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Internet-Based Therapies for Posttraumatic Stress
Epidemiological studies consistently reveal that lifetime exposure to at least one traumatic event is more common than not. A large body of evidence documents the negative influences of such trauma exposure on psychological health, well-being, and quality of life. Posttraumatic stress disorder (PTSD) is the most prototypical and disabling outcome of trauma exposure, with lifetime prevalence rates of approximately 10% in the general population and 10% to 20% in high-exposure groups, such as veterans of war. Although effective treatments for PTSD exist, there are significant barriers to care, including lack of access to trained mental health providers and stigma. This entry discusses one method of redressing barriers and obstacles to care: Internet-based approaches to PTSD treatment. Empirical evidence for existing Internet-based treatments is reviewed, and advantages and disadvantages of using the Internet to deliver PTSD treatment are addressed.
PTSD: Symptom and Treatment Overview
Trauma exposure is defined as experiencing or witnessing an event that causes intense fear, helplessness, or horror. Examples of potentially traumatic events are experiences of combat, life-threatening injury, physical or sexual assault, serious motor vehicle accidents, and natural disasters. Although the majority of individuals exposed to trauma do not experience significant or enduring negative mental health problems, approximately 8% of trauma-exposed individuals develop PTSD, which represents a significant public health problem.
PTSD is an anxiety disorder characterized by three symptom clusters. The first cluster consists of reexperiencing symptoms and includes nightmares or unwanted intrusive thoughts about the traumatic event, as well as emotional distress or physiological arousal when reminded of the trauma. The second cluster comprises avoidance and emotional numbing symptoms and includes efforts to avoid thoughts, memories, and contexts that are associated with the traumatic event, as well as numbing of emotional responsiveness and withdrawal. The third cluster consists of hyperarousal symptoms, which include difficulties with sleep, irritability, problems with concentration, an exaggerated startle response, and hypervigilance (a feeling of being constantly on guard). Many people diagnosed with PTSD also suffer comorbid psychological disorders, such as substance abuse and depression.
A number of evidence-based psychological treatments have been developed to treat PTSD. To date, the therapies that have received the most research attention and empirical support fall under the broad umbrella of cognitive behavioral therapy.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) includes several evidence-informed and problem-focused strategies designed to help the individuals with PTSD heal from traumatic exposure. As a rule, the CBT approach is structured, time-limited (i.e., 9 to 24 weekly sessions), experiential, and skills-based. CBT targets trauma-related beliefs and behaviors in an organized and systematic fashion. Each current evidence-based psychological treatment for PTSD (e.g., prolonged exposure therapy, stress inoculation training, and cognitive processing therapy) uses the CBT framework. Although these treatments differ in emphasis, they include components of psychoeducation, anxiety management, cognitive and exposure therapy, and relapse prevention. Numerous studies, including randomized controlled trials, indicate that CBT is effective in reducing PTSD symptoms in both acute and chronic presentations, with treatment effects maintained at extended (e.g., 1 year) follow-up.
Barriers to Care
Despite the effectiveness of psychological therapies for PTSD, logistical and psychological barriers to mental health care prevent many from getting the care they need and deserve. A large literature documents the problem of barriers to care, and two issues consistently emerge as primary factors: access to care and perceived stigma related to mental health problems and/or treatment.
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- Anthropology and Archaeology
- Anthropology and Trauma
- Anthropology and War
- Racial and Ethnic Factors
- Racial Variations in the Psychobiology of Trauma
- Resource Loss Among Adults, Groups, and Communities
- Resource Loss Among Children and Families
- Rituals and Ceremonies, Therapeutic Use of
