Lewis et al., 201840
UK
Funding source: The authors acknowledge the Cochrane Common Mental Disorder Group, whose single largest funder is the National Institute for Health Research (NIHR). Internal support was received from Cardiff University. | Objective: To evaluate the effectiveness of iCBT for the treatment of PTSD in adults.
Study design: SR and MA of RCTs, randomized crossover trials, and cluster-randomized trials.
Literature search time frame: Initial searches were conducted on September 24th, 2015, and May 6th, 2016. An update was performed on March 1st, 2018. The searches were not restricted by date, language, or publication status.
Number of studies included: 10 studies were identified and included in the quantitative synthesis (MA).
Quality assessment tool: The criteria in the Cochrane Handbook for Systematic Reviews of Interventions44 were applied to each included primary study to judge each potential source of bias as high, low, or unclear. The overall quality of available evidence was evaluated using the GRADE approach. | Adults (≥ 16 years of age) with traumatic stress symptoms. At least 70% of participants in any given study were required to meet diagnostic criteria for PTSD according to the DSM-III, DSM-IIIR, DSM-IV, DSM-V, ICD-9, or the ICD-10, as assessed by clinical interview or a validated questionnaire.
There were no restrictions placed on sex or gender, ethnicity, comorbidities, setting, type of traumatic event, severity of symptoms, or length of time since trauma. | Intervention: Guided or unguided iCBT delivered via a computer or mobile device. Interventions based on EMDR or online psychoeducation alone, and interventions using mindfulness-based approaches apart from mindfulness-based iCBT, were excluded.
Comparators: Face-to-face psychological therapy (CBT based), face-to-face psychological therapy (non-CBT based; e.g., EMDR, supportive therapy, non-directive counselling, psychodynamic therapy, and present-centred therapy), wait-list, repeated assessment, usual care, internet psychoeducation, internet psychological therapy (non-CBT).
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Severity of PTSD symptoms (as measured by standardized scales, e.g., CAPS-5, PCL-5) Dropout rates Diagnosis of PTSD after treatment (i.e., number of participants who met diagnostic criteria for PTSD in each arm of the study) Depression symptoms (as measured by standardized scales; e.g., BDI) Anxiety symptoms (as measured by standardized scales; e.g., BAI) Cost-effectiveness Adverse events (e.g., symptoms worsening, relapses to substance use, hospitalizations, suicide attempts, work absenteeism) Quality of life (using any measures)
Note: Studies that met the inclusion criteria were included regardless of whether they reported on these outcomes. |
