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Posttraumatic stress disorder (PTSD) is a stress disorder characterized by unwanted intrusive re-experiencing of an acutely distressing, often life-threatening, event, combined with symptoms of hyperarousal, avoidance, as well as negative thoughts and feelings. Evidence-based psychological interventions have been developed to treat these symptoms and reduce distress, the majority of which were designed to be delivered face-to-face with trained therapists. However, new developments in the use of technology to supplement and extend health care have led to the creation of e-Mental Health interventions.
Our aim was to assess the scope and efficacy of e-Mental Health interventions to treat symptoms of PTSD.
The following databases were systematically searched to identify randomized controlled trials of e-Mental Health interventions to treat symptoms of PTSD as measured by standardized and validated scales: the Cochrane Library, MEDLINE, EMBASE, and PsycINFO (in March 2015 and repeated in November 2016).
A total of 39 studies were found during the systematic review, and 33 (N=3832) were eligible for meta-analysis. The results of the primary meta-analysis revealed a significant improvement in PTSD symptoms, in favor of the active intervention group (standardized mean difference=-0.35, 95% confidence interval -0.45 to -0.25,
This review demonstrates an emerging evidence base supporting e-Mental Health to treat symptoms of PTSD.
Posttraumatic stress disorder (PTSD) is a stress disorder primarily characterized by four main symptom clusters: (1) unwanted intrusive re-experiencing of an acutely distressing, often life-threatening, event, (2) an ongoing state of hyperarousal, (3) an active avoidance of stimuli associated with an event that is perceived to be “traumatic”, and (4) negative thoughts or feelings that began or worsened after the trauma. Symptoms relating to PTSD are also found in people who may not have a formal diagnosis and can vary considerably in terms of severity. Other mental health problems such as poor anger control, drug and alcohol problems, and depression can develop alongside symptoms of PTSD, which can delay access to treatment and increase the burden of illness for individuals [
Evidence-based psychological interventions have been developed to treat symptoms of PTSD, and the majority of these are designed to be delivered face-to-face using trained therapists. A recent systematic review and meta-analysis of psychological therapies for PTSD [
Access to evidence-based psychological interventions for PTSD remains a high priority in health care agendas, where screening and early interventions are recommended to prevent the development of more chronic presentations. However, mental health resources are often stretched and there is a need to think about extending access to such treatments. Information technology is becoming increasingly part of everyday life, and the possibility of seeking support and reputable information for mental health problems online is becoming more available. The Internet offers a means of accessing e-Mental Health resources for people in need of support, wherever they may be and at whatever time they require input. For people who are limited in their ability to access outpatient health services, be it due to funding, reduced physical mobility, lack of transport, or for fear of stigmatization, e-Mental Health services may be the most viable way for them to receive treatment in a timely and effective manner. Subclinical groups may benefit from evidence-based psychological approaches that prevent problems from worsening. There is an opportunity to increase accessibility of effective psychological support and empower people to take control and self-manage symptoms by embracing technological advances. This could either be via complete self-management or with some additional guidance.
There is already a good evidence base to support the effectiveness of e-Mental Health resources based on psychological models of therapy such as computerized CBT (cCBT) for treatment of depression and some anxiety disorders. Indeed, meta-analyses conclude that cCBT may be a very promising and efficacious treatment for depression within a diverse range of settings and clinical groups [
For the purpose of this review, e-Mental Health interventions are defined as psychological interventions delivered via the Internet through an interactive computer interface, including desktop and mobile devices. The aim was to evaluate the broader evidence base for e-Mental Health interventions (both Web-based and mobile-based) for treatment of symptoms associated with PTSD, specifically investigating the role of exposure exercises. In line with the latest review on face-to-face therapies for PTSD, the authors have retained the distinction made between TF-CBT and non-TF-CBT. EMDR and psychodynamic approaches were beyond the scope of this review as they have not yet been translated into e-Mental Health formats. The choice was to include a broad range of clinical and subclinical groups, including people treated within a physical health setting and without a formal diagnosis of PTSD, to assess the possible scope of such interventions to aid self-management.
The following databases were searched in March 2015 using the keywords and phrases detailed in
Search terms for systematic review, combining Line 1 AND Line 2.