- Role of Trauma in Ethnic and Cultural Identity
- War, Origins in Animals and Early Societies
- Wars for Symbols
- Wars in Civilized Societies
- Arts and Humanities
- Business and Economics
- Children and Families
- Abduction/Kidnapping
- African Women and Girls' Trauma
- Campus Violence
- Childhood and Adolescent Trauma: An Overview
- Childhood and Adolescent Trauma: Assessment and Treatment
- Childhood Trauma and the Juvenile Justice System
- Childhood Traumatic Stress
- Children of War
- Critical Illness in Children
- Dissociative Identity Disorder and Trauma
- Family and Couples Trauma and Treatment
- Family-Based Treatment for Child Traumatic Stress
- Genetic Epidemiology
- Incest
- Marital Rape
- Marriage and the Marital Relationship
- Military Families, Effects of Combat and Deployment on
- Parenting During and After Traumatic Events
- Perinatal Trauma
- Perinatal Trauma, Long-Term Consequences of
- Protective Factors in Childhood Posttraumatic Stress Disorder
- Resilient Posttraumatic Adjustment in Childhood and Beyond
- Resource Loss Among Adults, Groups, and Communities
- Resource Loss Among Children and Families
- School Shootings
- Systemic Trauma Research
- Transgenerational Transmission of Trauma
- Crime and Law
- Abduction/Kidnapping
- Battered Women
- Blaming the Victim
- Campus Violence
- Childhood Trauma and the Juvenile Justice System
- Clergy, Sexual Abuse by
- Community Violence
- Comstock Act
- Correctional Officers and Trauma
- Crime Scene Investigation
- Criminal Behavior Consequent to War
- Date Rape/Acquaintance Rape
- Genocide
- Genocide in Non-Western Nations
- Genocide, Cambodia's Mass Casualty Trauma
- Hate Crimes
- Homicide and Trauma
- Human Trafficking
- Incarceration and Trauma
- Incest
- Law Enforcement Officers
- Lawsuits Against Behavioral Health Professionals
- Lawsuits Against Medical Professionals
- Male Rape
- Marital Rape
- Mass Violence
- Military Sexual Abuse
- Murder
- Perpetrators of Trauma
- Psychological Injury and Law
- Rapist Profiles
- School Shootings
- Secondary Trauma Among First Responders
- Secondary Trauma Among Judges, Jurors, Attorneys, and Courtroom Personnel
- Sexual Assault and Trauma
- Sexual Assault, Drug Facilitated
- Sexual Compulsion and Trauma
- Sexual Harassment of Women
- Sexual Predators
- Sexual Trauma, Causes of
- Slavery and Forced Servitude
- Social Learning Theory and Sexual Aggression
- Survival and Coping After Rape
- Terrorism, History of
- Trauma and Domestic Violence
- Wartime Rape
- Workplace Violence
- Crisis and Disaster
- Community Disasters
- Critical Incident Stress
- Debriefing
- Disaster Medicine
- Disaster Mortuary Services
- Disaster-Related Trauma
- Disasters, History of
- Early Interventions
- Emergency Care and Services
- First Responders and Trauma
- Humanitarian Missions
- Peacekeeping Missions
- Psychobiology of Crisis
- Psychological First Aid
- Psychological First Aid for Older Adults
- Psychospiritual Impact of Disaster
- Resilience and Hurricane Katrina
- Role of Media in Managing Disasters
- Culture and Ethnicity
- African American Culture and Trauma
- African Women and Girls' Trauma
- Cultural Aspects of Trauma
- Cultural Diversity in Trauma Response
- Culture and Cultural Beliefs
- Culture and Trauma
- Ethnicity, Culture, and Disaster Response
- Genocide
- Genocide in Non-Western Nations
- Genocide, Cambodia's Mass Casualty Trauma
- Nongovernmental Organizations, Governments, and Humanitarian Aid
- Race-Based Traumatic Stress
- Racial and Ethnic Factors
- Racial Variations in the Psychobiology of Trauma
- Racism-Induced Trauma
- Refugees
- Rituals and Ceremonies, Therapeutic Use of
- Role of Trauma in Ethnic and Cultural Identity
- Slavery and Forced Servitude
- Traumatization in the Name of Religion
- Death and Dying
- Ethics and Philosophy
- Assisted Suicide
- Boundaries and Boundary Violations
- Boundary Issues for Traumatologists
- Counterbalancing Stress
- Countertransference
- Ethical Dilemmas in Treatment of Trauma
- Ethics
- Humor and Trauma
- Philosophy and Ethics of Trauma Treatments
- Philosophy of Trauma
- Philosophy of Trauma Nursing
- Secondary Trauma Among Behavioral Health Professionals
- Secondary Trauma Among Chaplains
- Secondary Trauma Among First Responders
- Secondary Trauma Among Judges, Jurors, Attorneys, and Courtroom Personnel
- Secondary Trauma Among Medical Professionals
- Secondary Trauma Among Medics and Corpsmen
- Secondary Traumatic Stress
- Shame
- Trauma Caregivers
