Online stepped care for the treatment of posttraumatic stress disorder: A randomized controlled noninferiority trial.
Larissa N Roberts, Reginald D V Nixon
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In 30 seconds
This randomized controlled non-inferiority trial compared online stepped care with telehealth cognitive processing therapy (CPT) in 84 adults with PTSD or subthreshold PTSD. Stepped care began with self-guided online therapy, with pre-specified criteria for moving to CPT. Both groups improved in PTSD symptoms, depression, and quality of life, with no differential rates of change over time. Stepped care was non-inferior on clinician-rated PTSD at post-treatment and depression at all time points, but non-inferiority was not established for self-reported PTSD symptoms or quality of life. It used 8-10% less clinician time, while dropout was higher (43% versus 26%).
Key findings
- Both groups improved over time in PTSD symptoms (CAPS-5: g = 1.19 to 2.09; PCL-5: g = 1.23 to 2.59), depression (DASS-21: g = 0.63 to 1.13), and quality of life (AQoL-8D: g = -0.46 to -1.02).
- Stepped care was non-inferior to CPT for clinician-rated PTSD at post-treatment and for depression at all time points.
- Non-inferiority was not established for PCL-5 or quality-of-life outcomes, which favored CPT.
- Stepped care used 8-10% less clinician time, but dropout was higher than with CPT (43% versus 26%).
Why it matters
Online stepped care may offer a way to deliver PTSD treatment with less clinician time while achieving improvements across several outcomes. However, the findings do not show equivalent results across all measures, and higher dropout may limit its usefulness. The results highlight the importance of monitoring engagement and outcomes when evaluating lower-intensity treatment pathways.
What to keep in mind
The trial included 84 adults, and dropout was higher with stepped care. Non-inferiority was not established for self-reported PTSD symptoms or quality of life.