Internet-Delivered Cognitive Behavioral Therapy for Posttraumatic Stress Disorder in International Humanitarian Aid Workers: Study Protocol

Introduction: Humanitarian aid workers are likely to be exposed or witness complex emergencies. Posttraumatic stress disorder (PTSD) is one of the most widespread and most commonly studied mental health problems after exposure to adversities and trauma. However, face-to-face treatment has limited utilization in the resource-constrained settings where humanitarian aid workers often operate. Internet-delivered cognitive behavioral therapy (iCBT) is a treatment option with the potential to improve the access to evidence-based care for humanitarian aid workers. Until now, only a few studies have evaluated iCBT in the treatment of PTSD. No studies have yet explored the feasibility of iCBT for humanitarian aid workers with PTSD. The aim of this study is to determine completion rates, self-reported treatment credibility/expectancy, and decrease in symptoms (PTSD, anxiety, depression, and functional disability) of the TELLUS program in humanitarian aid workers with PTSD.
Methods: A pilot feasibility study will be conducted with 20 humanitarian aid workers with a full or subclinical PTSD diagnosis according to DSM-IV criteria. The intervention used is TELLUS, which is a therapist-assisted Internet-delivered treatment program based on trauma-focused CBT components for individuals with PTSD. It contains eight text-based modules, where each module is expected to be completed within one week.

Discussion: This study may set the ground for a large-scale randomized control trial that would test the effectiveness and cost-effectiveness of the program. The study may contribute to the better understanding of PTSD treatment and increase the availability of evidence-based treatments in resource-constrained settings.

1) The intervention (TELLUS) is credible to international humanitarian aid workers, 2) the intervention is significantly reduces symptoms of PTSD from pre- to post-test, and 3) the intervention significantly reduces symptoms of comorbid depression, anxiety, suicidality, and functional disability from pre- to pos-test.

The treatment is expected to last eight weeks and assessments are done: 1) before beginning of treatment (pre-treatment), 2) after four modules of the treatment (mid-treatment), 3) after completion of all eight modules of the treatment (post-treatment).

TELLUS is an Internet-delivered program based on trauma-focused CBT components for PTSD (Ivarsson et al., 2014). The treatment program contains eight text-based modules, where each module is expected to be completed within one week. The modules have homework assignments related to their content, which are communicated online with a supervised psychologist on a weekly basis.