- Trauma Memories: Research and Ethics
- First Responders
- History
- Humanitarian Aid
- Internet, the Media, and Entertainment
- Medicine
- Abortion
- Alcohol and Trauma
- Assisted Suicide
- Brain and Trauma
- Combat Medics and Corpsmen
- Critical Illness in Children
- Disaster Medicine
- Lawsuits Against Medical Professionals
- Medical Marijuana and Posttraumatic Stress Disorder
- Medical Trauma Research
- Pain
- Perinatal Trauma
- Perinatal Trauma, Long-Term Consequences of
- Pharmacotherapy
- Philosophy of Trauma Nursing
- Primary Care
- Psychopharmacology, Psychiatry, and Trauma
- Public Health
- Retraumatization
- Secondary Trauma Among Medical Professionals
- Sexual Assault, Drug Facilitated
- Somatic Complaints
- Trauma-Related Physical Symptoms and Illnesses
- Traumatized Nurses
- Traumatized Physicians
- Natural Sciences
- Biological Effects of Physical and Psychological Trauma
- Biological Mechanism of Traumatic Stress Response
- Biology and Posttraumatic Stress Disorder
- Brain and Memory
- Brain and Trauma
- Encoding Trauma, Neurobiology of
- Genetic Epidemiology
- Hippocampus
- Limbic System
- Neurobiological Effects of Trauma
- Neurobiology of Posttraumatic Stress Disorder and Suicide
- Psychobiology of Crisis
- Trauma and Metabolic Syndrome
- Trauma Resilience, Ecology of
- Traumatic Inventions and the Ethics of Scientific Discovery
- Traumatized Scientists
- Psychology and Psychiatry
- Acute Stress Disorder
- Biological Mechanism of Traumatic Stress Response
- Brain and Memory
- Burnout
- Clinical Trauma Psychology
- Cognitive Behavioral Therapy
- Cognitive Processing Therapy
- Cognitive Restructuring and Trauma
- Combat Stress Control
- Combat-Related Posttraumatic Stress Disorder
- Compassion Fatigue
- Complex Trauma
- Conservation of Resources Theory
- Counseling and Education About Trauma
- Counterbalancing Stress
- Countertransference
- Dissociation
- Dissociative Identity Disorder and Trauma
- Evidence-Based Practice
- Eye Movement Desensitization and Reprocessing: Theory and Research
- Eye Movement Desensitization and Reprocessing: Treatment
- Family and Couples Trauma and Treatment
- Family-Based Treatment for Child Traumatic Stress
- Fragility, Posttraumatic
- Iatrogenic Effects
- Lawsuits Against Behavioral Health Professionals
- Limbic System
- Marriage and the Marital Relationship
- Meditation
- Memory Work
- Military Psychology and Combat Stress Injuries
- Mowrer's Two-Factor Theory
- Pain
- Personality Disorders
- Pharmacotherapy
- Posttraumatic Stress Disorder
- Posttraumatic Stress Disorder Assessment and Systemic Treatment
- Posttraumatic Stress Disorder, Comorbidity
- Primary Care
- Promoting Resilience in the Traumatized
- Protective Factors in Childhood Posttraumatic Stress Disorder
- Psychological Injury and Law
- Psychological Responses to Trauma
- Psychological Trauma
- Psychological Trauma Research
- Psychoneuroimmunology and Trauma
- Psychopharmacology, Psychiatry, and Trauma
- Psychosensory Therapy
- Rape Counseling
- Rape Crisis Centers
- Rape Trauma Syndrome
- Recovery From Trauma
- Relapse Prevention and Posttraumatic Stress Disorder
- Resilience
- Resilience Bolstering
- Resilience, Growth, and Thriving
- Retraumatization
- Secondary Trauma Among Behavioral Health Professionals
- Secondary Traumatic Stress
- Shame
- Social Learning Theory and Sexual Aggression
- Social Support and Trauma
- Somatic Complaints
- Stigma
- Stress Inoculation Training
- Suicide
- Survival and Coping After Rape
- Systemic Trauma Research
- Theories of Psychological Stress
- Trauma and Selfhood
- Trauma and Sexuality
- Trauma Assessment
- Trauma Education
- Trauma Prevention
- Trauma Psychology Research
- Trauma Triggers
- Trauma-Related Happiness and Pleasure
- Trauma-Related Physical Symptoms and Illnesses
- Trauma, Causes of
- Trauma, Identity, and the Workplace
- Traumatic Stress and Resilience
- Traumatic Stress Responses
- Traumatized Practitioners, Supervisors of
- Victim, Survivor, Thriver
- Virtual Reality Exposure Therapy
- Vulnerability, Posttraumatic
- Public Health
- Religion and Spirituality
- Clergy, Counseling by
- Clergy, Sexual Abuse by
- Combat Chaplains
- Cults and Sects
- Growth, Posttraumatic
- Meditation
- Posttraumatic Growth Among Asylum Seekers and Other Immigrants
- Psychospiritual Impact of Disaster
- Religious and Pastoral Responses to Trauma
- Religious Fundamentalism
- Secondary Trauma Among Chaplains
- Spiritual and Religious Growth
