Internet-Delivered Cognitive Behavioural Therapy for PTSD

Overseen By Heather Hadjistavropoulos, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Regina

Disqualifiers: Psychosis, Alcohol, Drug problems, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 8 weeks

300 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests two online therapy courses designed to help Canadian public safety personnel (PSP) with symptoms of PTSD, anxiety, and depression. The PSP PTSD Course focuses specifically on PTSD, while the PSP Wellbeing Course addresses multiple mental health issues. Researchers aim to determine participants' course preferences, their level of engagement, and changes in their symptoms. This trial suits PSPs in Saskatchewan who have PTSD symptoms and can access a computer with internet. As an unphased trial, it offers PSPs the chance to contribute to valuable research that could enhance mental health resources for their community.

Do I have to stop taking my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It might be best to discuss this with the trial coordinators or your doctor.

What prior data suggests that these Internet-delivered cognitive behavioural therapy interventions are safe for Canadian public safety personnel?

Research shows that online cognitive behavioral therapy (ICBT) is well-received by public safety personnel (PSP). Participants typically report satisfaction and often complete the treatment.

For the PSP PTSD Course, studies have not fully assessed safety yet, but they show promising results in reducing symptoms. Similarly, the PSP Wellbeing Course, targeting symptoms of depression, anxiety, and PTSD, has shown early positive and effective results.

Overall, both courses have helped reduce symptoms without significant negative effects reported. This suggests that these online therapy programs are safe and manageable for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these treatments because they offer a fresh approach to managing PTSD specifically tailored for Canadian public safety personnel (PSP). Unlike traditional face-to-face therapy, these are Internet-delivered cognitive behavioral therapy (ICBT) programs, allowing participants to access help from the comfort of their own homes. One treatment arm focuses on PTSD-specific therapy, while the other offers a transdiagnostic approach, which can address a range of mental health issues. This flexibility and convenience can make mental health support more accessible and less stigmatizing for PSPs, who often face unique stressors in their line of work.

What evidence suggests that this trial's treatments could be effective for PTSD?

Research has shown that online cognitive behavioral therapy (ICBT) helps reduce symptoms of posttraumatic stress disorder (PTSD) in public safety personnel (PSP). In this trial, participants may receive ICBT for PTSD, which significantly lowers PTSD symptoms compared to those who do not receive the treatment. Alternatively, participants may receive the PSP Wellbeing Course. Studies indicate that this course effectively addresses symptoms of depression, anxiety, PTSD, panic disorder, and anger, although its effect on PTSD is moderate. Both treatments have been specially designed for Canadian PSP, leading to high satisfaction and reduced symptoms. These findings suggest that ICBT can be a valuable tool for improving mental health in high-stress public safety jobs. ^{3 4 6 7 8}

Who Is on the Research Team?

Heather D Hadjistavropoulos, PhD

Principal Investigator

University of Regina

Are You a Good Fit for This Trial?

This trial is for Canadian public safety personnel in Saskatchewan, aged 18 or older, who are experiencing symptoms of post-traumatic stress. Participants must have internet access and agree to provide a physician contact. It's not suitable for those with recent suicide attempts, hospitalization, substance abuse issues, psychosis or mania, ongoing psychological treatment, or high suicide risk.

Inclusion Criteria

I experience symptoms related to past trauma.

Willing to provide a physician as emergency contact

Residing in Saskatchewan for the duration of the intervention

Exclusion Criteria

I have concerns about receiving cognitive behavioral therapy.

I am currently in regular psychological therapy.

High suicide risk

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive Internet-delivered cognitive behavioural therapy tailored for PTSD or transdiagnostic symptoms

8 weeks

Weekly online sessions

Follow-up

Participants are monitored for symptom improvement and functioning at 8, 26, and 52 weeks post-enrollment

52 weeks

Engagement and Homework Compliance

Participants complete homework assignments to facilitate learning and engagement is measured

12 weeks

Weekly online engagement

What Are the Treatments Tested in This Trial?