Search lines | Search terms | Filtered by |
Line 1 | PTSD |
Title/Abstract |
Line 2 | (internet* OR web* OR tele* OR online OR “on-line” OR computer* OR mobile*) AND (“self-help” OR (self AND help) OR tool* OR resource* OR manual* OR package OR program* OR therap* OR intervention* OR application* OR technolog* OR device*) |
Title/Abstract |
The titles and abstracts for all identified papers were screened against the following inclusion criteria: (1) randomized controlled trial (RCT), (2) psychological therapy administered via a Web-based or mobile platform designed to treat symptoms of PTSD, (3) adults (aged 18 or over), (4) experience of a possible single-event trauma, and (5) assessed and reported symptoms of PTSD with a validated measure immediately after intervention. There was no restriction in terms of severity of PTSD symptoms or type of traumatic life event, and RCTs were included if they compared a waitlist, treatment as usual, or an active intervention. Interventions where participants received supplementary guidance from a therapist or other technical assistant were included and considered separately. Reasons for the exclusion of studies included technology that was not Web-based or mobile-based; study designs that were not RCTs including experimental manipulations, duplications, or interim or additional analysis; no measure of PTSD; an evaluation of complex intervention that included a Web-based intervention but did not exclusively test this; unpublished and unable to access results through personal communication; narrative literature reviews; and published protocols with no results.
Two of the authors (SS and JB) read titles and abstracts of all potential papers independently and selected relevant articles for further review. Possible RCTs were read in full to determine if the trial met the inclusion criteria. This process was repeated after the second systematic search in November 2016 for articles published since March 2015.
Literature searches were completed using reference manager software (Endnote X6 and Mendeley). Data were extracted from each paper on the (1) characteristics of each sample, including the population and demographic information such as the mean age or age range in years and the percentage of female participants, (2) characteristics of the treatment and control conditions, including the therapeutic model (for active conditions) and treatment duration, and (3) baseline and posttreatment scores on validated measures of PTSD. Authors were contacted directly for missing information. If the authors could not be contacted or did not respond, their papers were removed from the meta-analysis and included only in a narrative synthesis.
All studies were subject to a structured quality assessment to investigate risk of bias using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies [
The primary outcome of interest was severity of PTSD, measured continuously using a validated self-report or clinician-rated measures. This was qualified by the mean score value (M) and standard deviation (SD) on these measures.
RCTs were subdivided and considered separately if they compared an active treatment condition to another active treatment condition or to a waitlist or treatment as usual (TAU) condition.
Studies were also considered separately depending on the therapeutic approach taken as part of active treatment condition. They were grouped as follows:
TF-CBT: treatment interventions that specifically involved exposure to aspects of the trauma and support to reappraise the physical and cognitive reactions that occurred at the time of the event.
Non-TF-CBT: treatment interventions based on the principles of CBT that employed more general stress management techniques to help reduce anxiety (eg, relaxation).
Other e-Mental Health interventions for treatment of PTSD: this category was included to capture treatment interventions that were not strictly designed based on CBT-based principles.
Studies were further characterized by the level of guidance provided during this intervention and grouped as follows:
Individual tailored therapeutic feedback: feedback provided by a trained facilitator that related directly to the content of the therapeutic intervention.
Individual technical nontherapeutic support: support to facilitate technical functioning of the website or device that did not relate directly to the content of the therapeutic intervention.
Online discussion forum: a message board where participants could post messages and receive tailored feedback from a trained facilitator or peers.
Automated feedback only: feedback that was not individually tailored and was generated automatically in response to the completion of a task, for example.
Group feedback via videoconferencing: immediate feedback via videoconferencing provided by a trained facilitator or peers.
No guidance: no additional feedback or support in any form reported.
To assess the impact of intervention on total PTSD scores, standardized mean differences (SMDs) were calculated using postintervention mean and standard deviation values, with 95% confidence intervals (CI), as the primary outcome measures. Missing standard deviation values were calculated from the confidence intervals, standard errors, and sample sizes reported in the papers where possible and where this was not possible, additional information was requested from authors. In some cases, papers reported the median and interquartile ranges instead of the mean and standard deviation values and so this extra information was sought from authors. These data were pooled in a random-effects meta-analysis using Review Manager 5.0. The I2 statistic was calculated and used to assess heterogeneity of the studies included in each of the analyses. The following thresholds were followed: 0%-40% for unimportant heterogeneity, 30%-60% for moderate heterogeneity, 50%-90% for substantial heterogeneity, and 75%-100% for considerable heterogeneity [
Planned sensitivity analyses were conducted to test the robustness of the results. These included the exclusion of studies with a high risk of bias (defined as studies categorized as weak on the EPHPP tool) and where PTSD was not the primary outcome. Further planned subgroup analyses included the comparison condition (active comparison interventions vs waitlist or TAU control conditions), the model of therapy followed in the treatment condition (TF-CBT vs non-TF-CBT vs other models of therapy), and the type of guidance received during the treatment intervention (categorized as described in the section on guidance).
