Improving PTSD Symptoms With Internet-Based Treatment
Research shows that online therapy can provide a cost-effective, convenient, and effective form of treatment for people living with PTSD. Online therapy can also minimize the symptoms of depression and anxiety that often come with PTSD.
Many people will experience a traumatic experience at some point in life, but only a small number will develop post-traumatic stress disorder (PTSD). PTSD is a condition that can occur after experiencing trauma, and it can happen to anyone. Studies show that 8% of women and 4% of men will experience PTSD at some point in their lives.
Treatment for PTSD
PTSD looks different for each person who has it. In some people, their main symptom may be flashbacks to their traumatic event during which they relive the moment. For others, PTSD can manifest in feelings of sadness, emptiness, and anxiety.
Fortunately, many people see improvement in PTSD symptoms when they get treatment. A common treatment for PTSD is trauma-focused psychotherapy, in which the individual and their therapist will focus on the memory of the traumatic event to help process the experience. Sometimes this process includes talking about and visualizing the experience, and other times therapists will help individuals change unhelpful beliefs about the trauma. Other PTSD treatments include eye movement desensitization and reprocessing (EMDR), stress relief and breathing techniques (stress inoculation training), and medications.
When you’ve experienced trauma, sometimes the last thing you want to do is talk about it. You may fear that talking about it will only make you feel worse, and while it can be hard initially, many people find treatment to be beneficial in the long run. Getting treatment can improve your quality of life, reduce or eliminate PTSD symptoms, and help you learn new skills for coping.
Research on online PTSD treatment
Even though PTSD treatment has been proven effective, many people don’t seek the help they need. Sometimes, these barriers are lacking healthcare coverage, living in a rural area, lacking financial ability, and lacking adequate providers. However, online therapy for PTSD offers a solution to these barriers. People with PTSD can get the help they need conveniently, and there is promising research demonstrating online therapy’s value in treating PTSD.
People have used the internet as a source of healing since its inception. Individuals in pain find solidarity in forums where they can discuss their concerns with others who can empathize or on social media, where friends and family can offer support. Because traumatic experiences are often associated with shame, the unknown nature of the internet (particularly forums) can provide a safe space for individuals to work through their emotions.
The internet can close the gaps of time and proximity in human communications and create a unified state of connectedness. Online therapy is a natural step in treating PTSD in a world that already uses the internet as a source of healing. This article will look at a recent study by Christine Knaevelsrud and Andreas Maerker, which aimed to evaluate the efficacy of internet-based therapy for PTSD. Through reflective writing exercises and an online therapeutic alliance, participants had the opportunity to unpack their trauma in a safe space and build a genuine connection with their therapist.
Methods of study
In this study, ninety-six participants with post-traumatic stress disorder were assigned to ten internet-based (CBT) sessions conducted over five weeks. Cognitive-behavioral therapy helps patients challenge negative or unhelpful thoughts about themselves and the world, ideally leading to an improved outlook, functioning, and quality of life.
Each participant had to be at least 18 years old and been through a traumatic event. Ninety percent of participants were women, and the average age was 35 years old. Treatment was conducted by two doctoral-level clinical psychiatrists who had received special training in writing exercises for PTSD.
In each online session, therapists encouraged patients to engage in writing exercises to help them process their traumatic experiences. Through their study, researchers aimed to measure the severity of PTSD symptoms before and after therapeutic intervention. Additionally, researchers wanted to check for improvements in depression, anxiety, dissociation, and physical health. Following the first symptom assessment, assessments were conducted at the end of treatment and three months after treatment.
Phase 1: Self confrontation
In the first phase of the study, the therapists supported patients as they focused on the most painful images and thoughts related to their trauma and encouraged the patient to write about them. Participants were instructed to describe the event in a first-person, present-tense, and detailed manner, including the fears and thoughts concerning the traumatic experience. Their descriptions included sensory details, including feelings, smells, sights, and other stimuli.
Participants were encouraged not to concentrate on style, grammar, spelling, or the chronological order of their essays. If needed, the therapist supported the patient to address any avoided features that would be necessary for a thorough explanation of their trauma.
Phase 2: Cognitive restructuring
In the second phase, therapists helped patients form a new perspective on their traumatic experience and regain a new sense of control. Participants wrote a supportive letter to an imaginary friend who had experienced the same trauma the patient had. Through this activity, participants were able to indirectly reflect on their feelings of guilt and shame, improving dysfunctional thinking patterns and correcting negative assumptions.
Phase 3: Social sharing and farewell ritual
They were then instructed to write a final letter in which they summarized what happened to them then reflected on the therapeutic process. Patients discussed new coping mechanisms and how they plan to cope in the future. This letter could be addressed to themselves, a close friend, or another significant person, and it did not need to be sent—the process of writing it, rather than sending it, was the therapeutic component.
