Early intervention for preventing posttraumatic stress disorder: an Internet-based virtual reality treatment

Posttraumatic stress disorder (PTSD) develops in approximately 20% of people exposed to a traumatic event, and studies have shown that cognitive-behavioral therapy (CBT) is effective as a treatment for chronic PTSD. It has also been shown to prevent PTSD when delivered early after a traumatic event. However, studies have shown that uptake of early treatment is generally low, and therefore, the need to provide interventions through other mediums has been identified. The use of technology may overcome barriers to treatment.
This paper describes a randomized controlled trial that will examine an early CBT intervention for PTSD. The treatment incorporates virtual reality (VR) as a method for delivering exposure-based elements of the treatment. The intervention is Internet based, such that the therapist and patient will “meet” in a secure online site. This site will also include multi-media components of the treatment (such as videos, audios, VR) that can be accessed by the patient between sessions.
Two hundred patients arriving to a Level 1 emergency department following a motor vehicle accident will be randomly assigned to either treatment or control groups. Inclusion criteria are age 18–65, PTSD symptoms 2 weeks posttrauma related to current trauma, no suicidality, no psychosis. Patients will be assessed by telephone by a team blind to the study group, on four occasions: before and after treatment, and 6 and 12 months posttreatment. The primary outcome is PTSD symptoms at follow up. Secondary outcomes include depression and cost effectiveness. Analyses will be on an intention-to-treat basis.
The results will provide more insight into the effects of preventive interventions, in general, and Internet-based early interventions, in particular, on PTSD, in an injured population, during the acute phase after trauma. We will discuss possible strengths and limitations.

创伤后应激障碍（Posttraumatic stress disorder, PTSD）在暴露于创伤事件的人群中发病率约为20%。研究证实，认知行为疗法（cognitive-behavioral therapy, CBT）对慢性PTSD具有确切治疗效果，且在创伤事件后早期实施可有效预防PTSD发生。然而现有研究表明，早期治疗的接受度普遍偏低，因此学界提出需通过其他媒介提供干预方案，而技术应用或可突破治疗障碍。
本研究将开展一项随机对照试验，评估针对PTSD的早期认知行为干预方案。该治疗方案融入虚拟现实（virtual reality, VR）技术，以承载基于暴露疗法的治疗环节。本次干预依托互联网开展，治疗师与患者可通过安全在线平台完成“会面”，该平台同时集成治疗所需的多媒体组件（如视频、音频、虚拟现实内容），供患者在两次诊疗间隙自主访问。
本研究将纳入200名因机动车事故前往一级急诊科就诊的患者，按随机原则分配至治疗组与对照组。纳入标准为：年龄18~65岁，创伤后2周出现与本次创伤相关的PTSD症状，无自杀倾向，无精神障碍。研究将由对分组不知情的评估团队通过电话完成四次评估：治疗前后，以及治疗后6个月、12个月。主要结局指标为随访阶段的PTSD症状严重程度，次要结局指标包括抑郁症状与成本效益比。数据分析将遵循意向性治疗原则。
本研究结果将进一步阐明预防性干预（尤其是基于互联网的早期干预）对创伤急性期受伤人群PTSD的影响，同时探讨该方案的潜在优势与局限性。