Is only one cognitive technique also effective? Results from a randomized controlled trial of two different versions of an internet-based cognitive behavioural intervention for post-traumatic stress disorder in Arabic-speaking countries.

Background: Internet-based cognitive-behavioural interventions seem to be effective for the treatment of posttraumatic stress disorder (PTSD) in Arabic-speaking countries in the MENA region. However, due to high prevalence rates of trauma-related mental disorders in this region, it is important to scale up existing Internet-based interventions in order to increase the number of clients. Objective: The aim of the study was to examine whether a brief Internet-based intervention with one cognitive technique (TF-short, 6 assignments) results in the same PTSD symptom change and lower dropouts compared to a longer intervention with two cognitive techniques (TF-reg, 10 assignments). Method: A total of 224 Arab participants (67.4% female; M = 25.3 years old) with PTSD were randomly assigned to Internet-based CBT with either a TF-reg protocol (n = 110) or a TF-short protocol (n = 114). Symptoms of PTSD and secondary outcomes (anxiety, depression, somatic complaints, quality of life) were self-assessed online at baseline and post-treatment. Treatment-associated changes were estimated using multigroup latent difference score models. Results: The overall PTSD score assessed with the PDS decreased by about 15 points in both conditions. The between-group differences (TF-reg vs. TF-short) at post-assessment were non-significant, Δ = 0.29, p = .896, d = 0.02, 95% CI [-0.30, 0.34]. Like the primary outcome, all within-group changes for the secondary outcomes throughout the intervention were statistically significant and all between-group effects were non-significant. Overall, the dropout rates did not differ between the two conditions, χ2 (1/N = 175) = 0.83, p = .364. Conclusions: The findings suggest that the shorter condition results in the same symptom change and dropout rate as the longer condition. This highlights the potential of shorter, more scalable Internet-based interventions in socially restricted and (post-)conflict societies. ClinicalTrialsgov ID: NCT01508377.

Antecedentes: Las intervenciones cognitivo-conductuales basadas en Internet parecen ser efectivas para el tratamiento del trastorno de estrés postraumático (TEPT) en los países de habla árabe de la región MENA. Sin embargo, debido a las altas tasas de prevalencia de trastornos mentales relacionados con el trauma en esta región, es importante escalar las intervenciones existentes basadas en Internet para aumentar el número de clientes.Objetivo: El propósito del estudio fue examinar si una intervención breve basada en Internet con una técnica cognitiva (TF-corta, 6 asignaciones) da como resultado el mismo cambio sintomático del TEPT y menos abandonos en comparación con una intervención más prolongada con dos técnicas cognitivas (TF -reg, 10 asignaciones).Método: Un total de 224 participantes árabes (67,4% mujeres; M = 25,3 años) con TEPT fueron asignados aleatoriamente a TCC basada en Internet con un protocolo TF-reg (n = 110) o un protocolo TF-corta (n = 114). Los síntomas del TEPT y los resultados secundarios (ansiedad, depresión, quejas somáticas, calidad de vida) fueron autoevaluadas en línea al inicio y al finalizar el tratamiento. Los cambios asociados al tratamiento se estimaron utilizando modelos de puntuación de diferencia latente multigrupo.Resultados: El puntaje general de TEPT evaluado con la PDS disminuyó aproximadamente 15 puntos en ambas condiciones. Las diferencias entre grupos (TF-reg vs. TF-corta) en la evaluación posterior no fueron significativas, Δ = 0,29, p = .896, d = 0,02, IC del 95% [-0,30, 0,34]. Al igual que el resultado primario, todos los cambios dentro del grupo para los resultados secundarios a lo largo de la intervención fueron estadísticamente significativos y todos los efectos entre los grupos no fueron significativos. En general, las tasas de abandono no difirieron entre las dos condiciones, χ2 (1/N = 175) = 0.83, p = .364.Conclusiones: Los hallazgos sugieren que la condición más corta da como resultado el mismo cambio de síntomas y la misma tasa de abandono que la condición más larga. Esto resalta el potencial de intervenciones más breves y escalables basadas en Internet en sociedades socialmente restringidas y (post) conflicto.

Prevalence and predictors of psychopathology in the war-afflicted Syrian population.

Research on the psychological impact of war on affected populations is important for the planning and provision of interventions. However, most studies that address the effects of political violence have been restricted to Western countries, and even after six years of civil war in Syria, there has been no study addressing its psychological impact on the general population. The present study used an online survey to examine the level of psychological symptoms and correlates of distress in a sample of 387 subjects from different areas of Syria. We used t-tests to compare symptoms across zones with different levels of war activity, and multiple regression models to identify predictors of distress. Results indicate a high level of psychological distress indicative of psychopathology in all regions across the country. Rates were higher in areas with more intensive exposure ('hot' zones). Greater symptom severity was associated with living in a hot zone, female gender, older age, the number of potentially traumatic events, daily stressors, and (low) perceived feeling of safety; whereas social support, religiosity, and religious coping were associated with lower levels of symptoms. The elevated levels of mental health problems and direct relation between the level of exposure to violence and poorer mental health point to the need for mental health services. Reducing daily stressors and ensuring safety could contribute significantly to better mental health, although this does not replace the need for evidence-based psychotherapy. The planning and delivery of psychological interventions by NGOs should be informed by issues related to stigma, lack of understanding and acceptance of psychological care.