JMIR Publications

ABSTRACT

Background:

Background:

Posttraumatic Stress Disorder (PTSD) is a debilitating condition that remains undertreated. Online delivery of cognitive behavioural therapy supplemented with mindfulness meditation and yoga can be a viable treatment that emphasizes self-directed practice.

Objective:

This study examined the effectiveness of an online cognitive behaviour therapy program combined with mindfulness and yoga methods (CBT-MY) designed for daily use.

Methods:

Method: An 8-week single-arm experimental registered clinical trial (www.clinicaltrials.gov ID: NCT03684473) was conducted on a sample of adults, ages 18-35 years, with PTSD symptoms (n = 22). Each participant received online CBT-MY content and an hour of online counselling each week. Pre-post psychological outcomes were self-reported PTSD symptom severity, depression, anxiety, chronic pain, and mindfulness. Pre-post psychophysiological outcomes were pupillometry and heart rate variability (HRV) measured during a lab protocol. The HRV and pupillometry outcomes were also compared with cross-sectional data from a non-PTSD comparison group that did not receive the intervention and reported no history of clinical mental health diagnoses (n = 46).

Results:

Results:

Pre-post intention-to-treat analyses revealed substantial improvements in PTSD severity (d = 1.60), depression (d = 0.83), anxiety (d = 0.99), and mindfulness (d = 0.88). Linear multilevel mixed modelling revealed significant pre-post reductions in peak pupil diameter (PPD) at 8-week follow-up (ΔM = -.06, SE = .01, p = .000) but no significant changes in pre-post HRV (p = .87). Participants spent a mean of 12-minutes/day in self-directed mindfulness practice (M = 38.89 mins/week, SD = 28.16), guided yoga (M = 31.94 mins/week, SD = 28.24), and breath awareness techniques (M = 9.89 mins/week, SD = 11.87).

Conclusions:

Conclusion: Online CBT-MY program participation was associated with clinically significant symptom reductions in combination with significant PPD changes reflecting more normalized autonomic functioning. Future RCT research is needed to further examine the gains apparent in this single-arm study. Clinical Trial: This study was a registered single-arm experimental clinical trial (www.clinicaltrials.gov ID: NCT03684473).