Stirman and her colleagues (2021) conducted a pilot study of messaged-based CPT for treating PTSD. This article will summarize some of the key features of the open trial study and what it means for the future development of CPT.

What is a message-based CPT?

Using an asynchronous messaging approach, message-based CPT followed a standard CPT protocol of twelve sessions comprised of exercises and worksheets without a written trauma account. Asynchronous messaging allowed the clients to respond at their own convenience instead of being present and respond at the same time as therapists. Clients received the content in the PDF format and animated videos via Talkspace (an e-mental health platform in the USA), which presented the fundamental concepts and skills of CPT. Instead of the verbal communication by therapists, the introduction of the new materials for each session was shared through whiteboard videos. Clients were able to upload the completed worksheets to Talkspace and therapists reviewed them 5 days per week. Socratic questions were sent as a single message and clients were able to respond to them at their convenience. When necessary, 30-min video conferences, up to a maximum of three, were used to address any challenging situations or improve client engagement.

How was the study conducted?

A total of twenty-eight participants, who resided in the US, scored a 33 or above on the PTSD Checklist (PCL-5) and were not at high risk for suicidal thoughts and/or behaviors, were recruited to the CPT-text group via Talkspace and signed up to the platform through CPT-trained therapists. The study also had a comparison group that used messaging therapy using other therapeutic approaches and followed a similar format of asynchronous messaging with therapist review on 5 days per week. Participants in both groups had similar PTSD symptom profiles at baseline. CPT-text group completed a PCL-5 to measure PTSD symptoms and PHQ-8 to assess depression symptoms on a weekly basis.

What were the main findings?

The primary goal of the study was to assess the feasibility, engagement, and effectiveness of the message-based CPT format. Below are the important findings of the study:

• Most participants in the CPT-text group showed clinically significant improvement with the PCL-5 mean scores from pre- to post-treatment decreased two-fold.
• CPT-text group showed rapid symptom improvement compared to those in the comparison group.
• Among 25 CPT-text clients who completed the PHQ-8, comorbid depressive symptoms were reduced significantly from pre to post treatments with a large treatment effect.
• Clients and therapists appeared to write less to each other in CPT-text group compared to massage therapy using other modalities.
• The average time took to complete the CPT-text protocol was less than that of face-to-face CPT sessions.
• The drop-out rate of CPT-text (37%) was similar to that seen in face-to-face CPT studies.
• Better client engagement was seen in the CPT-text group most likely due to the daily check-in by the therapist.
• CPT-text was feasible to implement as less time was spent on messaging with minimal video sessions to deliver the content and skills.

What are the implications of this study?

Digital mental health platforms could overcome barriers of stigma, cost, transportation and inconvenience in accessing traditional PTSD treatments. Despite the few limitations, this study certainly demonstrates positive outcomes of adapting CPT to an online platform, adding to the growing literature that shows internet-based PTSD interventions are feasible and effective in treating PTSD. With therapist guidance, PTSD treatments like CPT have a higher potential of expanding the opportunities to provide treatment to remote locations and underserved communities with limited mental health services.

Reference:

Stirman, S. W., Song, J., Hull, T. D., & Resick, P. A. (2021). Open Trial of an Adaptation of Cognitive Processing Therapy for Message-Based Delivery. Technology, Mind, and Behavior, 2(1). https://doi.org/10.1037/tmb0000016