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Randomized Controlled Trial
. 2020 May 6;20(1):205.
doi: 10.1186/s12888-020-02595-z.

Evaluation of an internet-based intervention for service members of the German armed forces with deployment-related posttraumatic stress symptoms

Helen Niemeyer  1 , Christine Knaevelsrud  2 , Sarah Schumacher  2 , Sinha Engel  2 , Annika Kuester  2 , Sebastian Burchert  2 , Beate Muschalla  3 , Deborah Weiss  2 , Jan Spies  2 , Heinrich Rau  4 , Gerd-Dieter Willmund  4
Affiliations
Randomized Controlled Trial

Evaluation of an internet-based intervention for service members of the German armed forces with deployment-related posttraumatic stress symptoms

Helen Niemeyer et al. BMC Psychiatry. .

Abstract

Background: The present study was designed to evaluate the efficacy of a therapist-guided internet-based cognitive-behavioral therapy (iCBT) intervention for service members of the German Armed Forces with posttraumatic stress disorder (PTSD). The iCBT was adapted from Interapy, a trauma-focused evidence-based treatment based on prolonged exposure and cognitive restructuring. It lasted for 5 weeks and included 10 writing assignments (twice a week). The program included a reminder function if assignments were overdue, but no multimedia elements. Therapeutic written feedback was provided asynchronously within one working day.

Methods: Male active and former military service members were recruited from the German Armed Forces. Diagnoses were assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the Mini-International Neuropsychiatric Interview. Psychopathology was assessed at pre-treatment, post-treatment, and 3-month follow-up. Severity of PTSD was the primary outcome and anxiety was the secondary outcome. Participants were randomly allocated to a treatment group that received iCBT immediately or to a waitlist group that received iCBT after 6 weeks. Due to the overall small sample size (n = 37), the two groups were collapsed for the statistical analyses. Change during the intervention period was investigated using latent-change score models.

Results: Improvements in the CAPS-5 were small and not statistically significant. For anxiety, small significant improvements were observed from pre- to follow-up assessment. The dropout rate was 32.3%.

Conclusions: The low treatment utilization and the high dropout rate are in line with previous findings on treatment of service members. The interpretation of the current null results for the efficacy of iCBT is limited due to the small sample size, however for military samples effect estimates were also smaller in other recent studies. Our results demonstrate the need to identify factors influencing treatment engagement and efficacy in veterans.

Trial registration: Australian Clinical Trials Registry ACTRN12616000956404.

Keywords: Efficacy; Internet-based intervention; Military; Posttraumatic stress disorder; Service members.

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Conflict of interest statement

HR and GDW are employed by the German Armed Forces. Their employment had no influence on the study design or the collection, analysis and interpretation of data. All other authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Participants flow chart. Descriptive data on the patient flow through the study, that is the number of participants and drop-outs. Provides all details of the participant flow from the telephone screening to the follow-up assessment, which comprises also the detailed numbers of drop-outs per group and time-point (that is, according to the intervals between the assessments)
Fig. 2
Fig. 2
Individual trajectories. Individual trajectories of the change in PTSD symptoms over the course of the treatment. Shows the individual trajectories and the estimated mean changes in the CAPS-5 total and subscale-scores. The results for completers, the results from the last observation carried forward (LOCF) approach, and the results from the full information maximum likelihood (FIML) are displayed
See this image and copyright information in PMC

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