Internet-Based Psychotherapies for PTSD Symptoms in WTC Responders

Details

• Personal Author:
  Aaronson C ; Feder A ; Huckins L ; Litz B ; Pietrzak RH ; Presseau C ; Yehuda R
• Description:
  Background: The 9/11 terrorist attacks on the WTC were unprecedented in scope and impact, affecting hundreds of thousands of individuals of who lived, worked, or were passersby in the areas surrounding the WTC, as well as tens of thousands of workers who were involved in rescue, recovery and clean-up efforts following the attacks. Recent studies conducted in the second decade following 9/11/2001 have shown that rates of PTSD remain elevated in these populations, ranging from 14.3 to 21.9%. While trauma-focused cognitive behavioral therapies (CBT) is the most effective and empirically supported of available treatments for PTSD, the provision of this treatment to symptomatic WTC workers is often limited by geographical distance, reduced availability of expertly trained therapists, and stigma associated with seeking formal treatment. This study aimed to address this gap by conducting a randomized controlled trial (RCT) of a therapist-assisted, internet-based CBT, Integrative Testimonial Therapy (ITT) compared to therapist-assisted, Internet-based Modified Present-Centered Therapy (I-MPCT) in WTC workers and survivors with persistent clinically significant WTC-related PTSD symptoms (syndromal or subsyndromal PTSD). Methods: A total of 105 eligible participants (75% will syndromal PTSD, 25% with subsyndromal PTSD at screening) were randomized to ITT or I-MPCT, stratified by three groups: traditional responder (e.g., police), non-traditional responder (e.g., construction worker), and survivor. Participants completed self-report questionnaires at baseline, post-treatment, and 3 months following end of treatment. Of the 105 randomized participants, 85 (81%) completed treatment. A subsample provided saliva samples for genetic and epigenetic biomarker studies -67 (64%) at baseline, 56 (53%) at post-treatment. After comparing sociodemographic, trauma, and clinical characteristics of participants randomized to the two treatment groups, linear mixed-effects models were conducted to analyze treatment effects on all study outcome measures. Treatment (ITT vs. IMPCT), Time (baseline, post-intervention), and Treatment x Time interaction were entered as fixed factors; baseline scores as a fixed covariate, subject as a random effect, and scores on primary (i.e., PTSD Checklist for DSM-5, PCL-5) and secondary (e.g., Beck Depression Inventory - Version II, BDI-II; PCL-5 PTSD symptom clusters) outcome measures as dependent variables in separate analyses. As per intention-to-treat principles, all participants who completed the pre-treatment assessment, regardless of whether any participants dropped out of the trial, were included in these analyses. Additional analyses evaluated whether a history of prior mental health treatment influenced response to ITT and/or I-MPCT. Results: Significant main effects of time were observed for the primary outcome measure of PCL-5 scores as well as all PTSD symptom clusters, co-morbid depressive symptoms, quality of life (Q-LES-Q), and SF-8 mental health-related functioning, indicating that both ITT and I-MPCT yielded significant improvements in PTSD symptoms and additional, secondary outcomes. For the primary outcome measure of PCL-5 scores, the magnitude of this improvement was large (d=1.49, 95%CI=1.05-1.92). Magnitudes of improvements for secondary outcome measures were moderate-to-large, ranging from d=0.62 (95%CI=0.23-1.01) for quality of life (Q-LES-Q) to 1.33 (95%CI=0.91-1.75) for PTSD symptoms of alterations in arousal and reactivity. Main effects of treatment and interactions of treatment x time were not significant for any of the primary or secondary outcome measures. Additional analyses examining moderating effects of prior mental health treatment revealed significantly higher improvement in overall PTSD symptom severity in participants randomized to ITT who had a history of prior mental health treatment, and in those randomized to I-MPCT who did not have a history of prior treatment. Secondary analyses further revealed that lifetime treatment with psychotropic medication (but not psychotherapy) accounted for these effects. Conclusion: Findings from this novel RCT of therapist-assisted, internet-based psychotherapies suggest that both ITT and I-MPCT are efficacious for the treatment of WTC responders and survivors who have continued to experience clinically significant PTSD symptoms two decades following the 9/11 terrorist attacks. Findings additionally suggest personalizing these treatment interventions -selection of ITT vs. I-MPCT- based on the affected individual's mental health treatment history. Provision of these therapist-assisted, internet-based psychotherapies to WTC responders and survivors with PTSD can greatly reduce barriers preventing access to effective interventions for this chronic and disabling condition. [Description provided by NIOSH]
• Subjects:
  Behavior Biomarkers Construction Industry Emergency Responders Mental Health Nervous System Occupational Health Safety September 11 Terrorist Attacks Stress Disorders, Post-Traumatic Surveys And Questionnaires

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• Keywords:
  Cognitive Function Construction Workers Emergency Responders Mental Health Post-traumatic Stress Disorder Psychological Effects Psychology PTSD Questionnaires Rescue Workers Traumatic Incident Stress World Trade Center WTC

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• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Final Cooperative Agreement Report
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-38
• NIOSHTIC Number:
  nn:20066116
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, U01-OH-010729, 2021 Nov; :1-38
• Contact Point Address:
  Adriana Feder, M.D., Associate Professor, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029
• Email:
  adriana.feder@mssm.edu
• Federal Fiscal Year:
  2022
• Performing Organization:
  Icahn School of Medicine at Mount Sinai, New York
• Peer Reviewed:
  False
• Start Date:
  20160901
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20190831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:cab2c270da48c44476cfe6c053546d5565eec36e6ffa626731345c5a4d1617e3a65b3f58d307c2ecdc0328985ba47bed88ee845d4dafe105f9a8b8e56652ab97
• Download URL:
  https://stacks.cdc.gov/view/cdc/219141/cdc_219141_DS1.pdf
• File Type:
  [PDF - 2.12 MB ]