Internet-delivered Cognitive Therapy (iCT) for young people with Post Traumatic Stress Disorder (PTSD)

背景创伤是一种涉及重伤、暴力或死亡的事件，如暴力袭击或严重的道路交通事故。到18岁时，大多数青少年都会接触到创伤性事件。暴露在创伤中的青少年中，约有六分之一会患上创伤后应激障碍(PTSD)。创伤后应激障碍是一种严重的心理健康问题。它的特点是记忆中的可怕干扰(闪回和关于创伤的噩梦)，情绪的突然变化(恐惧、愤怒、悲伤)，思维的变化(感到内疚，有一种夸张的危机感)，以及行为的变化(试图避免创伤提醒)。患有创伤后应激障碍的青少年可能会有注意力和记忆力方面的问题。这可能意味着他们在学校考试中成绩不佳，这可能会对他们未来的就业前景产生终生影响。青春期的创伤后应激障碍降低了生活质量，恶化了身体健康，并可能导致严重的精神健康问题，如成年后的抑郁。如果不进行治疗，创伤后应激障碍可能会持续多年。目前已有治疗创伤后应激障碍的高效疗法。根据国际研究，卫生部建议患有创伤后应激障碍的青少年接受一种名为以创伤为重点的认知行为疗法的治疗。我们小组已经开发了这种疗法的一个版本，称为PTSD的认知疗法(CT用于PTSD)。我们的研究表明，在完成为期10周的认知疗法课程后，77%-90%的年轻人不再患有创伤后应激障碍。然而，这种高度有效的治疗方法在英国国民健康保险制度中并不常见。原因是没有足够训练有素的治疗师来提供治疗。这意味着大多数患有创伤后应激障碍的青少年没有得到他们应得的有效治疗。目的和目的增加青少年创伤后应激障碍治疗的可获得性的一种方法是通过互联网提供治疗，而不是面对面。使用互联网可以改善治疗的可及性，因为训练有素的治疗师可以治疗的患者数量是提供传统面对面预约时的五倍。因此，我们的目标是在我们有效的面对面认知疗法的基础上，开发一个互联网传播的认知疗法(ICT)方案，用于治疗青少年的创伤后应激障碍。我们将开发一个安全、互动、多媒体的ICT软件程序，专门为青少年设计，在计算机、平板电脑和智能手机上提供。然后，我们将在试点随机对照试验中评估这一新的ICT计划，将其与传统的面对面CT治疗创伤后应激障碍进行比较，并与等待名单比较条件进行比较。我们的试验旨在调查ICT是否可以被年轻人接受；评估以这种方式提供治疗是否可行和实用；并探索ICT对创伤后应激障碍、抑郁和焦虑症状的良好效果。应用和好处我们建议的ICT计划提供了一种新的方法。它将提供一个全程的循证认知疗法来治疗创伤后应激障碍。它将专门为青少年设计，在发展的每个阶段都有年轻的服务用户提供意见。它将利用技术来改善治疗提供，例如通过智能手机应用程序。它将是互动的，包括训练有素的治疗师的在线治疗，但它将把治疗师的时间减少到面对面治疗所需时间的20%左右。这有很多潜在的好处。信息和通信技术将增加治疗的可得性。青少年将能够以更方便(他们选择什么时候可以使用)和更有效(他们不需要去诊所)的方式获得高效的治疗。NHS和其他医疗机构的潜在好处是，在不增加成本的情况下，可以治疗的患者最多增加五倍。信息和通信技术为年轻人、他们的家庭和国民健康保险制度提供了极大的好处

ContextA trauma is an event that involves serious injury, violence, or death, such as violent assaults or serious road traffic accidents. By the age of 18 years, most adolescents will have been exposed to a traumatic event. About 1 in 6 adolescents who are exposed to a trauma will develop Post Traumatic Stress Disorder (PTSD).PTSD is a serious mental health problem. It is characterised by frightening disturbances in memory (flashbacks and nightmares about the trauma), sudden changes in emotion (fear, anger, sadness), changes in thinking (feeling guilty, having an exaggerated sense of danger), and changes in behaviour (trying to avoid trauma reminders). Adolescents with PTSD can have problems concentrating and remembering. This can mean that they under-achieve in school exams, which may have life-long consequences on their future job prospects. PTSD in adolescence reduces quality of life, worsens physical health, and can lead to serious mental health problems such as depression in adulthood. Without treatment, PTSD may last for many years. Highly effective treatments for PTSD exist. Based on international research, the Department of Health recommends that adolescents with PTSD receive a treatment called Trauma-Focused Cognitive Behavioural Therapy. Our group has developed a version of this treatment, called Cognitive Therapy for PTSD (CT for PTSD). Our research has shown that after completing a 10-week course of Cognitive Therapy, 77-90% of young people no longer have PTSD. However, this highly effective treatment is not often available in the NHS. The reason is that there are not enough trained therapists to deliver it. This means that most adolescents with PTSD do not get the effective treatment that they deserve. Aims and objectivesOne way of increasing the availability of therapy for adolescents with PTSD is to deliver it over the internet, rather than face-to-face. Accessibility of treatment is improved when using the internet because trained therapists could treat up to five times as many patients as they can when offering traditional face-to-face appointments. Our objective is therefore to develop an Internet-delivered Cognitive Therapy (iCT) programme for the treatment of PTSD in adolescents, based on our effective face-to-face Cognitive Therapy. We will develop a secure, interactive, multi-media, iCT software programme, designed specifically for adolescents, to be delivered on computers, tablets, and smart phones. We will then evaluate this new iCT program, in a pilot Randomised Controlled Trial, comparing it to traditional Face-to-Face CT for PTSD, and to a Wait List comparison condition. Our trial is designed to investigate whether iCT is acceptable to young people; to evaluate whether it is feasible and practical to deliver treatment in this way; and to explore how well iCT works for symptoms of PTSD, depression, and anxiety.Applications and benefitsOur proposed iCT programme offers a new approach. It will deliver a full course of evidence-based Cognitive Therapy to treat PTSD. It will be designed specifically for adolescents, with input from young service-users at every stage of development. It will use technology to improve the treatment delivery, e.g. via a smartphone App. It will be interactive and include online treatment from a trained therapist, but it will reduce therapist time to around 20% of that required in face-to-face treatment. There are many potential benefits. iCT will increase the availability of treatment. Adolescents will be able to access a highly-effective treatment in a way that is more convenient (it can be accessed when they choose) and more efficient (they do not need to travel to a clinic). The potential benefit to the NHS and other health-providers is that up to five times more patients can be treated, with no increase in cost. iCT offers the potential for very significant benefits for young people, their families, and the NHS