The search strategy conducted in March 2015 returned 2984 papers after duplicates were removed; 7 extra sources of information were obtained through hand searching or personal communication. A consensus was reached between two authors (SS and JB) that 30 RCTs met the inclusion criteria for the review. A further 9 papers were found following a repeat of this procedure in November 2016.
Flowchart of papers obtained and screened in the systematic search.
A description of key information characterizing the studies included in this review is provided in
The number of participants included in the RCTs ranged from 25 [
The countries where the research studies were carried out included the US (n=19), the Netherlands (n=5), Australia (n=4), Sweden (n=3), Germany (n=3), Switzerland (n=2), Canada (n=1), Poland (n=1), and China (n=1).
Seven studies included a sample who met full
Some studies focused on specific potentially traumatic events including bereavement [
Quality assessment of RCTs of e-Mental Health interventions for treatment of symptoms of PTSDa.
Study author (year) [ref] | Selection bias | Study design | Confounders | Blinding | Data collection methods | Withdrawals and dropouts | Global rating for design methods (A-F) |
Beatty (2016) [ |
• | ••• | ••• | •• | ••• | ••• | •• |
Beyer (unpublished) [ |
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Bomyea (2015) [ |
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Brief (2013) [ |
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Carpenter (2014) [ |
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Cernvall (2015) [ |
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Cieslak (2016) [ |
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Cox (2010) [ |
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Eisma (2015) [ |
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Engel (2015) [ |
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Hirai (2005) [ |
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Hirai (2012) [ |
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Hobfoll (2015) [ |
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Ivarsson (2014) [ |
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Kersting (2011) [ |
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Kersting (2013) [ |
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Knaevelsrud (2007) [ |
• | ••• | ••• | • | ••• | ••• | • |
Knaevelsrud (2015) [ |
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Krupnick (unpublished) [ |
•• | ••• | • | •• | ••• | • | • |
Lange (2001) [ |
•• | ••• | • | •• | ••• | ••• | •• |
Lange (2003) [ |
• | ••• | •• | •• | ••• | • | • |
Litz (2007) [ |
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Litz (2014) [ |
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Marsac (2013) [ |
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Miner (2016) [ |
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Mouthaan (2013) [ |
• | ••• | ••• | •• | ••• | • | • |
Nieminen (2016) [ |
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Owen (2005) [ |
•• | ••• | ••• | • | ••• | ••• | •• |
Possemato (2010) [ |
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Possemato (2011) [ |
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Sayer (2015) [ |
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Schoorl (2013) [ |
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Spence (2011) [ |
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Spence (2014) [ |
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Steinmetz (2012) [ |
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Wagner (2006) [ |
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Wang (2013) [ |
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Winzelberg (2003) [ |
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Zernicke (2014) [ |
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a•Weak; ••Moderate; •••Strong.
Of the 39 RCTs included, 21 compared the e-Mental Health intervention with a waitlist control condition [
The remaining studies compared to another active intervention, either instead of or as an additional arm to a waitlist control condition. Alternative active interventions included Web-based time management [
One final study directly compared a version of a Web-based CBT intervention with and without exposure to the traumatic event [
The e-Mental Health interventions included in the meta-analysis incorporated a variety of therapeutic models. The interventions were grouped by similarities in theoretical methodologies as also described in
We categorized 14 studies as TF-CBT [
We grouped 16 studies as non-TF-CBT approaches that included CBT techniques, as detailed above, but did not include an element of exposure to the traumatic event and support to reappraise reactions [
Nine studies trialed other types of e-Mental Health interventions including attentional bias modification [
In addition to this, interventions were further categorized into those that offered additional guidance. Some studies employed a combination of strategies to support completion. One study directly compared a Web-based intervention condition with and without guidance [
In addition to the study carried out by Beyer [
Two studies included intervention conditions where participants received individualized technical support but no tailored therapeutic guidance was offered [
Six studies included an online discussion forum where participants could interact with a licensed clinical psychologist or other mental health professional [
One study provided only automated feedback on participants’ performance on a test of mastery [
One study provided immediate feedback from both a behavioral medicine specialist and a group of peers completing the intervention live via video-conferencing technology [
A total of 12 studies reported on e-Mental Health interventions where participants were given no additional guidance [
The most commonly employed outcome measure of PTSD-related symptoms was the Impact of Events Scale (including the original IES, revised IES-R, and Dutch IES-D versions), which was administered in 16 studies [
Six papers did not include sufficient information to be included in the meta-analysis (including a total score on the measure of PTSD), and their authors did not respond to our request for further information. Therefore, 33 papers were included in the final meta-analysis. Where studies included multiple condition groups (≥3), these were included in the analyses as separate comparisons. The sample size was adjusted in these analyses to account for multiple comparisons (eg, the total sample size was halved if a comparison of the same active intervention was made to two independent control condition groups). In total, 5405 participants were included in the studies. Data from 3832 participants contributed to the meta-analyses.