Results
The study intended to see whether online therapy could effectively improve PTSD symptoms (and comorbid symptoms) and whether individuals could form positive and beneficial relationships with therapists without face-to-face interaction. After completing the study, researchers found that individuals’ PTSD symptoms were significantly improved from baseline to post-treatment assessment compared to control groups. Additionally, comorbid anxiety and depression incidences were reduced compared to control groups.
These improvements were sustained into the 3-month follow-up period. Due to low drop-out rates (16%) and reports of positive therapeutic relationships (76%), researchers deduced that a positive and stable therapeutic relationship could be established online. The research indicated that patients formed tight bonds with their online therapists as much as in traditional patient-therapist relationships as the study progressed.
Some people may doubt the validity of an online connection compared to an in-person connection. But 86% of the patients in this study described the therapeutic interactions as personal, 76% reported positive attitudes towards internet therapy instead of face-to-face therapy, and 60% of patients said they did not miss face-to-face communication with a therapist.
Also, a relatively low drop-out rate (16%) and the fact that the majority rated this exclusively internet-based contact as positive (76%) and personal (86%) indicated stable and positive therapeutic relationships online.
Significance and future research
Ultimately, this study demonstrated online therapy’s potential as a viable treatment alternative for PTSD. It also demonstrated the possibility of a stable and beneficial online therapeutic relationship, which may improve treatment. For those who may doubt the legitimacy of online therapy, this study shows that it can be an effective and positive experience for people living with PTSD.
Future research in online PTSD therapy may benefit from focusing on a direct comparison of in-person and online modalities in the treatment of PTSD to evaluate the efficacy of online therapeutic interventions more clearly. Though the results of this study are promising, more research about applicability and modes of online therapy would be beneficial in better understanding how online therapy can work for everyone.
Takeaway
If you’re interested in learning more about online therapy, don’t wait to get help. The licensed mental health providers at BetterHelp can assist you in getting started with a treatment plan that can help you address complex feelings related to trauma or any other mental health-related concerns.
What is the electronic treatment for PTSD?
Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS) are the most common forms of electronic treatments used for post-traumatic stress disorder (PTSD) as well as other mental disorders like depression, obsessive-compulsive disorder (OCD), and substance use disorders. Both methods use electrical currents to stimulate specific areas of the brain, but ECT is more invasive, and the process requires general anesthesia.
Can electroshock therapy help PTSD?
Research on electroshock therapy as an effective treatment for PTSD is ongoing, but recent available studies indicate it can help manage its symptoms. A 2023 meta-analysis compiled information from five studies showed ECT had a significant effect on reducing three symptom categories for each treatment group:
- Intrusion— Unelicited intrusive memories, flashbacks, nightmares, and emotional/physical symptoms after exposure to them.
- Behavioral Avoidance— Avoiding reminders of traumatic experiences such that they affect the individual's daily life. These may include sounds, smells, places, and people.
- Hyperarousal— Overactive, disproportionate stress responses to trauma triggers that disrupt daily functioning.
Another 2021 case report on electroconvulsive therapy (ECT) published in the National Library of Medicine also lends credence to the hypothesis that electroshock therapy can help reduce trauma-related nightmares commonly identified as a symptom of PTSD.
What is internet-based treatment?
Encyclopedia.com defines internet-based therapy as "a form of psychotherapy conducted over the internet rather than in face-to-face sessions."
What is currently the most effective treatment for PTSD?
According to a 2021 review published in the National Library of Medicine, the latest, most effective treatments for PTSD include trauma-focused therapies like Eye Movement Desensitization and Restructuring (EMDR), Cognitive Processing Therapy (CPT), and Prolonged Exposure Therapy (PE). In some cases, medications may be added to the treatment plan to help manage symptoms.
What type of therapy is recommended for PTSD?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) classifies PTSD under the category of trauma- and stressor-related disorders. Like the other conditions in this category, a PTSD diagnosis requires exposure to a traumatic or stressful event.
American Psychological Association (APA) guidelines strongly recommend four types of therapy for treating conditions involving exposure to trauma:
- Cognitive Behavioral Therapy (CBT)— Aims to uncover a patient's negative thought patterns that lead to unhealthy behaviors and emotional responses. Once they are identified, the therapist assists the patients in reframing those thought patterns to improve emotion control and encourage healthier behaviors.
- Cognitive Processing Therapy (CPT)— Challenges the patient's damaging beliefs related to their traumatic experience(s) so they may understand it differently and diminish their adverse effects on daily life.
