Exploring the feasibility and acceptance of huddinge online prolonged exposure therapy (HOPE) for severe and complex PTSD

ABSTRACT

Background: Trauma-focused cognitive behavioural therapy such as prolonged exposure is considered firsthand choice for treatment of posttraumatic stress disorder (PTSD) but is seldom available in regular care. Digital therapy is proposed to bridge this gap, but its effectiveness for severe and complex PTSD is uncertain. The primary objective of the current study was to examine the feasibility, acceptability, and preliminary effects of digital therapist-guided prolonged exposure (Huddinge Online Prolonged Exposure; HOPE).

Method: Thirty participants with moderate to severe PTSD, with the majority self-reporting complex PTSD symptoms, received HOPE over a ten-week period. Eighty percent of participants had been diagnosed with other psychiatric comorbidity by a mental health professional. Primary outcome was the feasibility and acceptability of treatment. Participants were repeatedly assessed using clinician- and self-rated outcome measures at baseline, during the treatment period, post-treatment, and at 1-month and 6-month follow-ups to estimate preliminary treatment effects. The Clinician Administered PTSD Scale version 5 (CAPS-5), administered by independent assessors, evaluated PTSD symptom severity.

Results: HOPE proved feasible and effective, delivering evidence-based treatment content in a psychiatric outpatient setting with reduced therapist time. The treatment was well-tolerated, with no severe adverse events and a 17% dropout rate. Sixty-four percent completed the exposure-based portion of the treatment, and overall satisfaction measured by the Client Satisfaction Questionnaire was moderate. Furthermore, significant reductions in PTSD symptoms as assessed with the CAPS-5 (Cohen's d = 1.30 [95% CI −1.79 to −0.82]) at the primary endpoint 1 month which were sustained at the 6-month follow up.

Conclusion: Altogether, this study indicate feasibility of treating severe and complex PTSD through a digital PE intervention, thereby building upon and extending previous research findings. Large-scale controlled trials are needed to further validate the specific effect and long-term benefits of HOPE.

Trial registration: ClinicalTrials.gov identifier: NCT05560854.

HIGHLIGHTS

• HOPE, a digital therapist-guided prolonged exposure programme, demonstrated feasibility and preliminary effects for severe and complex PTSD in a psychiatric outpatient setting, while requiring less therapist time.

• HOPE was well-tolerated by participants, with a relatively low dropout rate and average overall satisfaction.

• Significant reductions in PTSD symptoms were observed, and these benefits were sustained at the 6-month follow-up.

Antecedentes: La terapia cognitivo conductual centrada en el trauma como la exposición prolongada se considera una opción de primera mano para el tratamiento del trastorno de estrés postraumático (TEPT), pero rara vez esta disponible en la atención habitual. Se propone la terapia digital para cerrar esta brecha, pero su efectividad para el TEPT complejo y grave es incierta. El objetivo primario del presente estudio fue examinar la viabilidad, aceptabilidad y efectos preliminares de la exposición prolongada guiada por un terapeuta digital (Exposición Prolongada En línea de Huddinge; HOPE por sus siglas en ingles).

Método: Treinta participantes con TEPT moderado a severo, la mayoría de los cuales auto reportaron síntomas de TEPT complejo, recibieron HOPE durante un período de diez semanas. El ochenta por ciento de los participantes había sido diagnosticado con otra comorbilidad psiquiátrica por un profesional de salud mental. El resultado primario fue la viabilidad y aceptabilidad del tratamiento. Los participantes fueron evaluados repetidamente utilizando las medidas de resultado auto-evaluadas y evaluadas por el clínico al inicio del estudio, durante el período de tratamiento, el post-tratamiento y al mes y seis meses de seguimiento para estimar los efectos preliminares del tratamiento. La escala de TEPT administrada por el clínico versión 5 (CAPS-5), administrada por evaluadores independientes, evaluaron la gravedad de los síntomas de TEPT.

Resultados: HOPE demostró ser factible y efectiva, brindando contenido de tratamiento basado en la evidencia en un contexto de pacientes ambulatorios con un tiempo reducido del terapeuta. El tratamiento fue bien tolerado, sin eventos adversos serios y con una tasa de abandono del 17%. El sesenta y cuatro por ciento completo la porción del tratamiento basado en la exposición, y la satisfacción general medida por el Cuestionario de Satisfacción del Cliente fue moderada. Además, se observaron disminuciones significativas de los síntomas de TEPT evaluados con el CAPS-5 (d de Cohen = 1.30 [IC 95% −1.79 a −0.82]) en el criterio de valoración principal al mes, que se mantuvieron a los 6 meses de seguimiento.

Conclusiones: En conjunto, este estudio indica la viabilidad de tratar TEPT complejo y grave a través de una intervención de EP digital, aprovechando y ampliando así los hallazgos de investigaciones previas. Se necesitan estudios controlados a gran escala para validar aún más el efecto específico y los beneficios a largo plazo de HOPE.

KEYWORDS:

• Post-traumatic stress disorder; complex post-traumatic stress disorder; prolonged exposure; guided internet delivered treatment
• digital treatment
• trauma focused cognitive behaviour therapy

PALABRAS CLAVE:

• Trastorno de estrés postraumático
• trastorno de estrés postraumático complejo
• exposición prolongada
• tratamiento guiado entregado por internet
• tratamiento digital
• terapia cognitive conductual centrada en el trauma

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors upon request given that the request comply with Swedish and EU laws regulating protection of identifiable data.

Additional information

Funding

This work was supported by Innovationsfonden [FoUI 982623]. The funding organization did not have any role in the conception of the study design or in the collection, analysis, or interpretation of the data, in the writing of the report, or in the decision to submit the paper.