Efficacy of an Internet-based intervention for posttraumatic stress disorder in Iraq: a pilot study

In the past 20 years, war and human rights violations have led to high rates of exposure to traumatic events among the Iraqi population. Due to the ongoing violence, many physicians and mental health professionals have left Iraq in recent years. The Internet offers new possibilities for the psychological treatment of posttraumatic stress disorder (PTSD) in conflict areas. A therapist-supported cognitive-behavioral treatment manual that has been evaluated in Western countries was translated into Arabic and culturally adapted. The treatment was conducted via the Internet by Arabic-speaking therapists and was evaluated in an uncontrolled pilot study with 15 participants. Main outcome measures were PTSD (Posttraumatic Diagnostic Scale (PDS)), depression, anxiety (Hopkins Symptom Check List-25 (HSCL-25)), and quality of life (EUROHIS). The intervention resulted in a highly significant decrease in symptoms of PTSD, depression, and anxiety. Quality of life was higher at posttreatment. All treatment effect sizes were in the large range, indicating a significant improvement in mental health symptoms and quality of life. Preliminary clinical evidence indicates that new technologies can be used to provide humanitarian aid in the form of e-mental health services, even in areas that remain highly unstable.