- Cognitive Therapy— Encourages the patient to explore their perception so they may modify (unrealistic) negative observations and insights about traumatic event(s). The purpose is to reduce the impact these perceptions have on daily life.
- Prolonged Exposure Therapy (PE)—This type of CBT assists patients in approaching the feelings and memories associated with traumatic event(s). The purpose is to face those triggers and memories gradually, understand they aren't dangerous, and stop avoiding them so it's possible to move forward.
These types of treatments require a strong therapeutic alliance between the patient, psychologist, and physician (if appropriate) for the best possible treatment outcome.
What are internet-based programs?
Internet-based programs (also sometimes called online therapy) are used to treat mental health disorders virtually, typically via video chat.
Online therapy can be beneficial in many ways. It allows individuals to get therapy for those living in remote areas. It also eliminates barriers for those with difficulty commuting or physical disabilities that limit mobility.
Some studies indicate that patients can build a positive online therapeutic relationship and treatments like internet-based cognitive therapy (iCBT) are as effective as in-person therapy for treating mental health disorders.
For example, a meta-analysis published in The Lancet examined information from 17 randomized controlled clinical trials evaluating the effectiveness of internet-delivered vs in-person CBT. The results conclude that online CBT proved more effective than in-person treatment for reducing the severity of depression symptoms. While more studies are required for a more definitive analysis, research into the long-term effectiveness of online CBT also yields promising results. A 2017 review compiled information from 14 randomized controlled trials, including 902 participants. Follow-up assessments were conducted over three years.
Improved sustained treatment effects were reported as 50% for panic disorder, social anxiety disorder, generalized anxiety disorder, depression, mixed anxiety and depression, OCD, pathological gambling, and stress and chronic fatigue.
What is an example of an internet-based program?
There are a couple of types of internet-based programs for helping people with mental health conditions:
- Real-time web-based therapy programs via phone and online or video chat.
- Internet-based unguided self-help programs.
- Internet-based guided self-help programs combined with regular contact with a therapist.
- Web-based therapies via email, text, and online messaging or chat.
There is a growing body of research on the efficacy of these types of programs. For example, one controlled randomized trial from Oman measured therapeutic outcomes of therapist-guided online treatment versus internet-based self-help therapy. The trial involved 46 participants divided into an intervention (22) and a control group (24).
The intervention group participants attended one online session per week for six weeks facilitated by a certified psychotherapist. The control group received a weekly newsletter by email with self-help information and mental health advice based on the same therapeutic methods used in the intervention group.
The study's primary outcome provided evidence supporting the efficacy of online therapy in treating symptoms of anxiety and depression. Although participants from both groups reported improvement, therapist-guided online treatment proved more effective than online self-help-based methods.
Which are the internet-based services?
There are many platforms offering internet-based therapy services. These include, but aren't limited to:
- BetterHelp
- Regain
- Brightside
- Talkspace
What's new in the treatment of PTSD?
While internet-based treatment for PTSD continues to be effective for many individuals, researchers are testing new, innovative forms of treatment every day. Here are a few recent examples:
Written Exposure Therapy
In written exposure therapy (WET), patients are given specific instructions on writing about their traumas in narrative form. The treatment duration is five sessions of 50 minutes each—beginning with a summary of the previous session followed by 30 minutes of writing. After writing, the therapist briefly checks in with the patient and their experience. They're instructed to address and explore any related thoughts, emotions, memories, or other trauma-related things they experience in connection with their last session, which will be discussed in the beginning of the next.
A growing body of research suggests that WET is potentially more efficient at treating PTSD than other, more traditional types of therapy. One recent clinical trial compared efficacy rates for WET to CPT treatments in 169 active-duty service members diagnosed with PTSD. While treatment outcomes emerged as relatively comparable between them, the WET group had lower dropout rates and required less time spent in therapy sessions than CPT.
Mindfulness-Based Interventions
While mindfulness-based therapy has been used to treat many types of mental disorders, research into its efficacy in treating PTSD is growing. A recent study published in the National Library of Medicine recruited 53 adults (17 in the intervention group and 36 in the waiting list control group) identified as traumatized to participate in an online mindfulness-based intervention for symptoms. At a three-month follow-up, the intervention group reported reduced self-organization symptoms and relationship disturbances.
MDMA-Assisted Therapy
Psychedelic-assisted treatments for PTSD have been a source of debate between researchers, with some siting its potential effect on people with comorbid substance use disorders. Although research is ongoing, information from current studies suggests that MDMA has potential. One phase three study published in September of 2023 found that MDMA was "effective for reducing PTSD symptoms and functional impairment in a diverse population with moderate to severe PTSD."
Though the FDA has not yet approved MDMA-assisted therapy for PTSD, a decision is expected in early 2024.
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