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Post Traumatic Stress DisorderNCT05934162

Efficacy of Internet-delivered Cognitive-behavior Therapy for PTSD

A study testing Therapist-supported internet-delivered prolonged exposure and Therapist-supported internet-delivered CBT in people with Post Traumatic Stress Disorder, run by Karolinska Institutet at 1 site in Sweden.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

The goal of this clinical trial is to compare therapist-guided internet delivered prolonged exposure to an active control condition( therapist-guided internet delivered cognitive behavioral therapy containing relaxation techniques) for post-traumatic stress disorder. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Post Traumatic Stress Disorder
What is being tested?
Therapist-supported internet-delivered prolonged exposure and Therapist-supported internet-delivered CBT
Could I receive a placebo?
No, everyone receives an active treatment
How many people
286 participants
Where
1 siteSweden
Study dates
4 Sep 2023to 20 Aug 2026
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • current primary diagnosis PTSD according to DSM-5 diagnostic criteria
  • be 18 years of age or older
  • be able to read and communicate fluently in Swedish
  • have had a stable dose of any psychotropic medication for at least 4 weeks prior to study entry
  • Daily access to a computer or device with internet connection

Who cannot join

  • PTSD is not the primary concern
  • Initiation or adjustment of any psychotropic medication within the last 4 weeks prior to commencement of treatment
  • Serious mental health symptoms, such as mania, psychosis, alcohol, or substance use disorders or current suicide risk warranting immediate clinical attention.
  • Ongoing trauma-focused CBT or Eye movement desensitization and reprocessing therapy
  • Ongoing trauma-related threat (e.g. living with a violent spouse)

Trial locations and contacts

1 site in 1 country.

Maria Bragesjö, PhD contact

0703399387

maria.bragesjo@ki.se

Sweden1 site, 1 recruiting
  • Traumaprogrammet, Psykiatri Sydväst

    Stockholm

    Maria Bragesjö, PhD, maria.bragesjo@ki.se

    Recruiting

Other trials in Sweden

About this study

Official title: Efficacy and Mediators of Change of Cognitive-behavior Therapy for PTSD: a Randomized Controlled Trial

The goal of this clinical trial is to compare therapist-guided internet delivered prolonged exposure to an active control condition( therapist-guided internet delivered cognitive behavioral therapy containing relaxation techniques) for post-traumatic stress disorder.

The objective with this study is to investigate efficacy, mechanisms of change and cost effectiveness of therapist-guided internet delivered prolonged exposure.

Adult patients with post-traumatic stress disorder will be randomly assigned to receive either 10 weeks of therapist-guided internet delivered prolonged exposure or therapist-guided internet delivered cognitive-behavioral therapy containing relaxation.

Read the detailed description

PTSD is a debilitating psychiatric disorder strongly linked to subsequent psychiatric and medical problems. Trauma-focused cognitive behavioral therapy (CBT-T) such as prolonged exposure is an effective treatment for PTSD and is recommended in most clinical guidelines as first-line treatment but is seldom available in regular care. A possible solution to significantly improve access to evidence-based treatment would be the use of remotely delivered digital intervention. Preliminary research shows that therapist-guided internet delivered to be effective and safe, but studies have typically excluded patients with severe PTSD.

Before this type of treatment can be offered in regular care in Sweden, it needs to be further evaluated also with psychiatric patients suffering from severe PTSD. If therapist-guided internet delivered prolonged exposure would be found to effective, this project has the potential to be the first step towards implementation of a novel, superior and more cost-effective mode of treatment delivery for adults with PTSD in regular Swedish health care.

The study is a single-blind, parallel-group superiority randomized controlled trial with 284 patients (142 per arm) that will compare therapist-guided internet delivered prolonged exposure with therapist-guided internet delivered cognitive-behavioral therapy The primary outcome is the blind-rater administered Clinician-Administered PTSD Scale for DSM-5 (CAPS-5).

Secondary outcomes are cost effectiveness, mediators of change, dropout rate, and negative effects.

The trial will also be preregistered at the Open Science Framework.

