Pragmatic Randomised Controlled Trial of Guided Self-help Versus Individual Cognitive Behavioural Therapy with a Trauma Focus for Post-Traumatic Stress Disorder (RAPID)

Abstract

Post-traumatic stress disorder (PTSD) is a common, disabling condition that can occur following major traumatic events. Typical symptoms include distressing reliving, avoidance of reminders, and feeling a current sense of threat. First-choice treatments for PTSD are individual, face-to-face talking treatments, of 12-16 hours duration, including cognitive behavioural therapy with a trauma focus. If equally effective treatments could be developed that take less time and can be largely undertaken in a flexible manner at home, this would improve accessibility, reduce waiting times and hence the burden of disease. RAPID was a randomised controlled trial using a web-based programme called Spring. The aim was to determine if trauma-focused guided self-help provided a faster and cheaper treatment for PTSD than first-choice face-to-face therapy, whilst being equally effective. Guided self-help using Spring is delivered through eight steps. A therapist provides a one hour introductory meeting followed by four further, fortnightly sessions of 30 minutes each and four brief (around 5 minute) telephone calls or email contacts between sessions. At each session, the therapist reviews progress and guides the client through the programme, offering continued support, monitoring, motivation, and problem solving. 196 people with PTSD to a single traumatic event took part in the study. Guided self-help using Spring was found to be equally effective to first-choice face-to-face therapy at reducing PTSD symptoms at 16 weeks. Very noticeable improvements were maintained at 52 weeks post-randomisation in both groups, when most results were inconclusive but in favour of face-to-face therapy. Guided self-help using Spring was significantly cheaper to deliver and appeared to be well-tolerated. It is noteworthy that not everyone benefitted from guided self-help using Spring, highlighting the importance of considering it on a person-by-person basis, and personalising interventions. But, the RAPID trial has demonstrated that guided self-help using Spring provides a low intensity treatment option for people with PTSD that is ready to be implemented in the NHS.