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

创伤是一种涉及严重伤害、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，大多数青少年都经历过创伤性事件。创伤后应激障碍（PTSD）是一种严重的心理健康问题。其特征是记忆中的可怕干扰（关于创伤的闪回和噩梦），情绪的突然变化（恐惧，愤怒，悲伤），思维的变化（感到内疚，有夸大的危险感）和行为的变化（试图避免创伤提醒）。患有PTSD的青少年可能会有注意力和记忆力的问题。这可能意味着他们在学校考试中表现不佳，这可能对他们未来的就业前景产生终身影响。青春期的创伤后应激障碍降低了生活质量，损害了身体健康，并可能导致严重的心理健康问题，如成年后的抑郁症。如果不治疗，PTSD可能会持续多年。PTSD的有效治疗方法是存在的。根据国际研究，卫生署建议患有创伤后应激障碍的青少年接受一种名为创伤集中认知行为疗法的治疗。我们的小组已经开发了这种治疗方法的一个版本，称为PTSD的认知疗法（CT for PTSD）。我们的研究表明，在完成10周的认知疗法课程后，77-90%的年轻人不再患有PTSD。然而，这种高效的治疗方法在NHS中并不常见。原因是没有足够的训练有素的治疗师来提供治疗，这意味着大多数患有PTSD的青少年没有得到他们应得的有效治疗。目的和目标增加青少年创伤后应激障碍治疗的可用性的一种方法是通过互联网提供，而不是面对面。当使用互联网时，治疗的可及性得到改善，因为训练有素的治疗师可以治疗多达五倍的病人，因为他们可以提供传统的面对面预约。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，开发一种用于治疗青少年创伤后应激障碍的互联网认知疗法（iCT）计划。我们将开发一个专门为青少年设计的安全、互动、多媒体的iCT软件程序，通过电脑、平板电脑和智能手机提供。然后，我们将在一项试点随机对照试验中评估这种新的iCT计划，将其与传统的PTSD面对面CT进行比较，并与等待列表比较条件进行比较。我们的试验旨在调查iCT是否为年轻人所接受;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、抑郁和焦虑症状的效果如何。应用和益处我们提出的iCT计划提供了一种新方法。它将提供一个完整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，在每个发展阶段都听取年轻服务使用者的意见。它将使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，包括来自训练有素的治疗师的在线治疗，但它将减少治疗师的时间到面对面治疗所需时间的20%左右。有许多潜在的好处。iCT将增加治疗的可用性。青少年将能够以更方便（可以在他们选择时获得）和更有效（他们不需要前往诊所）的方式获得高效的治疗。对NHS和其他医疗服务提供者的潜在好处是，可以在不增加成本的情况下治疗多达五倍的患者。iCT为年轻人、他们的家庭和NHS带来了巨大的好处

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