Research questions to be answered are:

  1. Is guided i-CBT with exposure more efficacious than an active control condition (therapist-supported internet-delivered psychoeducation, relaxation and support) in regard to reduction of blinded assessor rated PTSD symptom severity 1-month post-treatment?
  2. Is guided i-CBT with exposure more cost-effective than an active control condition (therapist-supported internet-delivered psychoeducation, relaxation and support) in regard to reduction of blinded assessor rated PTSD symptom severity 1-month post-treatment?
  3. Are the therapeutic gains of i-CBT maintained at long term follow up (6 and 12 months after treatment)?
  4. Is guided i-CBT with exposure more efficacious than an active control condition (therapist-supported internet-delivered psychoeducation, relaxation and support) in regard to reduction in depressive symptoms and increase in quality of life up to 12 months after treatment completion?
  5. What are the mediators of change in guided i-CBT for PTSD?
Being tested
Therapist-supported internet-delivered prolonged exposure, Therapist-supported internet-delivered CBT
Keywords
PTSD, therapist-guided treatment, internet delivered treatment, digital treatment, therapist-assisted treatment, prolonged exposure, trauma focused CBT
Medical subject headings
Stress Disorders, Post-Traumatic

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Therapist-supported internet-delivered prolonged exposureBehavioural

    10 weeks of therapist-supported internet-delivered prolonged exposure

  • Therapist-supported internet-delivered CBTBehavioural

    10 weeks of therapist-supported internet-delivered CBT

Study groups in NCT05934162
Study groupRoleWhat they receive
Therapist-supported internet delivered prolonged exposureExperimentalTherapist-supported internet delivered prolonged exposure comprising psychoeducation about PTSD, controlled breathing, imaginal exposure including processing, in vivo exposure and relapse prevention. The treatment will be delivered in a digital platform for ten weeks. Participants will have access to a therapist that will guide them through treatment in a text based format.
Receives: Behavioral: Therapist-supported internet-delivered prolonged exposure
Therapist-supported CBTActive comparatorTherapist-supported CBT internet-delivered treatment comprising psychoeducation about PTSD, relaxation techniques and relapse prevention. . The treatment will be delivered in a digital platform for ten weeks. Participants will have access to a therapist that will guide them through treatment in a text based format.
Receives: Behavioral: Therapist-supported internet-delivered CBT

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in PTSD symptoms as assessed by the Clinician Administered PTSD Scale (CAPS-5)

    The CAPS-5 is structured interview that assesses the Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5) criteria for PTSD (Weathers et al., 2013). Each item is rated on a severity scale ranging from 0 (Absent) to 4 (Extreme/incapacitating) and combines information about frequency and intensity for each of the 20 symptoms. Total Score (Range 0-80 with higher scores representing more PTSD symptoms.

    Measured: Baseline, 1-month (primary endpoint), 6-month and 12-month post-treatment

Secondary outcomes (10)
  1. Change in PTSD symptoms as assessed by the PTSD Check List - DSM-5 (PCL-5)

    The PCL-5 is a 20-item self-report measure based upon the Diagnostic and Statistical Manual (DSM-5) criteria for PTSD. Total Score (Range 0-80 with higher scores representing more PTSD symptoms.

    Measured: Baseline, through the treatment period up to 10 weeks and 1-month, 6-month and 12-month post-treatment]

  2. Change in ICD-11 PTSD and complex PTSD symptoms as assessed by the International Trauma Questionnaire (ITQ).

    The ITQ includes six items measuring each PTSD symptom cluster and these items measure how bothersome each symptom has been in the past month. The ITQ also includes six items measuring each 'Disturbance in Self-Organization' (DSO) symptom in complex PTSD. These items measure how a respondent typically feels, thinks about oneself, and relates to others. The PTSD and DSO symptoms are accompanied by three items measuring associated functional impairments in the domains of social, occupation, and other important areas of life. All items are answered on a 5-point Likert scale ranging from 0 (Not at all) to 4 (Extremely). Thus, PTSD and DSO symptom scores range from 0 to 24 and CPTSD symptom scores range from 0 to 48. Higher scores represents more PTSD and complex PTSD symptoms.

    Measured: Baseline, immediately after treatment completion, 1-month, 6-month and 12-month post-treatment

  3. Change in depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9)

    The PHQ-9 is a widely used and well-validated instrument for measuring the severity of depressive symptoms. Scores are calculated based on how frequently a person experiences 9 symptoms of depression ranging from "not at all" response is scored as 0; "several days" response is 1; "more than half the days" response is 2; and "nearly every day" response is 3. Higher scores represents more depressive symptoms.

