Online treatment ‘as effective as face-to-face therapy’, a large-scale clinical trial has found.
Researchers at Cardiff University have pioneered a new form of virtual treatment for people with post-traumatic stress disorder (PTSD).
In a large-scale clinical trial, the research team found guided online therapy sessions for people with mild to moderate PTSD were as effective as face-to-face treatment.
The team say the results, published today in the British Medical Journal (BMJ) , mean this form of therapy should now be considered by the NHS as a first-line treatment for people with the condition.
Professor Jonathan Bisson, from Cardiff University’s National Centre for Mental Health, said:
“Our research has pioneered a new form of treatment for PTSD which could revolutionise NHS treatment of this debilitating condition in future.”
Sarah, a previous trial participant who is now a researcher and co-author on this study, said it had the potential to help many people. She said:
“Guided self-help got me back to being me – it gave me my life back after PTSD.”
‘Long waiting lists for help’
It is estimated about 4% of adults in the UK have PTSD, a common condition that can develop after experiencing traumatic events. Symptoms include re-experiencing the trauma, avoiding reminders and being very on edge, with distress and an impact on daily life which can last many years.
Psychological therapy with a focus on the traumatic event is the treatment of choice but waiting lists can be more than a year and there are a limited number of trained therapists to deliver treatment.
The research team held a large randomised controlled trial of internet-based cognitive behavioural therapy (CBT) involving 196 adults from across the UK with a diagnosis of mild to moderate PTSD. Half were given a Cardiff University-devised guided web and app-based therapy called Spring, involving an eight-step programme with guidance and support from a therapist, while the other half had 12 face-to-face therapy sessions.
Their progress was measured at 16 and 52 weeks, including by severity of symptoms of their PTSD and depression and anxiety, use of alcohol and impact on how they were functioning in daily life. Nineteen participants and 10 therapists were also interviewed in depth about their experiences of the new treatment, as part of the evaluation.
The trial found that more than 80% of people in both groups who were interviewed at 16 weeks no longer had PTSD.
Professor Bisson said:
“The RAPID trial to assess the Spring programme found that guided internet-based CBT is clinically effective, cheaper, flexible and as effective as face-to-face treatment.”
“The results should provide more treatment options for people with PTSD and improve their care.”
‘The programme was there when I needed it’
Sarah, a 46-year-old mum and communications manager from south Wales, said the Cardiff University programme was essential to treating the condition:
“My PTSD left me feeling very weird and discombobulated. When I was at home, I wanted to be out and when I was out, I wanted to be at home. I just couldn’t settle. I couldn’t sleep and felt fretful, anxious and jumpy, and over the course of around three or four months this just got progressively worse.
“I went to the GP, and they suggested I might have PTSD. At that time, I thought it was more associated with military veterans – but the more we spoke the more I realised that diagnosis felt right. I was put on a very long waiting list to see a counsellor but while I was waiting a mental health nurse rang and she mentioned there was a trial going on at Cardiff University.
“Within days I was part of the trial, which was assessing a new online guided self-help programme called Spring. It was just absolutely fantastic. I was a mum and had just started a new job so didn’t have time to be off work or out of action – but I could dip into the programme at any time when I felt I had the headspace. It felt like it was just there when I needed it most but every week I would also have contact with a therapist so I never felt alone. It wasn’t easy and I had to put in the hard yards – but I wanted to my life back.
“The final step in the programme was to write a very detailed first-person account of my traumatic event and then read it over and over again until I became desensitised. It was as though writing it down just took it out of my head. I just felt so much better in a relatively short space of time.”
Sarah was Public Involvement Lead on this trial and is a named author on the scientific paper. Her role is to bring a personal perspective on PTSD to the research process and she has also set up a patient group. She added:
“Awareness of PTSD is growing all the time – and people are realising it can be caused by many different experiences. I also think use of technology in healthcare is more relevant now than ever in a pandemic. This new research has the potential to help so many people. It’s truly amazing.”
The study was conducted between 2017 and 2021 with participants recruited from NHS services in England (Coventry, Warwickshire, Greater Manchester, London, and south-west Yorkshire), Scotland (Lothian) and Wales (Cardiff, Gwent, Mid Glamorgan, and the Vale of Glamorgan).
It was funded by the UK National Institute for Health Research Health Technology Assessment programme. The NHS costs of the study were funded by the Welsh Government through Health and Care Research Wales.
The research team is now working with the NHS to effectively disseminate and implement guided internet-based CBT at scale, to maximise its effect.
- Read the BMJ paper online
- Watch a video explaining the RAPID trial and how the new therapy works
- Watch a video of the user’s experience