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Feder A, Kowalchyk ML, Brinkman HR, Cahn L, Aaronson CJ, Böttche M, Presseau C, Fred-Torres S, Markowitz JC, Litz BT, Yehuda R, Knaevelsrud C, Pietrzak RH. Randomized controlled trial of two internet-based written therapies for world trade center workers and survivors with persistent PTSD symptoms. Psychiatry Res 2024; 336:115885. [PMID: 38603979 DOI: 10.1016/j.psychres.2024.115885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/12/2024] [Accepted: 03/27/2024] [Indexed: 04/13/2024]
Abstract
Posttraumatic stress disorder (PTSD) remains prevalent among individuals exposed to the 9/11 World Trade Center (WTC) terrorist attacks. The present study compared an Internet-based, therapist-assisted psychotherapy for PTSD to an active control intervention in WTC survivors and recovery workers with WTC-related PTSD symptoms (n = 105; 75% syndromal PTSD). Participants were randomized to integrative testimonial therapy (ITT), focused on WTC-related trauma, or modified present-centered therapy (I-MPCT), each comprising 11 assigned written narratives. The primary outcome was baseline-to-post-treatment change in PTSD symptoms on the PTSD Checklist for DSM-5 (PCL-5). Secondary measures included PTSD symptom clusters, depressive/anxiety symptoms, functioning, and quality of life. A significant main effect of time was observed for the primary outcome (average "large" effect size improvement, d = 1.49). Significant and "moderate-to-large" main effects of time were also observed for all PTSD symptom clusters, depressive symptoms, quality of life, and mental health-related functioning (d range=0.62-1.33). Treatment and treatment-by-time interactions were not significant. In planned secondary analyses incorporating 3-month follow-up measures, ITT was associated with significantly greater reductions than I-MPCT in PTSD avoidance and negative alterations in cognitions and mood, anxiety, and mental health-related functioning. Both therapies significantly lowered PTSD symptoms, suggesting they may benefit hard-to-reach individuals with chronic WTC-related PTSD symptoms.
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Affiliation(s)
- Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Mary L Kowalchyk
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hannah R Brinkman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leah Cahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cindy J Aaronson
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria Böttche
- Freie Universität Berlin, Department of Clinical Psychological Intervention, Berlin, Germany
| | - Candice Presseau
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Veterans' Administration Connecticut Healthcare System, West Haven, CT, USA
| | - Sharely Fred-Torres
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John C Markowitz
- New York State Psychiatric Institute, Department of Clinical Therapeutics, New York, NY, USA; Columbia University, Department of Psychiatry, New York, NY, USA
| | - Brett T Litz
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA; Boston University, Boston, Department of Psychological and Brain Sciences, MA, USA; Veterans' Administration Boston Healthcare System, Epidemiological Research and Information Center, Boston, MA, USA
| | - Rachel Yehuda
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Icahn School of Medicine at Mount Sinai, Department of Neuroscience, New York, NY, USA; James J. Peters Veterans' Administration Medical Center, Bronx, New York, USA
| | - Christine Knaevelsrud
- Freie Universität Berlin, Department of Clinical Psychological Intervention, Berlin, Germany
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA
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