- Spiritual Intelligence and Posttraumatic Growth
- Traumatization in the Name of Religion
- Social Work
- Battered Women
- Bereavement
- Cognitive Behavioral Therapy
- Cognitive Processing Therapy
- Comstock Act
- Ethics
- Evidence-Based Practice
- Military Social Work and Combat Stress Management
- Social Support and Trauma
- Social Work With the Traumatized Homeless
- Theories of Psychological Stress
- Trauma and Domestic Violence
- Trauma and Homelessness
- Trauma and Social Work Practice
- Trauma Research, Social Work Contributions to
- Traumatized Practitioners, Supervisors of
- Sociology
- Traumatology and Trauma Recovery
- Acute Stress Disorder
- Additive Trauma
- Alcohol and Trauma
- Bearing Witness to Trauma
- Biology and Posttraumatic Stress Disorder
- Clergy, Counseling by
- Clinical Trauma Psychology
- Cognitive Restructuring and Trauma
- Compassion Fatigue
- Complex Trauma
- Conspiracy of Silence
- Counseling and Education About Trauma
- Cultural Aspects of Trauma
- Cultural Diversity in Trauma Response
- Culture and Trauma
- Cumulative Trauma
- Dance and Trauma
- Despair, Posttraumatic
- Disaster-Related Trauma
- Early Interventions
- Encoding Trauma, Neurobiology of
- Ethical Dilemmas in Treatment of Trauma
- Eye Movement Desensitization and Reprocessing: Theory and Research
- Eye Movement Desensitization and Reprocessing: Treatment
- Fear, Posttraumatic
- Fragility, Posttraumatic
- Grief and Mourning
- Grief, Complicated
- Growth, Posttraumatic
- Hippocampus
- Homicide and Trauma
- Humor and Trauma
- Hypnosis in the Treatment of Posttraumatic Stress Disorder
- Iatrogenic Effects
- Incarceration and Trauma
- Literary Expressions of Trauma
- Managing Trauma Symptoms
- Medical Marijuana and Posttraumatic Stress Disorder
- Medical Trauma Research
- Military Trauma
- Neurobiological Effects of Trauma
- Neurobiology of Posttraumatic Stress Disorder and Suicide
- Perpetrators of Trauma
- Philosophy and Ethics of Trauma Treatments
- Philosophy of Trauma
- Poetry and Trauma
- Posttraumatic Growth Among Asylum Seekers and Other Immigrants
- Posttraumatic Stress Disorder
- Posttraumatic Stress Disorder Assessment and Systemic Treatment
- Posttraumatic Stress Disorder, Comorbidity
- Posttraumatic Stress Disorder, History of
- Prolonged Exposure
- Promoting Resilience in the Traumatized
- Psychological Responses to Trauma
- Psychological Trauma
- Psychological Trauma Research
- Psychoneuroimmunology and Trauma
- Psychosensory Therapy
- Rape Counseling
- Rape Crisis Centers
- Rape Trauma Syndrome
- Rapist Profiles
- Recovery From Trauma
- Relapse Prevention and Posttraumatic Stress Disorder
- Resilience
- Resilience and Hurricane Katrina
- Resilience Bolstering
- Resilience, Growth, and Thriving
- Sanctuary Model
- Self-Regulation
- Sexual Compulsion and Trauma
- Sexual Harassment of Women
- Sexual Predators
- Sexual Trauma, Causes of
- Shared Trauma
- Silencing Response
- Stigma
- Suicide
- Transgenerational Transmission of Trauma
- Trauma and Autobiography
- Trauma and Homelessness
- Trauma and Metabolic Syndrome
- Trauma and Metaphor
- Trauma and Selfhood
- Trauma and Sexuality
- Trauma and Social Work Practice
- Trauma as Entertainment
- Trauma Assessment
- Trauma Caregivers
- Trauma Education
- Trauma Memories: Research and Ethics
- Trauma Prevention
- Trauma Psychology Research
- Trauma Survival Strategies
- Trauma Triggers
- Trauma-Organized Systems
- Trauma-Related Happiness and Pleasure
- Trauma, Causes of
- Trauma, Definitions of
- Traumatic Bereavement
- Traumatic Stress and Resilience
- Traumatic Stress Responses
- Traumatized Scientists
- Traumatology
- Vicarious Trauma
- Victim, Survivor, Thriver
- Virtual Reality Exposure Therapy
- Vulnerability, Posttraumatic
- War Crimes
- War and Combat
- Anthropology and War
- Children of War
- Combat Chaplains
- Combat Medics and Corpsmen
- Combat Mortuary Services
- Combat Stress Control
- Combat-Related Posttraumatic Stress Disorder
- Combat-Related Stress Injury: Theory, Research, and Management
- Criminal Behavior Consequent to War
- Death Notification in War
- Military Families, Effects of Combat and Deployment on
- Military Psychology and Combat Stress Injuries
- Military Sexual Abuse
- Military Social Work and Combat Stress Management
- Military Trauma
- Secondary Trauma Among Medics and Corpsmen
- War Crimes
- War, Origins in Animals and Early Societies
- Wars for Symbols
- Wars in Civilized Societies
- Wartime Rape
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