Results of the quality assessment for risk of bias performed on the studies included in this systematic review can be found in
A meta-analysis on the between-group difference for end-point scores on measures of PTSD demonstrated a significant effect in favor of the treatment group (SMD -0.35, 95% CI -0.45 to -0.25,
Of the six studies that were not included in the meta-analysis, four studies found a significant difference on all subscales representing dimensional symptoms of PTSD, including intrusions, avoidance, and hyperarousal, in favor of the treatment intervention [
The planned sensitivity analyses (
Impact of Web-based interventions on PTSD: sensitivity analyses.
Analysis | Comparisons, n | Participants, n | SMDa (95% CI) | I2 statistic, % | |
Primary analysis | 38 | 3832 | -0.35 (-0.45 to -0.25) | <.001 | 81 |
Excluding studies with high risk of bias | 30 | 2340 | -0.36 (-0.50 to -0.21) | <.001 | 81 |
Excluding studies without PTSD as a primary outcome | 35 | 3551 | -0.34 (-0.44 to -0.24) | <.001 | 80 |
aSMD >0 favors control, and SMD <0 favors active intervention.
The first planned subgroup analysis involved separating studies into those that compared an active intervention to another active comparison condition and those that compared to either a waitlist control or treatment as usual.
Impact of Web-based interventions on PTSD: subgroup analyses.
Analysis | Subgroups | Comparisons, n | Participants, n | SMDa (95% CI) | I2 statistic, % | ||
Primary analysis | 38 | 3832 | -0.35 (-0.45 to -0.25) | <.001 | 81 | ||
Active | 18 | 1533 | -0.27 (-0.43 to -0.11) | <.001 | 52 | ||
Waitlist or TAU | 20 | 2352 | -0.41 (-0.69 to -0.14) | <.001 | 89 | ||
11 | 997 | -0.34 (-0.48 to -0.21) | <.001 | 92 | |||
Interapy | 3 | 465 | -10.24 (-12.32 to -8.15) | <.001 | 0 | ||
Other | 8 | 532 | -0.30 (-0.44 to -0.16) | <.001 | 77 | ||
Non-TF-CBT | 18 | 2227 | -0.36 (-0.50 to -0.22) | <.001 | 62 | ||
Expressive writing | 5 | 346 | -0.04 (-0.88 to 0.79) | .92 | 0 | ||
Attention bias modification | 1 | 102 | — | — | — | ||
Working memory capacity task | 1 | 42 | — | — | — | ||
Semistructured peer support | 1 | 72 | — | — | — | ||
Mindfulness-based stress reduction | 1 | 62 | — | — | — | ||
Individual tailored feedback | 16 | 1743 | -0.52 (-0.76 to -0.28) | <.001 | 90 | ||
Individual technical support | 2 | 261 | -0.27 (-0.40 to -0.14) | <.001 | 0 | ||
Online discussion forum | 6 | 913 | -0.26 (-0.53 to 0.01) | .06 | 72 | ||
Automated feedback only | 1 | 27 | — | — | — | ||
Live group feedback | 1 | 62 | — | — | — | ||
No guidance | 13 | 927 | -0.50 (-0.76 to -0.24) | <.001 | 13 |
aSMD > 0 favors control, and SMD < 0 favors active intervention.
