RAPID

A pragmatic randomised controlled trial of a trauma-focused Guided Self Help programme versus Individual Trauma-Focused Cognitive Behavioural Therapy for Post-Traumatic Stress Disorder.

Background

The aim of this research is to determine if trauma-focused guided self help (GSH) using a web-based programme provides a faster and cheaper treatment for Post-Traumatic Stress Disorder (PTSD) than individual trauma-focused cognitive behavioural therapy (TFCBT), whilst being equally effective.

Post-Traumatic Stress Disorder (PTSD)

PTSD is a common, often disabling mental disorder that can occur following major traumatic events such as abuse, assaults and accidents. Typical symptoms include:

• distressing reliving in the form of nightmares or intrusive thoughts
• avoidance of reminders
• distorted thoughts such as feeling shame for being abused
• hyperarousal, for example through increased irritability and jumpiness.

Recent news stories highlight the devastating impact that PTSD can have (eg the Saville Effect) and how the absence of timely intervention can lead to long-term suffering. They have also increased public awareness of PTSD and, potentially, the likelihood of presentation for help.

Improving patient care

The first choice treatments for PTSD are individual talking treatments (including TFCBT) of 12-16 hours duration. The limited number of therapists available and length of treatment means that there are long NHS waiting lists of up to 18 months. PTSD sufferers may also have difficulty committing to weekly appointments, especially if they are working, have childcare commitments or are scared to go out alone or to new places. 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. GSH has the potential to address this gap.

Guided self help

The RAPID Study is a randomised controlled trial of carefully developed GSH using a web and app-based programme, with up to three hours contact with a therapist either in person, via internet video link or telephone, versus face-to-face TFCBT.

Outcomes

Outcomes will include measures of:

• PTSD
• depression
• anxiety
• insomnia
• self-efficacy
• thoughts
• quality of life
• disability.

Information will be collected to estimate the costs of delivering the GSH and of the savings if it is successful from the perspective of the patient, their family, the health service and society as a whole.