The acceptability of a guided internet-based trauma-focused self-help programme (Spring) for post-traumatic stress disorder (PTSD)

Eur J Psychotraumatol. 2023;14(2):2212554. doi: 10.1080/20008066.2023.2212554.

Abstract
in English, Spanish, Chinese

Background: Guided internet-based, cognitive behavioural therapy with a trauma-focus (i-CBT-TF) is recommended in guidelines for post-traumatic stress disorder (PTSD). There is limited evidence regarding its acceptability, with significant dropout from individual face-to-face CBT-TF, suggesting non-acceptability at least in some cases.Objective: To determine the acceptability of a guided internet-based CBT-TF intervention, 'Spring', in comparison with face-to-face CBT-TF for mild to moderate PTSD.Method: Treatment adherence, satisfaction, and therapeutic alliance were measured quantitatively for participants receiving 'Spring' or face-to-face CBT-TF as part of a Randomised Controlled Trial. Qualitative interviews were conducted with a purposive sample of therapists and participants.Results: 'Spring' guided internet-based CBT-TF was found to be acceptable, with over 89% participants fully or partially completing the programme. Therapy adherence and alliance for 'Spring' and face-to-face CBT-TF did not differ significantly, apart from post-treatment participant-reported alliance, which was in favour of face-to-face CBT-TF. Treatment satisfaction was high for both treatments, in favour of face-to-face CBT-TF. Interviews with participants receiving, and therapists delivering 'Spring' corroborated its acceptability.Conclusions: Guided internet-based CBT-TF is acceptable for many people with mild to moderate PTSD. Findings provide insights into future implementation, highlighting the importance of personalising guided self-help, depending on an individual's presentation, and preferences.

Antecedentes: La terapia cognitivo conductual guiada por internet con un enfoque en el trauma (i-CBT-TF por sus siglas en inglés) se recomienda en las guías clínicas para el trastorno de estrés postraumático (TEPT). Existe evidencia limitada en relación a su aceptabilidad, con un abandono significativo de la CBT-TF presencial, lo que sugiere no aceptabilidad al menos en algunos casos.

Objetivo: Determinar la aceptabilidad de una intervención de CBT-TF guiada por internet, ‘Spring’, en comparación con CBT-TF presencial para TEPT de leve a moderado.

Método: Se midieron cuantitativamente la adherencia al tratamiento, satisfacción y alianza terapéutica para los participantes que recibieron CBT-TF Spring o presencial como parte de un Estudio Controlado Aleatorizado. Se condujeron entrevistas cualitativas con una muestra intencional de terapeutas y participantes.

Resultados: Se encontró que la CBT-TF guiada por internet ‘Spring’ era aceptable, con más del 89% de los participantes completando total o parcialmente el programa . La adherencia al tratamiento y la alianza para la CBT-TF sea ‘Spring’ y presencial no difirieron significativamente, aparte de la alianza informada por los participantes después del tratamiento, que estaba a favor de la CBT-TF presencial. La satisfacción con el tratamiento fue alta para ambos tratamientos, en favor de la CBT-TF presencial. Las entrevistas con los participantes que recibieron y los terapeutas que entregaron ‘Spring’ corroboraron su aceptabilidad.

Conclusiones: La CBT-TF guiada por internet es aceptable para muchas personas con TEPT de leve a moderado. Los hallazgos brindan información sobre la implementación futura, destacando la importancia de personalizar la autoayuda guiada, según la presentación y preferencias de cada individuo.

背景：创伤后应激障碍 (PTSD) 指南推荐引导式在线聚焦创伤认知行为疗法（i-CBT-TF）。其可接受性的证据有限，个体面对面的 CBT-TF 中有显著流失，表明至少在某些情况下是不可接受的。

目的：为了确定引导式在线 CBT-TF 干预‘Spring’相较于面对面 CBT-TF对于轻度至中度 PTSD 的可接受性。

方法：作为随机对照试验的一部分，对接受‘春天’或面对面 CBT-TF 的参与者的治疗依从性、满意度和治疗联盟进行了定量测量。对治疗师和参与者的立意抽样进行了定性访谈。

结果：发现‘春天’引导式在线CBT-TF 是可以接受的，超过 89% 的参与者完全或部分完成了该计划。‘春天’和面对面 CBT-TF 的治疗依从性和联盟没有显著差异，除了面对面 CBT-TF更好的治疗后参与者报告的联盟。两种治疗的治疗满意度都很高，面对面的 CBT-TF相对更高。接受访谈的参与者和提供‘春天’的治疗师证实了它的可接受性。

结论：许多轻至中度 PTSD 患者可以接受引导式在线 CBT-TF。结果提供了对未来实施治疗的启示，强调了个性化引导式自助的重要性，这取决于个人表现和偏好。

Keywords: CBT basada en internet; Post-traumatic stress disorder; Trastorno de estrés postraumático; abandono; acceptability; aceptabilidad; autoayuda guiada; dropout; guided self-help; internet-based cbt; 创伤后应激障碍; 可接受性; 在线cbt; 引导式自助; 流失.

Plain language summary

Guided internet-based trauma-focused CBT is an acceptable treatment for PTSD.A model of acceptability explained 45% of variance in treatment outcome.Importance of adapting guided self-help to suit presentation and preferences.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cognitive Behavioral Therapy*
  • Humans
  • Internet
  • Internet-Based Intervention*
  • Research Design
  • Stress Disorders, Post-Traumatic* / therapy

Grants and funding

This project was funded by the UK National Institute for Health Technology Assessment (NIHR HTA) programme; project No 14/192/97, and has been published in full in the NIHR Health Technology Assessment journal (further information available at www.journalslibrary.nihr.ac.uk/programmes/ hta/1419297#/); the NHS costs of the study were funded by the Welsh Government, through Health and Care Research Wales. The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication. This report presents independent research commissioned by the NIHR. The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, NIHR, Medical Research Council, NIHR Central Commissioning Facility, NIHR Evaluation, Trials, and Studies Coordinating Centre (NETSCC), the HTA programme, or the Department of Health.