The additional subgroup analyses showed that studies grouped together as following TF-CBT protocols were not only significantly effective compared to controls but were as effective as studies grouped together as following non-TF-CBT protocols. The heterogeneity of TF-CBT was high, falling within the substantial range. A subgroup analysis grouping together only those studies that trialed the intervention package, Interapy, demonstrated an unimportant level of heterogeneity, while retaining a significant between-group difference. The large variation in heterogeneity can be accounted for the other studies grouped together as TF-CBT interventions. Web-based expressive writing interventions did not significantly differ from their control conditions but demonstrated an unimportant level of heterogeneity suggesting that these interventions were more comparable. In terms of the single studies that could not be included in the meta-analysis, the attention bias modification training was reported to be equally effective at reducing symptoms of PTSD and an active control condition [
For the subgroup analysis of guidance, groups of studies demonstrated a significant between-group difference regardless of whether guidance was provided in the form of individual tailored feedback during the therapeutic intervention, as individual technical support only or if no guidance was provided at all. The heterogeneity of studies included in the subgroup analysis was the lowest for no guidance group. Both the individual tailored feedback group and the individual technical support group demonstrated at least a substantial degree of heterogeneity. The only subgroup that did not show a significant between-group difference included the studies that had only an online discussion forum. A meta-analysis could not be carried out on the two remaining groups: automated feedback only and live group feedback, given that only a single study included this method in each case. However, in terms of the results described in these papers, Hirai and Clum [
Impact of e-Mental Health interventions on PTSD, divided by comparison group.
This systematic review and meta-analysis summarizes the results of RCTs designed to assess the impact of e-Mental Health interventions on symptoms of PTSD. There is some evidence to suggest that these e-Mental Health treatments are effective at reducing PTSD-related distress over and above a variety of control conditions. Results from the primary meta-analysis of endpoint data showed a medium and significant between-group difference in PTSD symptoms, in favor of the active intervention conditions. However, there was considerable heterogeneity between the studies included in this review, raising some concerns about how meaningful it is to make direct comparisons between the studies included in this meta-analysis. The results remained similar when removing studies that were found to present a high risk of bias, suggesting that factors other than those contributing the quality assessment scores may have accounted for the high level of heterogeneity between studies.
When dividing studies by the characteristics of the condition to which they were compared, the results became slightly clearer. A medium and significant between-group difference was found for studies compared to either a waitlist control or TAU condition, favoring the active intervention. While still favoring the active intervention, only a small significant between-group difference was found for studies compared to another active condition. Studies compared to an active intervention were much less heterogeneous, providing some further confidence to support the reliability of these estimated effects. This evidence suggests that not only is there some good evidence emerging to support the efficacy of e-Mental Health treatments for PTSD but that these interventions contain an active component that is stronger than other Web- or mobile-based activities including psychoeducation, behavioral activation, weekly non-specific support, and factual writing about a traumatic event.
In a further subgroup meta-analysis, we explored the impact of different models of therapy. A medium and significant between-group difference favoring the active intervention was found for both studies categorized as employing TF-CBT techniques and non-TF-CBT techniques. The main difference between these interventions was that the former required participants to take part in exercises that encouraged them to re-engage with the trauma and work on reappraising the cognitive and physical consequences of the event, while the latter included CBT techniques with a more general focus on anxiety and stress management. From this analysis, there appears to be little difference between the two groups, with both being as effective as the other at reducing symptoms of PTSD. However, it is still important to note that these two subgroups of studies still demonstrated a high degree of heterogeneity, suggesting some qualitative differences between studies included in the analysis. CBT is a broad term, encompassing a wide range of therapeutic techniques. In addition to this, some studies reported incorporating techniques from alternative models of therapy, such as motivational interviewing, alongside CBT techniques. It is possible that some of the heterogeneity between studies could be accounted for by differences in the therapeutic techniques employed. When comparing studies that used the same Web-based treatment program (Interapy), the results were much less heterogeneous and remained significant and in favor of the active intervention condition. However, the between-group difference reduced to a small effect. This result was limited by the exclusion of four additional studies that trialed the efficacy of the Interapy program, as total PTSD scores could not be gathered from all the authors.
