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Cited by 90Posttraumatic Stress Disorder ResearchDigital Mental Health InterventionsSleep and related disorders

Internet-based early intervention to prevent posttraumatic stress disorder in injury patients: Randomized controlled trial

Open access
Mouthaan, Joanne, Sijbrandij, Marit, de Vries, Giel-Jan, Reitsma, Johannes B, van de Schoot, Rens, Goslings, J Carel, Luitse, Jan SK, Bakker, Fred C +2 more·2013·Journal of Medical Internet Research
DOI 10.2196/jmir.2460PMC PMC3742408
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Abstract

BACKGROUND: Posttraumatic stress disorder (PTSD) develops in 10-20% of injury patients. We developed a novel, self-guided Internet-based intervention (called Trauma TIPS) based on techniques from cognitive behavioral therapy (CBT) to prevent the onset of PTSD symptoms. OBJECTIVE: To determine whether Trauma TIPS is effective in preventing the onset of PTSD symptoms in injury patients. METHODS: Adult, level 1 trauma center patients were randomly assigned to receive the fully automated Trauma TIPS Internet intervention (n=151) or to receive no early intervention (n=149). Trauma TIPS consisted of psychoeducation, in vivo exposure, and stress management techniques. Both groups were free to use care as usual (nonprotocolized talks with hospital staff). PTSD symptom severity was assessed at 1, 3, 6, and 12 months post injury with a clinical interview (Clinician-Administered PTSD Scale) by blinded trained interviewers and self-report instrument (Impact of Event Scale-Revised). Secondary outcomes were acute anxiety and arousal (assessed online), self-reported depressive and anxiety symptoms (Hospital Anxiety and Depression Scale), and mental health care utilization. Intervention usage was documented. RESULTS: The mean number of intervention logins was 1.7, SD 2.5, median 1, interquartile range (IQR) 1-2. Thirty-four patients in the intervention group did not log in (22.5%), 63 (41.7%) logged in once, and 54 (35.8%) logged in multiple times (mean 3.6, SD 3.5, median 3, IQR 2-4). On clinician-assessed and self-reported PTSD symptoms, both the intervention and control group showed a significant decrease over time (P<.001) without significant differences in trend. PTSD at 12 months was diagnosed in 4.7% of controls and 4.4% of intervention group patients. There were no group differences on anxiety or depressive symptoms over time. Post hoc analyses using latent growth mixture modeling showed a significant decrease in PTSD symptoms in a subgroup of patients with severe initial symptoms (n=20) (P<.001). CONCLUSIONS: Our results do not support the efficacy of the Trauma TIPS Internet-based early intervention in the prevention of PTSD symptoms for an unselected population of injury patients. Moreover, uptake was relatively low since one-fifth of individuals did not log in to the intervention. Future research should therefore focus on innovative strategies to increase intervention usage, for example, adding gameplay, embedding it in a blended care context, and targeting high-risk individuals who are more likely to benefit from the intervention. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 57754429; http://www.controlled-trials.com/ISRCTN57754429 (Archived by WebCite at http://webcitation.org/6FeJtJJyD).

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  • Most prior interventions targeting psychological outcomes were not informed by psychological insights and proven psychotherapeutic approaches delivered by trained mental health professionals.

    “This may be because most prior interventions, while targeting psychological outcomes, were not informed by psychological insights and proven psychotherapeutic approaches to promote adjustment to stress, grief, and trauma (21-24) delivered by trained mental health professionals.”

    From EMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU (2024) · cites this paper as [23]

    The Introduction describes Trauma TIPS as self-guided, supporting the point that this intervention was not delivered by a mental health professional. But the Introduction and Methods > Interventions explicitly say it was based on established cognitive behavioral therapy techniques, contrary to the claim that it was not informed by psychotherapeutic approaches. This single trial also does not establish what was true of most prior interventions. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • An online cognitive behavioral therapy-based intervention only reduced PTSD symptoms in participants with high acute PTSD symptoms.

    “an online cognitive behavioral therapy-based intervention only reduced PTSD symptoms in participants with high acute PTSD symptoms (63).”

    From Intranasal Oxytocin to Prevent Posttraumatic Stress Disorder Symptoms: A Randomized Controlled Trial in Emergency Department Patients (2017) · cites this paper as [63]

  • Recruiting emergency department patients for research purposes early after trauma exposure is feasible, based on previous early intervention studies.

    “Based on previous early intervention studies, recruiting ED patients for research purposes early after trauma exposures is feasible [10,15,16,60,98].”

    From Efficacy of oxytocin administration early after psychotrauma in preventing the development of PTSD: study protocol of a randomized controlled trial (2014) · cites this paper as [98]

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  1. [34]Muthén LK Muthén BO Mplus User's Guide, Sixth edition 2010 2013-08-09 Los Angeles Muthén & Muthén http://www.statmodel.com/download/usersguide/Mplus%20Users%20Guide%20v6.pdf

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Authors
Mouthaan, J., Sijbrandij, M., de Vries, G.-J., Reitsma, J. B., van de Schoot, R., Goslings, J. C., Luitse, J. S., Bakker, F. C., Gersons, B. P., & Olff, M.
Affiliations
  • Amsterdam UMC Location University of Amsterdam (NL)
  • Amsterdam Public Health (NL)
  • Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
Corresponding author
Mouthaan, Joanne
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2013-08-13
Volume
15
Issue
8
Pages
e165
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/jmir.2460
PMC
PMC3742408
OpenAlex
W2124727215
Cited by
90
References
50
Citations by year
2026: 2 · 2025: 5 · 2024: 5 · 2023: 2 · 2022: 7 · 2021: 7 · 2020: 9 · 2019: 8 · 2018: 9 · 2017: 9 · 2016: 12 · 2015: 9 · 2014: 5 · 2013: 1
FWCI
10.00
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Journal of Medical Internet Research (publishedVersion, other-oa)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
  • Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion, other-oa)
  • Pure Amsterdam UMC (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • VU Research Portal (submittedVersion, other-oa)
Funders
  • ZonMw (62300038)
  • Nederlandse Organisatie voor Wetenschappelijk Onderzoek
  • Achmea
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords
post-traumatic stress disorder, PTSD prevention, online intervention, self-guided intervention, trauma patients, trauma center patients, cognitive behavioral therapy, in vivo exposure, stress management, psychoeducation, intervention uptake, anxiety and depressive symptoms, mental health service utilization, growth mixture modeling
MeSH terms
Adult, Female, Humans, Male, Middle Aged, Netherlands, Stress Disorders, Post-Traumatic, Wounds and Injuries, Internet

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