Internet-based Cognitive Behavioral Therapy for Adults with Post Traumatic Stress Disorder: A Systematic Review BACKGROUND Post traumatic stress disorder (PTSD) results from exposure to a traumatic event that poses actual or threatened death or injury and produces intense fear, helplessness, or horror. Dissemination and effective delivery of short-term, evidence-based treatments for PTSD is an urgent priority to address this growing public health problem and to prevent the development of costly chronic mental health disorders. Recent findings suggest that CBTbased online therapy may be an effective method of providing PTSD treatment. Julie Fricke Brunel University, London Olu Onyimadu Brunel University, London David Humphreys University of Oxford Catherine Meads Brunel University, London RESULTS 9 RCTs were included (n=626), and six were meta-analysed (n=501). A separate analysis was conducted for each of the subscales of the IES-R to obtain the average mean differences (intrusion (n=501, -6.4 [-8.5-4.2]), avoidance (n=501, -7.0 [-9.4-4.7]), and hyper-arousal (n=389, -4.7 [-6.1-3.3]). Sizeable reductions of symptoms in the experimental group were found (including secondary outcomes, such as depression, mood, anxiety, and overall mental and physical health). Analysis 1.1: Internet-based CBT for PTSD - Intrusion Analysis 1.2: Internet-based CBT for PTSD - Avoidance AIM To systematically review the effectiveness of internet-based cognitive behavioral therapy (CBT) interventions for adults with PTSD Analysis 1.3: Internet-based CBT for PTSD - Hyper-Arousal METHODS •  A systematic search for relevant studies was conducted through 9 databases between February and March 2015 – e.g Cochrane, Campbell, Medline, Embase, Web of Science (Science Citation Index) •  Inclusion criteria were an internetbased CBT intervention (RCT) for adults with PTSD with a primary outcome of decreasing or improving post traumatic stress symptoms. Comparators were no intervention (e.g. wait-list control) or therapistassisted internet-based CBT versus therapist alone •  Studies were excluded if they compared specific variations of CBT treatment (e.g. exposure vs. nonexposure CBT), if participants were clinically diagnosed with other personality or mental health disorders, abused drugs or alcohol, or had suicidal intentions •  The Cochrane risk of bias tool was used to assess bias and the RevMan software to conduct meta-analyses Evidence Live Oxford, April 2015 CLINICAL SIGNIFICANCE All included studies reported a high level of clinically relevant change in experimental group vs. control group: participants had either changed diagnostic category or no longer met any PTSD criteria altogether FUTURE RESEARCH •  More empirical studies to further substantiate effectiveness •  More diverse trial locations (e.g. low socioeconomic status) to see if it affects change •  Trials that include an equal number of men and women •  An attempt to standardize PTSD treatment (helps adaptations and scale-ups) •  Research on whether or not treatment should differ between trauma type •  Translate programmes to different languages; international options CONCLUSION Web-based cognitive behavioral therapy seems to be a promising and innovative treatment for reducing the severity and frequency of PTSD symptoms, but because of the lack of clinical trials, more need to be conducted to substantiate effectiveness LIMITATIONS •  A lack of published research / available RCTs •  Heterogeneity; various components •  Small sample sizes; generalizability and power •  Unclear outcome assessment bias; reporting bias •  Primarily self-report outcome measures •  Implementation fidelity is not addressed – Result of intervention? What works? •  Missing data; intention-to-treat; drop-outs •  Modern limitations: user engagement, digital divide Contact: [email protected]