title: Web-based psychotherapy for posttraumatic stress disorder in war-traumatized Arab patients: randomized controlled trial.
abstract: BACKGROUND
  In recent years, armed conflicts in the Middle East have resulted in high rates of exposure to traumatic events. Despite the increasing demand of mental health care provision, ongoing violence limits conventional approaches of mental health care provision. Internet-based interventions for posttraumatic stress disorder (PTSD) have proved feasible and effective in Western countries, but their applicability and efficacy in war and conflict regions remains unknown.
  
  
  OBJECTIVE
  This study investigated the efficacy of a cognitive behavioral Internet-based intervention for war-traumatized Arab patients, with focus on Iraq.
  
  
  METHODS
  A total of 159 individuals with PTSD participated in a parallel group randomized trial. Participants were randomly allocated by a computer-generated sequence to a treatment group (n=79) or a waiting list control group (n=80). The treatment group received 2 weekly 45-minute cognitive behavioral interventions via Internet over a 5-week period (10 sessions in total). The primary outcome was recovery from posttraumatic stress symptoms.
  
  
  RESULTS
  Posttraumatic stress symptoms were significantly reduced from baseline to posttreatment (intention-to-treat analysis) in the treatment group relative to the control group (F1,157=44.29, P<.001, d=0.92). Treatment effects were sustained at 3-month follow-up. Completer analysis indicated that 29 of 47 patients (62%) in the treatment group had recovered from posttraumatic stress symptoms at posttreatment (reliable change and Posttraumatic Stress Diagnostic Scale score <20) versus 1 patient (2%) in the control group (OR 74.19, 95% CI 9.93-585.8, P<.001) indicating that the chance of recovering was 74.19 times higher in the treatment than in the control group.
  
  
  CONCLUSIONS
  The results indicate, even in unstable and insecure settings with ongoing exposure to human rights violations through war and dictatorships, people with posttraumatic stress symptoms benefit from a cognitive behavioral treatment provided entirely through the Internet. This method of delivery could improve patients' access to humanitarian aid in the form of e-mental health services.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trial Registry, ACTRN12611001019998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347505 (Archived by WebCite at http://www.webcitation.org/6Wto4HCdH).
authors: Department of Clinical Psychology, Freie University, Berlin, Germany. christine.knaevelsrud@fu-berlin.de.
authors: Christine
authors: http://orcid.org/0000-0003-1342-7006
authors: C
authors: Knaevelsrud
authors: Janine
authors: http://orcid.org/0000-0001-8994-8313
authors: J
authors: Brand
authors: Alfred
authors: http://orcid.org/0000-0003-0995-3361
authors: A
authors: Lange
authors: Jeroen
authors: http://orcid.org/0000-0002-4510-997X
authors: J
authors: Ruwaard
authors: Birgit
authors: http://orcid.org/0000-0001-8770-2889
authors: B
authors: Wagner
mesh_terms: D000293:Adolescent; D000328:Adult; D018912:Arabs; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D011613:Psychotherapy / Q000379:methods*; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D017216:Telemedicine / Q000379:methods*; D014857:Warfare; D055815:Young Adult
keywords: Internet; Middle East; cognitive therapy; mental health service; posttraumatic stress disorders; violence; war