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


METHODS
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.


CONCLUSIONS
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.


BACKGROUND
Australian Clinical Trials Registry ACTRN012606000401550.
Knaevelsrud
Christine
C
Treatment Center for Torture Victims, Berlin, Germany. c.knaevelsrud@bzfo.de
Maercker
Andreas
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology / Q000523:psychology / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000209:etiology / Q000523:psychology / Q000628:therapy; D004213:Dissociative Disorders / Q000209:etiology / Q000523:psychology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology / Q000628:therapy*; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome