From research to routine care: implementation of guided digital therapy with Spring PTSD

Background: Cognitive behavioural therapy with a trauma-focus (CBT-TF) is a recommended first-line treatment for post-traumatic stress disorder (PTSD), but access is limited by high costs and logistical barriers. Guided digital CBT-TF offers a scalable and accessible alternative.Objective: To evaluate the real-world effectiveness of Spring PTSD, a guided digital CBT-TF, within routine National Health Service (NHS) practice.Method: Adults with a primary diagnosis of PTSD were offered Spring PTSD with brief therapist guidance. Outcomes were assessed via an online survey that measured PTSD symptoms (International Trauma Questionnaire; ITQ), psychological distress (Clinical Outcomes in Routine Evaluation - Outcome Measure; CORE-OM), functional impairment (Work and Social Adjustment Scale; WSAS), subjective distress (Subjective Units of Distress Scale; SUDS), and satisfaction (Client Satisfaction Questionnaire; CSQ-8). Pre-to-post-treatment changes were analysed using paired t-tests or Wilcoxon signed-rank tests, as appropriate. Analyses were conducted for the sub-sample who self-reported completing treatment and the full sample, with Multiple Imputation (MI) and Last Observation Carried Forward (LOCF).Results: Data from 460 participants were analysed. Significant reductions were observed from pre-to post-treatment in PTSD symptoms, psychological distress, functional impairment, and subjective distress in the full sample (using MI and LOCF) and the sub-sample who self-reported having finished treatment. Satisfaction was high among those who reported finishing treatment, with the majority rating the programme as excellent or good. However, substantial missing data were noted, primarily due to reliance on therapists for demographic data collection and governance restrictions limiting the collection of identifiable information during this service evaluation.Conclusions: Findings support the feasibility, scalability, and acceptability of guided digital CBT-TF. However, the substantial missing data and limited ability to assess engagement highlight the challenges of collecting real-world effectiveness data outside of research. Future service evaluations should prioritise more robust and integrated data collection processes to improve the quality and utility of real-world evidence.