Discussion
depression, traumatic, post-traumatic stress, trauma
EVENTS
The current study was a randomised trial with 102 participants recently exposed to trauma and experiencing symptoms of post-traumatic stress, comparing the digital intervention CIPE against a waiting list. The results indicated that the CIPE group had significantly larger reductions in symptoms of post-traumatic stress than the waiting list. Moderate-to-large effect sizes were observed at post-assessment and 1 month after the intervention. The intervention also conferred some benefit with regard to symptoms of depression and quality of life as compared to the control group. The results concur with the data from our pilot trial (Bragesjö et al., The current trial is the first to evaluate a digital, therapist-guided exposure-based intervention provided in the early phase after trauma in a larger RCT. The effect sizes found in this trial are comparable to or larger than those found in studies that have evaluated CBT-T as an early intervention when delivered face-to-face (Bryant et al., The results in this trial clearly show that it is possible to reach and deliver interventions to trauma-afflicted individuals remotely using a digital platform. CIPE is a flexible intervention as it does not require any scheduled appointments or participants to commute to a clinic. Together with the anonymity of the digital format for trauma victims struggling with shame (Kantor, Knefel, & Lueger-Schuster, There are concerns among clinicians that exposure-based interventions may not be tolerable for many trauma-afflicted individuals (Deacon & Farrell, The main strengths of the current trial study were the randomised design, the large sample size, the use of repeated measures as well as the controlled follow-up time of 1 month after treatment completion. The trial also acknowledges limitations and provides important research questions for future research. One important methodological limitation of this trial was that the outcome measures were self-report questionnaires. The groups may have differed in implicit expectation on how to report their symptoms, which may have introduced a bias towards greater effects. Future trials would benefit from using clinician-administered assessments using blinded assessors. Second, the negative effects on natural recovery seen in a small group of trauma victims provided with critical incident stress debriefing immediately post-trauma were not found until 18 months later (Rose, Bisson, Churchill, & Wessely, Notwithstanding its limitations, this trial provides evidence that CIPE is efficacious in reducing short- and long-term symptoms of post-traumatic stress compared to a waiting list condition. The trial is the largest to date showing that it is safe and feasible to deliver exposure-based interventions in the early post-trauma phase with remotely-delivered therapist support. CIPE holds the potential to increase the outreach to the millions of people exposed to psychologically traumatic events each year.