Pragmatic Randomised Controlled Trial of Guided Self-help Versus Individual Cognitive Behavioural Therapy with a Trauma Focus for Post-Traumatic Stress Disorder (RAPID)
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Jonathan I Bisson DM FRCPsych, Professor in Psychiatry1* Cono Ariti MSc, Study Statistician2 Katherine Cullen MSc, Research Officer3 Neil Kitchiner RMN PhD, Director and Consultant Clinical Lead, Veterans’ NHS Wales1,4 Catrin Lewis PhD Research Associate1 Neil P Roberts DClinPSy, Consultant Clinical Psychologist; Honorary Senior Research Fellow1,4 Natalie Simon PhD Research Assistant1 Kim Smallman PhD, Research Associate2 Katy Addison MA Research Associate2 Vicky Bell Research Associate 5 Lucy Brookes-Howell, Senior Research Fellow2 Sarah Cosgrove, Public Advisory Group Chair1 Anke Ehlers PhD, Professor of Experimental Psychopathology and Wellcome Trust Principal Research Fellow6 Deborah Fitzsimmons PhD, Professor of Health Economics and Outcomes Research3 Paula Foscarini-Craggs PhD, Research Associate2 Shaun R S Harris PhD, Research Officer3 Mark Kelson, PhD, Associate Professor7 Karina Lovell PhD, Professor of Mental Health5 Maureen McKenna, RMN PG Cert, Lead Consultant Psychological Therapist8 Rachel McNamara PhD, Principal Research Fellow2 Claire Nollett, Tim Pickles, MSc, Health and Care Research Wales NIHR Doctoral Fellow2 Rhys Williams-Thomas, Research Associate2
Post-traumatic stress disorder (PTSD) is a common, disabling condition that can occur following major traumatic events. Typical symptoms include distressing reliving, avoidance of reminders, and feeling a current sense of threat. First-choice treatments for PTSD are individual, face-to-face talking treatments, of 12-16 hours duration, including cognitive behavioural therapy with a trauma focus. If equally effective treatments could be developed that take less time and can be largely undertaken in a flexible manner at home, this would improve accessibility, reduce waiting times and hence the burden of disease. RAPID was a randomised controlled trial using a web-based programme called Spring. The aim was to determine if trauma-focused guided self-help provided a faster and cheaper treatment for PTSD than first-choice face-to-face therapy, whilst being equally effective. Guided self-help using Spring is delivered through eight steps. A therapist provides a one hour introductory meeting followed by four further, fortnightly sessions of 30 minutes each and four brief (around 5 minute) telephone calls or email contacts between sessions. At each session, the therapist reviews progress and guides the client through the programme, offering continued support, monitoring, motivation, and problem solving. 196 people with PTSD to a single traumatic event took part in the study. Guided self-help using Spring was found to be equally effective to first-choice face-to-face therapy at reducing PTSD symptoms at 16 weeks. Very noticeable improvements were maintained at 52 weeks post-randomisation in both groups, when most results were inconclusive but in favour of face-to-face therapy. Guided self-help using Spring was significantly cheaper to deliver and appeared to be well-tolerated. It is noteworthy that not everyone benefitted from guided self-help using Spring, highlighting the importance of considering it on a person-by-person basis, and personalising interventions. But, the RAPID trial has demonstrated that guided self-help using Spring provides a low intensity treatment option for people with PTSD that is ready to be implemented in the NHS.
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