Interventions

• PSP PTSD Course
• PSP Wellbeing Course

Trial Overview The study tests two online cognitive behavioural therapy courses tailored for PTSD and related mental health issues like anxiety and depression among public safety workers. The goal is to see which course works better for symptom improvement and how participants engage with the online format.

How Is the Trial Designed?

Group I: Transdiagnostic ICBT Tailored for PSP Experimental Treatment 1 Intervention

Therapist-guided, transdiagnostic Internet-delivered cognitive behavioral therapy tailored specifically for Canadian public safety personnel.

Group II: ICBT for PTSD Tailored for PSP Experimental Treatment 1 Intervention

Therapist-guided, Internet-delivered cognitive behavioral therapy for PTSD tailored specifically for Canadian public safety personnel.

PSP PTSD Course is already approved in Canada for the following indications:

Approved in Canada as PSP PTSD Course for:

• Posttraumatic Stress Disorder (PTSD)

Who Is Running the Clinical Trial?

University of Regina

Lead Sponsor

Trials

59

Recruited

9,100+

Government of Canada

Collaborator

Trials

13

Recruited

2,400+

Published Research Related to This Trial

In a study involving 150 public safety personnel, both transdiagnostic and PTSD-specific internet-delivered cognitive behavioral therapy (ICBT) showed high client satisfaction and significant symptom improvement, with 98% of participants recommending the course to others.

More participants preferred transdiagnostic ICBT over PTSD-specific ICBT, although the difference was not statistically significant; however, transdiagnostic ICBT led to greater reductions in panic disorder symptoms compared to PTSD-specific ICBT.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet-delivered cognitive behavioural therapy for symptoms of PTSD among public safety personnel: Initial outcomes of an open cohort preference trial of transdiagnostic and disorder-specific therapy. McCall, H., Dear, BF., Landry, C., et al.[2023]

Internet-delivered cognitive behavioral therapy (iCBT) significantly reduces PTSD symptoms compared to inactive controls (like waitlist and treatment-as-usual), with a moderate effect size of 0.71 based on a meta-analysis of 12 randomized controlled trials involving 1,306 participants.

When compared to other active interventions, iCBT showed a smaller effect size of 0.28, indicating it may be less effective than some existing treatments, suggesting the need for further research to optimize its use in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

EFFECTIVENESS OF INTERNET-DELIVERED COGNITIVE BEHAVIORAL THERAPY FOR POSTTRAUMATIC STRESS DISORDER: A SYSTEMATIC REVIEW AND META-ANALYSIS. Sijbrandij, M., Kunovski, I., Cuijpers, P.[2022]

A tailored internet-delivered cognitive behavioral therapy (ICBT) program for Canadian public safety personnel (N=83) resulted in large reductions in depression and anxiety symptoms, and moderate reductions in PTSD symptoms after 8 weeks of treatment.

Most participants who initially reported high levels of depression, anxiety, and PTSD experienced clinically significant symptom improvements, indicating that ICBT is a promising treatment option for this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Initial Outcomes of Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy Tailored to Public Safety Personnel: Longitudinal Observational Study. Hadjistavropoulos, HD., McCall, HC., Thiessen, DL., et al.[2021]

A study involving 217 participants found that internet-delivered cognitive therapy for PTSD (iCT-PTSD) was significantly more effective than internet-delivered stress management therapy (iStress-PTSD) in reducing PTSD symptoms, with a notable effect size of -4.92 on the PTSD Checklist for DSM-5 (PCL-5).