    Measured: Baseline, immediately after treatment completion, 1-month, 6-month and 12-month post-treatment

  4. Change in quality of life measured by Euroqol, EQ-5D

    Change in overall health from baseline to post treatment and follow up . EQ-5D is a standardized self-report measure of overall health status measured in terms of five dimensions; mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Mobility dimension asks about the person's walking ability. Self-care dimension asks about the ability to wash or dress by oneself, and usual activities dimension measures performance in "work, study, housework, family or leisure activities". In pain/discomfort dimension, it asks how much pain or discomfort they have, and in anxiety/depression dimension, it asks how anxious or depressed they are. The respondents self-rate their level of severity for each dimension using a three-level scale: 1 having no problems, 2 having some problems and 3 having extreme problems. A higher score indicate worse severity.

    Measured: Baseline, immediately after treatment completion, 1-month, 6-month and 12-month post-treatment

  5. Change in Assessing Quality of Life 6 Dimensions (AQoL-6D)

    Used to assess cost-effectiveness. 20 questions that assess different aspects of quality of life. The AQoL provides a utility score that ranges from 1.00 (full health) to 0.00 (death-equivalent health states) to -0.04 (health states worse than death.

    Measured: Baseline, immediately after treatment completion, 1-month, 6-month and 12-month post-treatment

  6. Change in Treatment Inventory of Costs in Psychiatric Patients (TIC-P)

    Self-rated questionnaire on healthcare utilization and productivity losses in patients with a psychiatric disorder. The TIC-P questionnaire measures costs in two dimensions: use of health resources and loss of productivity. Lower cost is better.

    Measured: Baseline, immediately after treatment completion, 1-month, 6-month and 12-month post-treatment

  7. Adverse events related to treatment measured by the Negative effects questionnaire

    Self-rated questionnaire on negative effects. It contains 32 items that are scored on a five point Likert-scale (0-4) and differentiates between negative effects that are attributed to treatment and those possibly caused by other circumstances. The total score of the NEQ ranges from 0 to 80 points, a higher score reflects more negative effects.

    Measured: Immediately after treatment completion, 1-month, 6-month and 12-month post-treatment

  8. Participants satisfaction with treatment, assessed by The Client Satisfaction Questionnaire (CSQ-8).

    The CSQ-8 yields a single score measuring a single dimension of overall satisfaction. An "overall score" is calculated by summing the score on each of the eight scale item. Scores range from 8 to 32, with higher values indicating higher satisfaction.

    Measured: Immediately after treatment completion

  9. Number of completed treatment modules

    Data will be gathered on total number of completed modules during the 10 week treatment.

    Measured: Baseline up to treatment completion at 10 weeks

  10. Number of messages sent and received in the digital platform

    Data will be gathered on total number of messages sent and received back and forth between the participant and the therapist during the 10 week treatment.

    Measured: Baseline up to treatment completion at 10 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted6 Jul 2023
  2. Study start4 Sep 2023
  3. Primary completion20 Aug 2025 (estimated)
  4. Study completion20 Aug 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomized controlled trial
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
286 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05934162
Sponsor's protocol ID
2023-02866-01
Other IDs
2023
Status last verified
Dec 2023
First submitted
26 Jun 2023
Last updated
7 Dec 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Bragesjo M, Ivanov VZ, Andersson E, Ruck C. Study protocol of a randomized controlled superiority trial of Huddinge Online Prolonged Exposure therapy (HOPE) for adults with posttraumatic stress disorder. Trials. 2025 Dec 12;27(1):43. doi: 10.1186/s13063-025-09361-0.

    PubMed 41388429

Questions about this trial

What is this clinical trial studying?

A study testing Therapist-supported internet-delivered prolonged exposure and Therapist-supported internet-delivered CBT in people with Post Traumatic Stress Disorder, run by Karolinska Institutet at 1 site in Sweden.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 7 Dec 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Sweden. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Maria Bragesjö, PhD (0703399387, maria.bragesjo@ki.se), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in PTSD symptoms as assessed by the Clinician Administered PTSD Scale (CAPS-5) (time frame: Baseline, 1-month (primary endpoint), 6-month and 12-month post-treatment). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05934162, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Dec 2023.

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