Condensed internet-delivered prolonged exposure provided soon after trauma: A randomised pilot trial

Abstract

Exposure to trauma is common and may have detrimental psychological consequences. Brief exposure therapy provided early after trauma has shown encouraging results in promoting recovery. To scale up treatment availability, we developed a 3-week internet-delivered intervention comprised of four modules based on prolonged exposure (condensed internet-delivered prolonged exposure; CIPE) with therapist support. In this pilot study, we assessed the feasibility, acceptability, and preliminary efficacy of CIPE delivered within 2 months after the index event. Thirty-three participants were randomised to CIPE or a waiting list (WL). The frequency, vividness and distress of intrusive recollections or flashback memories of the traumatic event were assessed using an intrusive memory smartphone app. Symptoms of post-traumatic stress were assessed by the PTSD Symptom Checklist for DSM-5 (PCL-5). The most common index traumas in the sample were rape, interpersonal violence and life-threatening accidents. A majority of participants (82%) randomised to CIPE completed all modules, and the number of logins per participant to the Internet platform was high during the three-week intervention (M = 19.6, SD = 11.8). At post-treatment, the CIPE participants had a more favourable reduction than the WL group on the vividness and distress ratings, as well as on the PCL-5 sum score (bootstrapped d = 0.85; 95% CI [0.25-1.45]). Treatment effects were sustained at 6-months follow up and no severe adverse events associated with the intervention were found. CIPE seems to be a feasible and possibly efficacious early intervention after trauma. Large-scale trials are needed to assess its efficacy and long-term benefits.

Keywords: Acute stress disorder (ASD); Early intervention; Intrusions; Intrusive memory; Post-traumatic stress disorder (PTSD); Prevention; Prolonged exposure.

Fig. 1

Participant flow chart.

Fig. 2

Frequency scatter graphs of daily vividness ratings associated with each intrusion recorded in the intrusive memory app or by paper and s tencil for CIPE and W'L at pre- and post-intervention. The circle size illustrates number of participants who reported the indicated rating of vividness each day.

Fig. 3

Frequency scatter graphs of daily distess ratings associated with each intrusion recorded in the intrusive memory app or by paper and stencil for CIPE and W'L at pre- and post-intervention. The circle size illustrates number of participants who reported the indicated rating of distress each day.