Both treatments were superior to a waiting list for symptom reduction, and iCT-PTSD showed greater benefits for individuals with high dissociation or complex PTSD, indicating its effectiveness as a trauma-focused intervention while being safe, with no serious adverse events reported.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Therapist-assisted online psychological therapies differing in trauma focus for post-traumatic stress disorder (STOP-PTSD): a UK-based, single-blind, randomised controlled trial. Ehlers, A., Wild, J., Warnock-Parkes, E., et al.[2023]

A study involving 82 Canadian public safety personnel (PSP) found that internet-delivered cognitive behavioural therapy (ICBT) was perceived as beneficial, with clients reporting positive impacts such as skill development and normalizing mental health issues.

Clients appreciated the flexible format and content of the ICBT program, but also faced challenges like technology issues and time constraints; their feedback led to rapid improvements in the program tailored specifically for PSP.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Insights into internet-delivered cognitive behavioural therapy for public safety personnel: Exploration of client experiences during and after treatment. Beahm, JD., McCall, HC., Carleton, RN., et al.[2021]

The combination of internet-delivered cognitive behavioral therapy (iCBT) and internet-delivered eye movement desensitization and reprocessing (iEMDR) showed large effect sizes in reducing PTSD symptoms, with 55% of participants no longer meeting PTSD criteria after treatment.

Despite some participants experiencing symptom worsening during treatment, overall improvements were reported by follow-up, indicating the potential effectiveness and safety of this internet-based approach for PTSD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet-delivered eye movement desensitization and reprocessing (iEMDR): an open trial. Spence, J., Titov, N., Johnston, L., et al.[2021]

A 10-week Internet-based cognitive behavioral treatment for PTSD, involving 16 participants, showed clinically significant reductions in PTSD severity, indicating its effectiveness as a treatment option.

Participants reported high levels of satisfaction with the program and a strong therapeutic alliance with their online therapist, suggesting that this method of treatment is both accessible and well-received.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A therapist-assisted Internet-based CBT intervention for posttraumatic stress disorder: preliminary results. Klein, B., Mitchell, J., Gilson, K., et al.[2022]

Citations

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Internet-delivered cognitive behavioural therapy for ... Internet-delivered cognitive behavioural therapy for symptoms of PTSD among public safety personnel: Initial outcomes of an open cohort preference trial.

2. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/31359407/

Internet-delivered cognitive behavioural therapy for post ... Evidence showed that i-CBT may be associated with a clinically important reduction in post-treatment PTSD symptoms compared with wait list.

3. clinicaltrials.gov clinicaltrials.gov/study/NCT04335487

Internet-Delivered Cognitive Behaviour Therapy for PTSD ... Research shows that ICBT is effective at reducing symptoms of posttraumatic stress, and there is also evidence that the findings of research trials translate ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S0887618524000379

Outcomes of transdiagnostic internet-delivered cognitive ... Transdiagnostic online therapy was tailored to public safety personnel (PSP). PSP showed good treatment satisfaction, course completion, and symptom reduction.

5. cda-amc.ca cda-amc.ca/sites/default/files/ou-tr/op0537-internet-delivered-cognitive-behavioural-therapy-for-post-traumatic-stress-disorder-protocol.pdf

Internet-Delivered Cognitive Behavioural Therapy for Post- ... Although iCBT may be less costly than interventions currently in use for the treatment of other mental health indications (e.g., major depressive disorder and.

6. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/37609530/

Internet-delivered cognitive behavioural therapy for ... Initial outcomes of transdiagnostic internet-delivered cognitive behavioural therapy (ICBT) tailored for PSP are promising, but prior research has not evaluated ...

7. sciencedirect.com sciencedirect.com/science/article/pii/S2214782923000568

Internet-delivered cognitive behavioural therapy for ... Initial outcomes of transdiagnostic internet-delivered cognitive behavioural therapy (ICBT) tailored for PSP are promising, but prior research has not evaluated ...

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10568396/

Internet-Delivered Cognitive Behavioral Therapy Tailored ... Internet-delivered cognitive behavioral therapy (ICBT) provides a convenient and accessible treatment format that can be tailored to the needs of SSOs of PSP.