Depression / etiology
  • Depression / psychology
  • Depression / therapy
  • Dissociative Disorders / etiology
  • Dissociative Disorders / psychology
  • Dissociative Disorders / therapy
  • Female
  • Follow-Up Studies
  • Health Status
  • Humans
  • Internet*
  • Male
  • Middle Aged
  • Physician-Patient Relations
  • Severity of Illness Index
  • Stress Disorders, Post-Traumatic / complications
  • Stress Disorders, Post-Traumatic / psychology
  • Stress Disorders, Post-Traumatic / therapy*
  • Stress, Psychological / etiology
  • Stress, Psychological / psychology
  • Stress, Psychological / therapy*
  • Treatment Outcome