In relation to the alternative models of therapy trialed in previous RCTs for treatment of PTSD, as yet, there is little evidence to support the use of Web-based attentional bias modification paradigms, and only some emerging evidence to support a working memory capacity paradigm and mindfulness-based stress reduction techniques from single studies alone. A meta-analysis of expressive writing, without any additional CBT techniques, showed a nonsignificant difference between active intervention and control groups. There is scope to explore some of these alternative therapy models in greater depth. Face-to-face mindfulness-based approaches have been gathering evidence for treatment of recurrent and chronic depression, anxiety, and stress [
For the final subgroup analysis, we explored the impact of the type of guidance or support that participants received while completing e-Mental Health interventions. Medium-sized, significant group-differences, favoring the active interventions were found regardless of whether participants received individual tailored feedback or no guidance. Studies that provided participants with merely technical support demonstrated a small significant between-group difference in favor of the active intervention. This suggests that while previous studies have indicated that guidance improves outcomes for e-Mental Health interventions [
The only subgroup that did not demonstrate a significant between-group difference consisted of studies that had facilitated support with the e-Mental Health intervention via an online discussion forum. This was the only group-based means of providing feedback included in the meta-analysis. Emotions such as shame, guilt, and fear of negative evaluation from others are commonly associated with PTSD [
This review considered RCTs of e-Mental Health resources for treatment of PTSD-related symptoms, including TF-CBT, non-TF-CBT, and other psychological therapies. It encompassed research on trauma spanning different countries, including people with different experiences in terms of the characteristics of the trauma and severity of PTSD-related symptoms. Many of the studies demonstrated strengths in design, assessment, and analysis of results. The results are consistent with but also extend previous findings; this study reports a significant between-group difference when comparing active interventions to active control conditions as well as more passive waitlist or TAU control conditions [
This review did not consider acceptability of the interventions. Quality assessment indicated that studies varied in terms of participant retention, and it may be worthwhile to perform an analysis of dropout rates in an addition to the outcomes already assessed in this review. As people may be given access to e-Mental Health resources in their own homes without direct supervision, it is paramount that the risks and potential adverse effects associated with completing these type of interventions are thoroughly investigated. Finally, there were variations between studies in terms of treatment adherence, that is, the level of engagement necessary to constitute an episode of treatment. Some studies required submission of a set number of essays by participants, whereas others were monitored simply by the frequency of logging in to the intervention. For future research, determining the optimal level of engagement for therapeutic benefit of online treatments needs to be investigated in order to establish model fidelity of interventions and permit consistent clinical application.
This review focused on the use of e-Mental Health resources for treatment of PTSD. Only one study reported an RCT of a mobile-based treatment for PTSD. With the development of new mobile-based treatments, it is likely that future reviews may be able to make comparisons between Web-based and mobile-based technologies. Also missing from the scientific literature at present are studies that compare the relative efficacy of Web- or mobile-based and face-to-face therapist-delivered interventions for treatment of PTSD. In addition, there are limited follow-up data to assess the long-term benefits of interventions trialed. The review highlighted a number of weaknesses in the design of past studies particularly in relation to sample methods, the most notable being the unequal gender balance seen in most studies to date.
Research in this field is developing at a fast pace with creation of new technologies ever increasing. Future studies need to focus on maintaining a high quality of assessment of the efficacy and acceptability of these technologies in the face of these rapid developments. Assessment of side effects and risks should not be overlooked, despite the potential for interventions being more readily accessible. Replications of findings are needed to investigate the use of similar e-Mental Health interventions across diagnostics groups and health settings and could benefit from research to better understand which specific intervention packages or components work best and for whom. Related to this is the issue of gaining a better understanding of more practical factors influencing outcome such as an individual’s technological literacy, the ease of use given graphical interface designs, and the mode of delivery (eg, via computers or apps on mobile and tablet devices). There is scope for developing more user-friendly tools. Collaborations between software engineers and designers, who have the ability to build the technology; psychologists, who have the theoretical knowledge of evidence-based therapeutic interventions; and individuals trialing prototypes, who have a unique expertise in their implementation, will be very important for creating user-friendly and effective resources. There is far to go in terms of gathering the same level of evidence base as therapist-delivered approaches. However, the results presented in this systematic review take a small step forward in understanding how technology such as e-Mental Health resources may offer additional opportunities for increasing access to effective psychological support for people suffering from PTSD, to improve well-being.
Characteristics of studies.
cognitive behavioral therapy
computerized cognitive behavioral therapy
confidence interval
Diagnostic and Statistical Manual of Mental Disorders
Eye Movement Desentitization Reprocessing Therapy
Effective Public Health Practice Project
Impact of Events Scale
Impact of Events Scale-Dutch version
Impact of Events Scale-revised
non‒trauma-focused cognitive behavioral therapy
PTSD Checklist-5
PTSD Checklist-Civilian Version
PTSD Checklist-Military Version
posttraumatic stress disorder
randomized controlled trial
standardized mean differences
treatment as usual
trauma-focused cognitive behavioral therapy
This report represents independent research funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health. The authors would like to acknowledge the contributions of Chi Fung Ching and Cameron Touron for their help with screening articles as part of the systematic review conducted in November 2016. Open access for this article was funded by King’s College London.
None declared.