JMIR Publications

ABSTRACT

Background:

Cognitive behavioral interventions delivered via the Internet are demonstrably efficacious treatment options for posttraumatic stress disorder (PTSD) in underserved populations from Arabic-speaking countries. However, the role of specific treatment components remains unclear, particularly in conflict-affected areas of the Middle East and North Africa.

Objective:

The aim of this study was to evaluate two brief internet-based treatments regarding efficacy, including change in PTSD symptom severity during treatment. Both treatments were developed in line with Interapy, an internet-based, therapist-assisted cognitive behavioral therapy protocol for PTSD. The first treatment comprised self-confrontation and social sharing (EXPO; 6 sessions) and the second comprised cognitive restructuring and social sharing (CR; 6 sessions). The two treatments were compared with each other and with a waitlist control group (WAIT).

Methods:

In total, 365 Arabic-speaking participants (mean age 25.49 years; 74.5% female) with PTSD were allocated to CR (n=118), EXPO (n=122), or WAIT (n=125) between February 2021 and December 2022. PTSD symptom severity, posttraumatic maladaptive cognitions, anxiety, depressive and somatoform symptom severity, and quality of life were assessed by self-report at baseline and after treatment/waiting time. PTSD symptom severity was additionally measured throughout treatment/waiting time. Treatment satisfaction was assessed after treatment completion. Treatment use and satisfaction were compared between the two treatment conditions using Chi-square, Welch tests, or appropriate alternatives. Multiple imputation was performed to deal with missing data and evaluate treatment-associated changes. Changes associated with treatment were analyzed using multi-group change modeling in the completer and the intention-to-treat sample.

Results:

Overall, 83.3% of participants started one of the treatments, of whom 61.5% completed the respective treatment. Treatment condition was not significantly associated with the proportion of participants who started vs. did not start treatment (P=.20) or with treatment completion vs. treatment dropout (P=.71). Nearly 90% of all completers who filled out the evaluation questionnaire (n=118) reported high treatment satisfaction, with no significant differences between the treatment conditions (P=.48). In both treatment conditions, PTSD, anxiety, depressive and somatoform symptom severity, and posttraumatic maladaptive cognitions decreased and quality of life improved significantly from baseline to post-treatment (all P<.005). On average, compared to baseline assessment, PTSD symptom severity decreased significantly after four sessions in both treatment conditions. Moreover, both treatment conditions were significantly superior to the waitlist control group regarding PTSD symptom severity (all P<.005) and most other comorbid mental health symptoms (P values between <.001 and .03). Differences between the two conditions in the magnitude of change for all outcome measures were non-significant (all P>.005).

Conclusions:

Brief internet-based cognitive-behavioral treatments for PTSD focusing primarily on either self-confrontation or cognitive restructuring are applicable and efficacious for Arabic-speaking participants. Clinical Trial: German Clinical Trials Register DRKS00010245; https://drks.de/search/de/trial/DRKS00010245