A Web-Based Cognitive Behavioral Therapy, Mindfulness Meditation, and Yoga Intervention for Posttraumatic Stress Disorder: Single-Arm Experimental Clinical Trial

Megan A Kirk; Bilal Taha; Kevin Dang; Hugh McCague; Dimitrios Hatzinakos; Joel Katz; Paul Ritvo

doi:10.2196/26479

A Web-Based Cognitive Behavioral Therapy, Mindfulness Meditation, and Yoga Intervention for Posttraumatic Stress Disorder: Single-Arm Experimental Clinical Trial

JMIR Ment Health. 2022 Feb 28;9(2):e26479. doi: 10.2196/26479.

Authors

Megan A Kirk^{1

2}, Bilal Taha³, Kevin Dang¹, Hugh McCague⁴, Dimitrios Hatzinakos³, Joel Katz⁵, Paul Ritvo^{1

5}

Affiliations

¹ School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada.
² Yale Center for Emotional Intelligence, Yale School of Medicine, Yale University, New Haven, CT, United States.
³ Department of Electrical and Computer Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON, Canada.
⁴ Institute for Social Research, York University, Toronto, ON, Canada.
⁵ Department of Psychology, York University, Toronto, ON, Canada.

PMID: 34499613
PMCID: PMC8922150
DOI: 10.2196/26479

Abstract

Background: Posttraumatic stress disorder (PTSD) is a debilitating, undertreated condition. The web-based delivery of cognitive behavioral therapy supplemented with mindfulness meditation and yoga is a viable treatment that emphasizes self-directed daily practice.

Objective: This study aims to examine the effectiveness of a web-based cognitive behavioral therapy, mindfulness, and yoga (CBT-MY) program designed for daily use.

Methods: We conducted an 8-week, single-arm, experimental, registered clinical trial on adults reporting PTSD symptoms (n=22; aged 18-35 years). Each participant received web-based CBT-MY content and an hour of web-based counseling each week. Pre-post outcomes included self-reported PTSD symptom severity, depression, anxiety, chronic pain, and mindfulness. Pre-post psychophysiological outcomes included peak pupil dilation (PPD) and heart rate variability (HRV). HRV and PPD were also compared with cross-sectional data from a non-PTSD comparison group without a history of clinical mental health diagnoses and CBT-MY exposure (n=46).

Results: Pre-post intention-to-treat analyses revealed substantial improvements in PTSD severity (d=1.60), depression (d=0.83), anxiety (d=0.99), and mindfulness (d=0.88). Linear multilevel mixed models demonstrated a significant pre-post reduction in PPD (B=-0.06; SE=0.01; P<.001; d=0.90) but no significant pre-post change in HRV (P=.87). Overall, participants spent an average of 11.53 (SD 22.76) min/day on self-directed mindfulness practice.

Conclusions: Web-based CBT-MY was associated with clinically significant symptom reductions and significant PPD changes, suggesting healthier autonomic functioning. Future randomized controlled trials are needed to further examine the gains apparent in this single-arm study.

Trial registration: ClinicalTrials.gov NCT03684473; https://clinicaltrials.gov/ct2/show/NCT03684473.

Keywords: PTSD; cognitive behavioral therapy; cognitive therapy; internet delivery; intervention; mindfulness; posttraumatic stress disorder; psychophysiology; pupillometry; therapy.

©Megan A Kirk, Bilal Taha, Kevin Dang, Hugh McCague, Dimitrios Hatzinakos, Joel Katz, Paul Ritvo. Originally published in JMIR Mental Health (https://mental.jmir.org), 28.02.2022.

Associated data

ClinicalTrials.gov/NCT03684473