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.

Improving PTSD symptoms through online mental health programs

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 after a traumatic event

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.

Future research on post-traumatic stress disorder treatment

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.