Internet‐based cognitive and behavioural therapies for post‐traumatic stress disorder (PTSD) in adults

Background Therapist‐delivered trauma‐focused psychological therapies are effective for post‐traumatic stress disorder (PTSD) and have become the accepted first‐line treatments. Despite the established evidence‐base for these therapies, they are not always widely available or accessible. Many barriers limit treatment uptake, such as the number of qualified therapists available to deliver the interventions; cost; and compliance issues, such as time off work, childcare, and transportation, associated with the need to attend weekly appointments. Delivering Internet‐based cognitive and behavioural therapy (I‐C/BT) is an effective and acceptable alternative to therapist‐delivered treatments for anxiety and depression. Objectives To assess the effects of I‐C/BT for PTSD in adults. Search methods We searched MEDLINE, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials to June 2020. We also searched online clinical trial registries and reference lists of included studies and contacted the authors of included studies and other researchers in the field to identify additional and ongoing studies. Selection criteria We searched for RCTs of I‐C/BT compared to face‐to‐face or Internet‐based psychological treatment, psychoeducation, wait list, or care as usual. We included studies of adults (aged over 16 years), in which at least 70% of the participants met the diagnostic criteria for PTSD, according to the Diagnostic and Statistical Manual (DSM) or the International Classification of Diseases (ICD). Data collection and analysis Two review authors independently assessed s, extracted data, and entered data into Review Manager 5. The primary outcomes were severity of PTSD symptoms and dropouts. Secondary outcomes included diagnosis of PTSD after treatment, severity of depressive and anxiety symptoms, cost‐effectiveness, adverse events, treatment acceptability, and quality of life. We analysed categorical outcomes as risk ratios (RRs), and continuous outcomes as mean differences (MD) or standardised mean differences (SMDs), with 95% confidence intervals (CI). We pooled data using a fixed‐effect meta‐analysis, except where heterogeneity was present, in which case we used a random‐effects model. We independently assessed the included studies for risk of bias and we evaluated the certainty of available evidence using the GRADE approach; we discussed any conflicts with at least one other review author, with the aim of reaching a unanimous decision. Main resu