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. 2022 Feb 28;9(2):e26479.
doi: 10.2196/26479.

A Web-Based Cognitive Behavioral Therapy, Mindfulness Meditation, and Yoga Intervention for Posttraumatic Stress Disorder: Single-Arm Experimental Clinical Trial

Megan A Kirk  1   2 , Bilal Taha  3 , Kevin Dang  1 , Hugh McCague  4 , Dimitrios Hatzinakos  3 , Joel Katz  5 , Paul Ritvo  1   5
Affiliations

A Web-Based Cognitive Behavioral Therapy, Mindfulness Meditation, and Yoga Intervention for Posttraumatic Stress Disorder: Single-Arm Experimental Clinical Trial

Megan A Kirk et al. JMIR Ment Health. .

Abstract

Background: Posttraumatic stress disorder (PTSD) is a debilitating, undertreated condition. The web-based delivery of cognitive behavioral therapy supplemented with mindfulness meditation and yoga is a viable treatment that emphasizes self-directed daily practice.

Objective: This study aims to examine the effectiveness of a web-based cognitive behavioral therapy, mindfulness, and yoga (CBT-MY) program designed for daily use.

Methods: We conducted an 8-week, single-arm, experimental, registered clinical trial on adults reporting PTSD symptoms (n=22; aged 18-35 years). Each participant received web-based CBT-MY content and an hour of web-based counseling each week. Pre-post outcomes included self-reported PTSD symptom severity, depression, anxiety, chronic pain, and mindfulness. Pre-post psychophysiological outcomes included peak pupil dilation (PPD) and heart rate variability (HRV). HRV and PPD were also compared with cross-sectional data from a non-PTSD comparison group without a history of clinical mental health diagnoses and CBT-MY exposure (n=46).

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 models demonstrated a significant pre-post reduction in PPD (B=-0.06; SE=0.01; P<.001; d=0.90) but no significant pre-post change in HRV (P=.87). Overall, participants spent an average of 11.53 (SD 22.76) min/day on self-directed mindfulness practice.

Conclusions: Web-based CBT-MY was associated with clinically significant symptom reductions and significant PPD changes, suggesting healthier autonomic functioning. Future randomized controlled trials are needed to further examine the gains apparent in this single-arm study.

Trial registration: ClinicalTrials.gov NCT03684473; https://clinicaltrials.gov/ct2/show/NCT03684473.

Keywords: PTSD; cognitive behavioral therapy; cognitive therapy; internet delivery; intervention; mindfulness; posttraumatic stress disorder; psychophysiology; pupillometry; therapy.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
CONSORT (Consolidated Standards of Reporting Trials) flow diagram of participant enrollment, follow-up, and analysis. CAPS-5: Clinician-Administered Posttraumatic Stress Scale; HRV: heart rate variability; ITT: intention-to-treat; PP: per-protocol; PTSD: posttraumatic stress disorder. Unstable medical condition (ie.current suicide ideation, substance abuse, current medical treatment).
Figure 2
Figure 2
The HF-HRV of participants with PTSD at baseline (T1) and postintervention (T2) compared with participants without PTSD during the 25-minute protocol conditions of rest, stress, and guided meditation. HF-HRV is presented as a log10-transformed plot with SE bars. HF-HRV: high-frequency heart rate variability; PTSD: posttraumatic stress disorder; T1: time point 1; T2: time point 2.
Figure 3
Figure 3
Mean change in relative PPD size across the 25-minute protocol. PPD is presented as relative pupil size and expressed as a ratio (0.10=10%) with 95% CI bars. PPD: peak pupil dilation; PTSD: posttraumatic stress disorder; T1: time point 1; T2: time point 2.
See this image and copyright information in PMC

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