Therapist-assisted Internet-based Writing CBT for Specific ...
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Therapist-assisted Internet-based Writing CBT for Specific Cohorts with Posttraumatic Stress Disorder PhD Maria Böttche Berlin Center for Torture Victims Freie Universität Berlin Anxiety and Depression Association of America April, 11 th , 2015
Transcript of Therapist-assisted Internet-based Writing CBT for Specific ...
Therapist-assisted Internet-based Writing CBT
for Specific Cohorts with Posttraumatic Stress Disorder
PhD Maria Böttche
Berlin Center for Torture Victims
Freie Universität Berlin
Anxiety and Depression Association of America
April, 11th, 2015
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Effective Treatment
Components
Traumafocussed Therapy
g = 1.08, K = 27, N = 1310
Cognitive Therapy
g = 1.63, K = 10, N = 585
Narrative Therapy
g = 1.00, K = 4, N = 242
Internet-based Interventions
Effective for PTSD in Western countries (Lange et al. 2003, Knaevelsrud et al., 2006, Wagner et al.,
2006)
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Advantages of Internet Use
Easy access
Travel problems
Absence of professionals
“Non-visuality” of therapist
Age gap
Feelings of shame and guilt
Stigma
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Internet-based writing CBT
Based on disorder specific cognitive-behavioral manual (Lange et al., 2003)
culturally adapted
age-specific adaption
Duration of treatment: ca. 5-6 weeks (2 structured assignments / week)
10/11 writing sessions
Individual patient-therapist-relationship – feedback within 24h
Baseline Post Follow-up
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Integrative Testimonial Therapy
Randomized Control Trial
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Resource-oriented reconstruction
ITT
Biographical Reconstruction
Integration of traumatic event into biography
Moderate Exposure
Letter to the younger self from
the current perspective
Cognitive Reappraisal
ITT
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Assessed for eligibility
(n= 333)
Ineligible (n= 239)
Incomplete screening/no response
(n = 161)
Met exclusion criteria
(n = 78)
Randomly assigned to treatment (n= 94)
Allocated to Integrative
Testimonial Therapy
(n= 47)
Completed waiting period
(n= 44)
Completed Intervention
(n= 41)
Allocated to Waitlist control
group
(n= 47)
Completed 3-month follow-up
(n= 38)
Completed 6-month follow-up
(n= 36)
Completed 12-month follow-up
(n=37)
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Integrative Testimonial Therapy
Randomized Control Trial
Treatment Group Waiting List
n = 47 n = 47
Age (years) M (SD) 70.89 (4.97) 71.91 (4.48)
Women N (%) 35 (74.5) 26 (55.3)
Education (years) M (SD) 11.45 (1.65) 11.70 (1.49)
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Repeated-measures ANOVA for Intent-to-treat Data
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0
1
2
3
4
5
6
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Pre Post 3-month 6-month 12-month
Intrusion
Hyperarousal
Avoidance
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Repeated-measures ANOVA for Intent-to-treat Data
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Dwithin Dwithin Dwithin (preto3
month)
(preto6
month)
(preto12
month)
Anxiety .64 .96 .67
Depression .24 .72 .21
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Pre Post 3-month 6-month 12-month
Brief
Sym
pto
m I
nvento
ry
Anxiety
Depression
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0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
Pre Post 3-month 6-month 12-month
Quality of Life
Dwithin Dwithin Dwithin (preto3
month)(preto6month)
(preto12month)
Qualityoflife .46 .50 .55
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Gesamt
Aufgabe Zi
el
Bindung
1
3
5
7
WAI
Gesamt
Aufgabe
Ziel
Bindung
Dropout-Rate 9.57 % (post)
TG: 12.77%
WL: 6.38%
Feasability
Total Task Goal Bond
Total
Task
Goal
Bond
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Ilajnafsy
Randomized Control Trial
Ilajnafsy = “psychological help”
www.ilajnafsy.org
www.virtual-traumacenter.org
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Describing most painful moment
ITT
Self-Confrontation
Encouraging letter to a fictive friend with similar experience
Cognitive Reappraisal
Letter to self/perpetrator/friend
from the current perspective
Social Sharing
Ilajnafsy
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Assessed for eligibility
(n= 1070)
Ineligible (n= 824)
Incomplete screening/no response
(n = 231)
Met exclusion criteria
(n = 593)
Randomly assigned to treatment (n= 159)
Allocated to Intervention
(n= 79)
Completed waiting period
(n= 47)
Completed Intervention
(n= 47)
Allocated to Waitlist control
group
(n= 80)
Completed follow-up
(n= 28)
No reply to invitation (n= 87)
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Ilajnafsy
Randomized Control Trial
Treatment Group Waiting List
n = 79 n = 80
Age (years) M (SD) 29.11 (3.01) 27.15 (6.48)
Women n (%) 60 (76) 55 (69)
Education n (%)
Secondary school 17 (22) 28 (35)
University 56 (71) 38 (48)
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Repeated-measures ANOVA for Intent-to-treat Data
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0
2
4
6
8
10
12
14
Pre Post 3-month
Intrusion
Hyperarousal
Avoidance
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Repeated-measures ANOVA for Intent-to-treat Data
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Dwithin (preto3
month)
Anxiety 1.44
Depression 1.69
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
Pre Post 3-month
Anxiety
Depression
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Dwithin (preto3
month)
Qualityoflife 1.30
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
Pre Post 3-month
Quality of Life
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Gesamt
Aufgabe Zi
el
Bindung
1
3
5
7
WAI
Gesamt
Aufgabe
Ziel
Bindung
Dropout-Rate 41% (post)
TG: 32/79
Feasability
Total Task Goal Bond
Total
Task
Goal
Bond
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Conclusion Efficacy
Decrease of PTSD symptoms
Increase of Quality of life
Positive therapeutic relationship
Successful adaption for hard-to-reach trauma survivors
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Challenges
Treatment
Use of media-specific techniques
Circumstances
Technical Problems
Mistrust concerning confidentiality
No adequate treatment alternatives for referrals
