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

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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