Interapy. Treatment of posttraumatic stress through the Internet: a controlled trial

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Abstract

On-line therapy offers many advantages over face-to-face settings. Interapy includes psycho-education, screening, effect measures and protocol-driven treatment via the Internet for clients. The present paper reports the results of a controlled trial on the Interapy treatment of posttraumatic stress and grief in students, gaining course credits. The participants in the experimental condition (n=13) improved significantly than the participants in the waiting-list control condition (n=12), on trauma-related symptoms and general psychopathology. The effect sizes were large. Eighty percent of the treated participants showed clinically significant improvement after treatment. The possibilities for future research with Interapy, including studies into moderating variables, are discussed.

Section snippets

Participants

Potential participants were 41 individuals who had experienced a traumatic event at least 3 months ago. They were recruited from a pool of 500 students in return for course credit-points. Applicants were excluded from Interapy if they met one of the following criteria: substance abuse; severe major depression; psychological dissociation; psychotic disorder or the use of anti-psychotic medication; extremely high scores in general psychopathology; presently involved in any other psychological

Results

Since the data showed a fairly normal distribution we used parametric tests including T-tests for the main effects of time, MANOVA and ANOVA testing the differences in improvement between the treatment and the control condition (the interaction effects). First the differences between post- and pretreatment are analyzed (Section 2). In Section 3, the follow-up scores are compared with the pre- and posttreatment scores. Effect sizes were calculated for the interaction effects comparing

Follow-up

As Table 1 indicates, decrease in trauma symptomatology continues during the follow-up period. T-tests for paired observation demonstrated that after follow-up, the treated participants still showed less intrusions t(12)=2.70, p<0.02 and avoidance (t(12)=2.24, p<0.05) than prior to treatment. General psychopathology as measured by the SCL-90 remained at the low level in posttreatment. Participants remained significantly less depressed (t(l2)=3.55, p<0.05), showed less somatization (t(12)=3.68; p

Discussion

The writing model we advocate, whether face-to-face or through the Internet, is based on clinical practice. The elements of the protocol were derived from numerous case studies (Lange, 1994). Several of the details seem to be important, including the fixed amount of time and the exact schedule, both helping the patient not to ‘lose himself’. Since structured writing may be hard on patients (they have to confront themselves with utterly painful feelings and cognitions), it is important that the

Acknowledgements

We thank the NFGV (Dutch Federation of Mental Health) in Utrecht for the grant they awarded us to initiate this project. We are indebted to Stefan Geerts and Marlies van Gelderen, who participated in the study during their graduate training in clinical psychology, and to Jacobine van der Smagt who reanalyzed the data for the revision.

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      The remainder reported on mixed types of trauma, some other type of trauma, or did not specify. In over third of the identified RCTs the treatment intervention was pharmacologic [26,31,34,40,47,48,50,59,62,63,65,66,69–79,84,89,98,100,102,104,105,107], in nearly a third of RCTs the treatment intervention was psychotherapy [23,24,29,35,38,43,46,51–54,57,60,61,67,81–83,86,87,90,92–95,106], in eleven RCTs the treatment intervention was complementary and alternative medicine [32,36,39,41,44,45,55,80,99,108,109], in four RCTs the treatment intervention was behavioral [27,85,88,96], and in two RCTs the treatments were combinations of multiple individual treatments [33,42]. In the fourteen remaining RCTs, other treatments that could not be categorized were examined [25,28,30,37,49,56,58,64,68,91,97,103,110,111].

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