The heterogeneity observed in the analysis is likely attributed, at least in part, to the diversity of routine care provided across studies. The decision to combine the waitlist control group and the no-treatment group was made due to the limited number of studies in the no-treatment group; separating them would not have added substantial value to the analysis. However, it has been suggested that the baseline effects in waitlist control groups may be lower than those in no-treatment groups 80, which could potentially exaggerate the relative effects of active interventions when compared to no-treatment controls. Publication bias and sensitivity analyses indicated no significant evidence of publication bias, and the robustness of the study findings was confirmed. This suggests that the results remained consistent and unaffected by variations in influencing factors or parameters.
Nonresponse to CBT
Specifically, in the corpus of 20 studies under review, the Symptom Scale was uniformly employed as the primary outcome indicator. Additionally, the CPSS was utilized in 6 studies, the UCLA-PTSD RI in another 6, and the CRIES-13 in 3 studies. The remaining 6 studies adopted diverse instruments, namely the TSC-C, HTQ, IES-R, PCL-5, ETI-CA, and CROPS. The studies encompassed a diverse array of countries and regions, including five from the United States, three from mainland China, two from Northern Ireland, two from the United Kingdom, and one each from Norway, Iran, Thailand, Mexico, Germany, Colombia, South Africa, and the Netherlands. Of the 20 studies, 17 employed a 1-to-12-month post-intervention follow-up survey, and only four interventions (TF-CBT, CBT, meditation, and mindfulness) reported follow-up survey data in detail.
How effective is CBT for PTSD?
Similarly, 8.7% (4/46) of individuals in the iCBT group reported a clinically significant increase in symptoms of anxiety at post-treatment. None of the 41 participants allocated to the psycho-educational website reported clinically significant increase in their symptoms of depression or anxiety. Additionally, no participants in either treatment group reported a clinically significant increase in PTSD symptoms. Information on the effectiveness of iCBT for PTSD symptoms was available from two systematic reviews5,14 and two RCTs.36,37 The systematic review by Kuester et al.21 provided pooled results on PTSD symptom severity, rather than results from individual included studies. Because of this it was not possible to extract PTSD symptom severity data from only the relevant primary studies and these findings are not discussed further.
Appendix 5. Overlap between Included Systematic Reviews
- For example, a (fictitious) patient called Mary was experiencing ongoing domestic abuse, but on one occasion she was subjected to non-fatal strangulation.
- In the absence of timely intervention and psychological support, the disorder may precipitate a progressive decline in emotional, behavioral, and cognitive well-being, potentially culminating in suicidal ideation and behavior 19.
- These findings are consistent with previous reviews on the effectiveness of MBIs, such as TF-CBT, mindfulness, yoga, and meditation, in reducing PTSD symptoms among veterans 70, adults 71, and children 72.
- A large number of participants (approximately 75%) in each treatment group also experienced clinically significant reduction in symptoms of PTSD, while no participants reported a clinically significant increase in symptoms of PTSD (as assessed with the reliable change index).
- Therapists participating in the Lewis et al.36 study were asked to record any adverse event arising during the trial.
Access to a psychoeducational website that contained informational content from the first three treatment modules (which focused on relaxation, grounding, and coping strategies). This document was externally reviewed by content experts and the following individuals granted permission to be cited. Z.B.J. participated in the Sober living house conceptualization phase by developing the initial research idea, research questions or hypotheses, and the overall research design. Z.B.J., S.X.Y., Z.J.C. conducted data collection, screening of the literature and literature inclusion.
Objective:
Three systematic reviews with meta-analyses and two additional randomized controlled trials were identified regarding the clinical effectiveness of internet-delivered cognitive behavioural therapy for patients (≥16 years of age) with a primary diagnosis of post-traumatic stress disorder. The features of the treatment programs (e.g., number of modules, duration, level of guidance, and frequency of support), scales used to assess clinical outcomes, and characteristics of patients (e.g., age, sex, type of trauma) examined in these studies were heterogeneous. The aforementioned interventions are collectively classified as mind–body interventions, with the majority falling under the category of mind–body therapies (MBT), a therapeutic approach grounded in the understanding of the intricate interplay between mental and physical processes. These interventions are designed to alleviate the impact of stress and tension while promoting overall physical and psychological well-being 38. Mind–body therapies have increasingly been employed as an alternative strategy for mitigating PTSD symptoms. Numerous systematic reviews and meta-analyses have evaluated the efficacy of psychological and psychosocial treatments for PTSD in children and adolescents 39,40,41.
Table 3Characteristics of Included Primary Clinical Studies
The primary outcomes measured were changes in PTSD symptom scores post-treatment and at follow-ups ranging from 1 to 12 months. Trauma-focused CBT, an evidence-based practice for children, is being disseminated and implemented through a variety of strategies, including distance learning/Internet training, live training in addition to ongoing phone consultation, a learning collaborative model, and mixed models. It has been used to spread the trauma-focused CBT model among community clinicians treating traumatized children. Data from these dissemination/implementation models vary, but overall they support the effectiveness of both the trauma-focused CBT model in treating traumatized children and a variety of dissemination and implementation models.115 Short-term group CBT has been found to be a useful treatment approach with long-term benefit. All participating clinicians were trained to use the CBT models and received case consultation for 18 months by expert clinician consultants and the treatment developers.117 This exercise can provide a model for implementing CBT in communities following massive disasters.
None of the included studies5,14,21,36,37 examined unguided iCBT programs for the treatment of individuals with PTSD. Since this is such a well-researched and popular therapy type, there are many therapists who use it with their clients. To find a therapist, check out Psych Central’s resource page on how to find mental health support. Current evidence suggests both a psychological and neurophysiological basis for the response to CBT. The preventive potential of CBT for PTSD has been recognized, when instituted early in at-risk populations. There is a need for more studies in developing countries following disasters that affect huge populations.
Conceptualizations of “Brain Fog” in Other Clinical Populations
No relevant evidence regarding the clinical effectiveness of iCBT for suicidality in patients with PTSD was identified. The research strategy was implemented by two researchers to import the obtained literature into Endnote X 9.1 software and to exclude duplicate literature. Z BJ and S XY were responsible for independently screening and extracting the literature, respectively.
- Consequently, they feel unable to engage in activities and relationships that used to be important for them.
- With SFBT, a therapist may ask questions designed to elicit details of your strengths and resources, instead of asking for details of the traumatic event.
- Because of this it was not possible to extract PTSD symptom severity data from only the relevant primary studies and these findings are not discussed further.
- The aim of these calls was to assess the participants’ mood, substance use, suicidal or self-harming thoughts, frequency of logging into the program, time spent in enjoyable activities, and to discuss technical problems or distress related to the program.
- Randomization was done using appropriate computer-assisted methods that could not be influenced by study investigators, decreasing the risk for a biased allocation process (selection bias).
- The treatment plan used to target “brain fog” is dependent on the underlying mechanisms contributing to symptoms (eg, is it due to PTSD, comorbid mental health conditions, or health issues).
- The RCT38 comparing iCBT with an exposure component to iCBT without an exposure component reported a dropout rate of 12% in the exposure group and 14% in the group without an exposure component.
- We are remembering a cluster of things that make sense of that individual experience at that time.
If the individual is preoccupied by the social life event and is unable to focus on the assessment, then they are likely to have difficulty in engaging with therapy. Patient cognitive behavioral therapy histories that involve many adverse events can raise certain issues at assessment, not least how to make sense of their cumulative effects. When people experience multiple traumas their memory of these may become blurred and entangled, with one memory triggering another.