title: Early intervention for preventing posttraumatic stress disorder: an Internet-based virtual reality treatment.
abstract: BACKGROUND
  Posttraumatic stress disorder (PTSD) develops in approximately 20% of people exposed to a traumatic event, and studies have shown that cognitive-behavioral therapy (CBT) is effective as a treatment for chronic PTSD. It has also been shown to prevent PTSD when delivered early after a traumatic event. However, studies have shown that uptake of early treatment is generally low, and therefore, the need to provide interventions through other mediums has been identified. The use of technology may overcome barriers to treatment.
  
  
  OBJECTIVE
  This paper describes a randomized controlled trial that will examine an early CBT intervention for PTSD. The treatment incorporates virtual reality (VR) as a method for delivering exposure-based elements of the treatment. The intervention is Internet based, such that the therapist and patient will "meet" in a secure online site. This site will also include multi-media components of the treatment (such as videos, audios, VR) that can be accessed by the patient between sessions.
  
  
  METHODS
  Two hundred patients arriving to a Level 1 emergency department following a motor vehicle accident will be randomly assigned to either treatment or control groups. Inclusion criteria are age 18-65, PTSD symptoms 2 weeks posttrauma related to current trauma, no suicidality, no psychosis. Patients will be assessed by telephone by a team blind to the study group, on four occasions: before and after treatment, and 6 and 12 months posttreatment. The primary outcome is PTSD symptoms at follow up. Secondary outcomes include depression and cost effectiveness. Analyses will be on an intention-to-treat basis.
  
  
  CONCLUSIONS
  The results will provide more insight into the effects of preventive interventions, in general, and Internet-based early interventions, in particular, on PTSD, in an injured population, during the acute phase after trauma. We will discuss possible strengths and limitations.
authors.affiliation: School of Social Work, Bar Ilan University, Ramat Gan, Israel.|Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel; sarafreedman@gmail.com.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Freedman
authors.affiliation: Sonarion Ltd., Jerusalem, Israel.
authors.forename: Ehud
authors.initials: E
authors.lastname: Dayan
authors.affiliation: Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Yael Bleich
authors.initials: YB
authors.lastname: Kimelman
authors.affiliation: Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Heidi
authors.initials: H
authors.lastname: Weissman
authors.affiliation: Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Renana
authors.initials: R
authors.lastname: Eitan
keywords: Internet-based therapy; PTSD; cognitive behavior therapy; early intervention
references.citation: J Anxiety Disord. 2010 Aug;24(6):635-44
references.pmid: 20447802
references.citation: Br J Psychiatry. 2007 Feb;190:97-104
references.pmid: 17267924
references.citation: Arch Gen Psychiatry. 2012 Feb;69(2):166-76
references.pmid: 21969418
references.citation: Br J Psychiatry. 2006 Apr;188:323-9
references.pmid: 16582058
references.citation: Stud Health Technol Inform. 2009;144:19-21
references.pmid: 19592722
references.citation: J Consult Clin Psychol. 2003 Oct;71(5):901-9
references.pmid: 14516238
references.citation: Psychiatr Serv. 2011 Jul;62(7):765-73
references.pmid: 21724790
references.citation: Depress Anxiety. 2010 Oct;27(10):933-44
references.pmid: 20734361
references.citation: Behav Res Ther. 2003 Apr;41(4):489-94
references.pmid: 12643970
references.citation: Am J Psychiatry. 2007 Jan;164(1):82-90
references.pmid: 17202548
references.citation: Cyberpsychol Behav Soc Netw. 2010 Feb;13(1):95-101
references.pmid: 20528299
references.citation: Cogn Behav Ther. 2010;39(1):72-7
references.pmid: 19675958
references.citation: J Anxiety Disord. 2010 May;24(4):387-96
references.pmid: 20227241
references.citation: Cyberpsychol Behav. 2002 Dec;5(6):529-35
references.pmid: 12556115
references.citation: Am J Psychiatry. 1999 Nov;156(11):1780-6
references.pmid: 10553743
references.citation: Br J Psychiatry. 1999 Apr;174:353-9
references.pmid: 10533555
references.citation: J Med Internet Res. 2013 Aug 13;15(8):e165
references.pmid: 23942480
references.citation: J Clin Psychiatry. 2007 Nov;68(11):1639-47
references.pmid: 18052556
references.citation: Perspect Psychol Sci. 2011 Jan;6(1):21-37
references.pmid: 26162113
references.citation: Psychol Assess. 2018 Mar;30(3):383-395
references.pmid: 28493729
references.citation: N Engl J Med. 2004 Jul 1;351(1):13-22
references.pmid: 15229303
references.citation: J Clin Psychiatry. 2001 Aug;62(8):617-22
references.pmid: 11561934
references.citation: Depress Anxiety. 2012 Oct;29(10):833-42
references.pmid: 22941845