title: Efficacy and Feasibility of a Therapist-Guided Internet-Based Intervention for Older Persons with Childhood Traumatization: A Randomized Controlled Trial.
abstract: OBJECTIVE
  Although cognitive-behavioral treatment approaches for post-traumatic stress disorder (PTSD) exist, only a small proportion of older adults seeks psychological treatment. Alternative treatment approaches are thus needed to fill the gap between provision and use of psychological interventions. This study aimed to investigate the efficacy and feasibility of an Internet-based, therapist-guided cognitive-behavioral therapy (Internet-based CBT) for older individuals with PTSD symptoms.
  
  
  METHODS
  Patients with clinically meaningful (i.e., subsyndromal or greater) PTSD symptoms were randomly assigned to a 6-week treatment group of therapist-guided Internet-based CBT (N = 47; treatment group) or a wait-list group (N = 47; WL). The treatment group was assessed pre- and post-treatment as well as at 3-, 6- and 12-month follow-ups.
  
  
  RESULTS
  Linear mixed-effects analyses showed a significant interaction between group (treatment versus WL) and time (pre versus post) for PTSD symptoms with a moderate between-group effect size in favor of the treatment group (d = 0.42). Effects in the treatment group were maintained up to the 12-month follow-up. Findings indicate a significant interaction (group × time) for quality of life (d = 0.39) and self-efficacy (d = 0.38). With regard to the feasibility, attrition rate was very low in both groups (treatment group: 12.8%, WL: 6.4%) and working alliance was very high.
  
  
  CONCLUSIONS
  Results suggest that therapist-guided Internet-based CBT is associated with a substantial reduction in PTSD symptoms, and increase in resource-related variables in older adults with (subsyndromal) PTSD. This Internet-based intervention may offer a promising option in a stepped-care approach for older trauma-affected persons who may otherwise not pursue mental health treatment.
authors.affiliation: Division of Clinical Psychological Intervention, Freie Universität Berlin, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Knaevelsrud
authors.affiliation: Division of Clinical Psychological Intervention, Freie Universität Berlin, Germany; Center UEBERLEBEN (former Berlin Center for Torture Victims, Berlin, Germany. Electronic address: m.boettche@bzfo.de.
authors.forename: Maria
authors.initials: M
authors.lastname: Böttche
authors.affiliation: U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale University School of Medicine, New Haven, CT.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pietrzak
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, HELIOS Hansehospital Stralsund, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Harald Jürgen
authors.initials: HJ
authors.lastname: Freyberger
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, HELIOS Hansehospital Stralsund, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kuwert
mesh_terms: D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D017063:Outcome Assessment, Health Care; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D017216:Telemedicine / Q000379:methods*
keywords: Elderly; PTSD; randomized controlled trial; trauma; treatment outcome; web-based intervention