Is Online Therapy as Effective as Face-to-Face Therapy for Post-Traumatic Stress Disorder?

What you need to know

• Guided internet-based cognitive behavioral therapy was found to be as effective as face-to-face therapy for treating mild to moderate post-traumatic stress disorder (PTSD).
• The online therapy was significantly cheaper to deliver than face-to-face therapy.
• Online therapy could help more people access effective PTSD treatment, reducing wait times and increasing convenience for patients.

What is post-traumatic stress disorder?

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event. Common symptoms include:

• Reliving the traumatic event through flashbacks or nightmares
• Avoiding reminders of the trauma
• Negative changes in thoughts and mood
• Feeling on edge, easily startled, or having angry outbursts

PTSD affects about 4% of adults in the UK. Without treatment, symptoms can persist for years and significantly impact a person’s quality of life, relationships, and ability to work. PTSD is also associated with higher rates of other mental and physical health problems.

How is PTSD usually treated?

The main recommended treatment for PTSD is trauma-focused cognitive behavioral therapy (CBT-TF). This is typically delivered face-to-face by a therapist over 8-12 weekly sessions. CBT-TF helps people process traumatic memories and change unhelpful thoughts and behaviors related to the trauma.

While effective, there are some challenges with traditional face-to-face CBT-TF:

• Long wait times to see a therapist (sometimes over a year in the UK)
• Difficulty attending weekly in-person sessions due to work, childcare, etc.
• Reluctance to leave home or discuss trauma face-to-face for some patients

To address these issues, researchers have been exploring internet-based CBT-TF options that could increase access to treatment.

What did this study investigate?

This study, called the RAPID trial, compared two types of CBT-TF for adults with mild to moderate PTSD:

1. Traditional face-to-face CBT-TF: Up to 12 in-person sessions with a therapist, 60-90 minutes each
2. Guided internet-based CBT-TF: An 8-step online program with up to 3 hours of therapist guidance

The researchers wanted to determine if the online therapy was “non-inferior” to face-to-face therapy. In other words, was it at least as effective as the traditional approach?

How was the study conducted?

The study included 196 adults in the UK with mild to moderate PTSD related to a single traumatic event. Participants were randomly assigned to receive either face-to-face or internet-based CBT-TF.

The main outcomes measured were:

• PTSD symptom severity at 16 weeks and 52 weeks
• Depression, anxiety, and other mental health symptoms
• Quality of life and daily functioning
• Cost-effectiveness of the treatments

The researchers also interviewed some participants and therapists to get their perspectives on the online therapy approach.

What were the key findings?

Effectiveness of treatment

At 16 weeks after starting treatment:

• Both groups showed large improvements in PTSD symptoms
• The online therapy was found to be “non-inferior” to face-to-face therapy
• About 85% of participants no longer met criteria for PTSD diagnosis in both groups

At 52 weeks:

• Improvements were maintained in both groups
• Face-to-face therapy showed slightly better results, but the difference was small

Cost of treatment

• The online therapy cost an average of £277 per patient to deliver
• Face-to-face therapy cost significantly more at £729 per patient

Patient and therapist perspectives

Most participants found the online therapy acceptable and helpful. Some benefits mentioned included:

• Flexibility to complete at home on their own schedule
• Feeling more in control of the pace of treatment
• Less intimidating than face-to-face sessions for some

Some challenges noted were:

• Less personal connection with the therapist
• Difficulty staying motivated for some without in-person accountability
• Technical issues for a small number of participants

Therapists generally felt the online program was a good option, especially for increasing access to treatment. However, some had concerns about conducting exposure therapy remotely.

What are the implications of these findings?

This study provides strong evidence that guided internet-based CBT-TF can be an effective first-line treatment for mild to moderate PTSD. Some key implications include:

1. Increased access to treatment: Online therapy could help more people receive timely, evidence-based care for PTSD.

2. Cost savings: The significantly lower cost of online therapy could allow mental health services to treat more patients with limited resources.

3. Patient choice: Having both online and face-to-face options gives patients more control over their treatment approach.

4. Reduced barriers: Online therapy may help people who struggle to attend in-person sessions due to work, childcare, mobility issues, or anxiety about leaving home.

5. Pandemic preparedness: Having effective online options is valuable for continuing mental health care during situations like the COVID-19 pandemic.

What are the limitations of the study?

While the results are promising, there are some important considerations:

• The study only included people with mild to moderate PTSD from a single traumatic event. The results may not apply to those with more severe or complex PTSD.

• The follow-up period was one year. Longer-term outcomes are still unknown.

• The study was conducted in the UK healthcare system. Results may vary in other countries or healthcare settings.

• Some participants dropped out of the online therapy (10%) more often than face-to-face therapy (4%), suggesting it may not be suitable for everyone.

Conclusions

Guided internet-based CBT-TF appears to be an effective, well-tolerated, and cost-efficient treatment option for adults with mild to moderate PTSD. While face-to-face therapy may still be preferable or necessary for some individuals, having online options could significantly improve access to care for many people struggling with PTSD.

As one of the largest and most rigorous studies on this topic to date, these findings will likely influence clinical guidelines and healthcare policy regarding PTSD treatment. However, more research is still needed on long-term outcomes and the effectiveness of online therapy for more complex cases of PTSD.

If you or a loved one is dealing with PTSD, discuss treatment options with your healthcare provider. They can help determine if internet-based CBT-TF might be a good fit based on your individual needs and circumstances.