title: Internet-delivered cognitive therapy for PTSD: a development pilot series.
abstract: BACKGROUND
  Randomised controlled trials have established that face-to-face cognitive therapy for posttraumatic stress disorder (CT-PTSD) based on Ehlers and Clark's cognitive model of PTSD is highly effective and feasible with low rates of dropout. Access to evidence-based psychological treatments for PTSD is insufficient. Several studies have shown that therapist-assisted treatment delivery over the Internet is a promising way of improving access to cognitive behavioural therapy interventions.
  
  
  OBJECTIVE
  To develop an Internet version of CT-PTSD that significantly reduces therapist contact time without compromising treatment integrity or retention rates.
  
  
  METHODS
  We describe the development of an Internet version of CT-PTSD. It implements all the key procedures of face-to-face CT-PTSD, including techniques that focus on the trauma memory, such as memory updating, stimulus discrimination and revisiting the trauma site, as well as restructuring individually relevant appraisals relating to overgeneralisation of danger, guilt, shame or anger, behavioural experiments and planning activities to reclaim quality of life. A cohort of 10 patients meeting DSM-IV criteria for PTSD worked through the programme, with remote guidance from a therapist, and they were assessed at pre- and post-treatment on PTSD outcome, mood, work and social adjustment and process measures.
  
  
  RESULTS
  No patients dropped out. Therapists facilitated the treatment with 192 min of contact time per patient, plus 57 min for reviewing the patient's progress and messages. Internet-delivered CT-PTSD was associated with very large improvements on all outcome and process measures, with 80% of patients achieving clinically significant change and remission from PTSD.
  
  
  CONCLUSIONS
  Internet-delivered cognitive therapy for PTSD (iCT-PTSD) appears to be an acceptable and efficacious treatment. Therapist time was reduced to less than 25% of time in face-to-face CT-PTSD. Randomised controlled trials are required to evaluate systematically the acceptability and efficacy of iCT-PTSD.
authors.affiliation: Department of Experimental Psychology, University of Oxford, Oxford, UK.|Oxford NIHR Cognitive Health Clinical Research Facility, Oxford, UK; jennifer.wild@psy.ox.ac.uk.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wild
authors.affiliation: Department of Experimental Psychology, University of Oxford, Oxford, UK.|Oxford NIHR Cognitive Health Clinical Research Facility, Oxford, UK.|NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Warnock-Parkes
authors.affiliation: NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Grey
authors.affiliation: NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Stott
authors.affiliation: Department of Experimental Psychology, University of Oxford, Oxford, UK.|Oxford NIHR Cognitive Health Clinical Research Facility, Oxford, UK.
authors.forename: Milan
authors.initials: M
authors.lastname: Wiedemann
authors.affiliation: Department of Experimental Psychology, University of Oxford, Oxford, UK.|Oxford NIHR Cognitive Health Clinical Research Facility, Oxford, UK.
authors.forename: Lauren
authors.initials: L
authors.lastname: Canvin
authors.affiliation: NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK.
authors.forename: Harriet
authors.initials: H
authors.lastname: Rankin
authors.affiliation: Department of Experimental Psychology, University of Oxford, Oxford, UK.|Oxford NIHR Cognitive Health Clinical Research Facility, Oxford, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Shepherd
authors.affiliation: Department of Experimental Psychology, University of Oxford, Oxford, UK.|Oxford NIHR Cognitive Health Clinical Research Facility, Oxford, UK.
authors.forename: Ava
authors.initials: A
authors.lastname: Forkert
authors.affiliation: Department of Experimental Psychology, University of Oxford, Oxford, UK.|Oxford NIHR Cognitive Health Clinical Research Facility, Oxford, UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Clark
authors.affiliation: Department of Experimental Psychology, University of Oxford, Oxford, UK.|Oxford NIHR Cognitive Health Clinical Research Facility, Oxford, UK.
authors.forename: Anke
authors.initials: A
authors.lastname: Ehlers
keywords: Internet-based treatment; PTSD; cognitive therapy; posttraumatic stress disorder; trauma