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

Trial Summary

What is the purpose of this trial?

This study evaluates two Internet-delivered cognitive behavioural therapy (ICBT) interventions: one for symptoms of posttraumatic stress disorder (PTSD) and one for symptoms of anxiety, depression, and PTSD. Both interventions have been tailored for Canadian public safety personnel (PSP). Outcomes of interest include preference for disorder-specific or transdiagnostic care, engagement with the interventions, changes in symptoms and functioning, and strengths and limitations of implementing ICBT with Canadian PSP.

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 data supports the effectiveness of the treatment Internet-Delivered Cognitive Behavioural Therapy for PTSD?

Research shows that Internet-Delivered Cognitive Behavioural Therapy (ICBT) is effective in reducing symptoms of PTSD, depression, and anxiety among public safety personnel. Participants in studies reported high satisfaction and significant improvement in symptoms, with many recommending the treatment to others. ^{1 2 3 4 5}

Is Internet-Delivered Cognitive Behavioural Therapy (ICBT) safe for treating PTSD?

Research indicates that Internet-Delivered Cognitive Behavioural Therapy (ICBT) is generally safe for treating PTSD, with participants showing significant improvements in symptoms and high satisfaction with the treatment. Some challenges like technology issues and timeline difficulties were noted, but overall, the therapy was well-tolerated and perceived as beneficial. ^{1 2 5 6 7}

How is the Internet-Delivered Cognitive Behavioural Therapy for PTSD treatment different from other treatments for PTSD?

This treatment is unique because it is delivered over the internet, making it more accessible for public safety personnel who face barriers to traditional in-person therapy. It offers both PTSD-specific and transdiagnostic approaches, allowing individuals to choose based on their preferences, and includes flexible scheduling and therapist support, which can be tailored to individual needs. ^{1 2 4 6 7}

Research Team

Heather D Hadjistavropoulos, PhD

Principal Investigator

University of Regina

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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 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]

References

1. Netherlands 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. [2023]

2. Canada pubmed.ncbi.nlm.nih.gov

Initial Outcomes of Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy Tailored to Public Safety Personnel: Longitudinal Observational Study. [2021]

3. England 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. [2023]

4. England pubmed.ncbi.nlm.nih.gov

Internet-delivered eye movement desensitization and reprocessing (iEMDR): an open trial. [2021]

5. England pubmed.ncbi.nlm.nih.gov

A therapist-assisted Internet-based CBT intervention for posttraumatic stress disorder: preliminary results. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

EFFECTIVENESS OF INTERNET-DELIVERED COGNITIVE BEHAVIORAL THERAPY FOR POSTTRAUMATIC STRESS DISORDER: A SYSTEMATIC REVIEW AND META-ANALYSIS. [2022]

7. Netherlands pubmed.ncbi.nlm.nih.gov

Insights into internet-delivered cognitive behavioural therapy for public safety personnel: Exploration of client experiences during and after treatment. [2021]