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EV0430

Huddinge Online Prolonged Exposure (HOPE) for adults with post-traumatic stress disorder

HUDDINGE ONLINE PROLONGED EXPOSURE THERAPY (HOPE) FOR ADULTS WITH POSTTRAUMATIC STRESS DISORDER

Internet-based prolonged exposure therapy (HOPE), delivered with written-only therapist support, produced greater reductions in both clinician-rated and self-reported PTSD symptoms than a matched active control.

The study aimed to test the superiority of HOPE, an entirely text-based internet-delivered prolonged exposure program with written-only therapist support, over a matched active control in a sample recruited using broad eligibility criteria. The design was an assessor-blinded, parallel-group, superiority randomized controlled trial (RCT); 289 adults diagnosed with PTSD were randomized 1:1 to 10 weeks of therapist-guided HOPE or an active control consisting of psychoeducation, relaxation, and stress management without exposure. The primary outcome was clinician-rated PTSD symptom severity (CAPS-5) at 1 month after treatment; randomization was stratified by complex PTSD (CPTSD) status and legal sex, and analyses used intention-to-treat linear mixed models retaining all randomized participants. In the sample, 89.3% were women, the mean age was 44.3 years (SD 11.4), 65.7% met ICD-11 criteria for complex PTSD (ITQ), 69.2% had at least one comorbid diagnosis, 58.5% were taking a psychotropic medication, and 33.2% were taking an antidepressant; the data presented are from an interim analysis of the ongoing study (n=255 assessed at 1 month; CAPS-5 n=214, PCL-5/PHQ-9 n=194). The between-group difference in change from baseline to the 1-month follow-up favored HOPE by 5.14 points on the CAPS-5 (95% confidence interval 2.14 to 8.15, p=0.001), 5.86 points on the PCL-5 (95% CI 2.09 to 9.63, p=0.002), and 1.97 points on the PHQ-9 (95% CI 0.42 to 3.51, p=0.013). The between-group effect size for the CAPS-5 was reported as d=0.47, and both groups improved over time. Explicit withdrawal from treatment occurred in 19/289 participants (6.6%; HOPE 11/146, 7.5%; control 8/143, 5.6%), and no serious adverse events were reported. The authors suggest that therapist-guided digital prolonged exposure may be a scalable option in settings with limited access to specialist PTSD services.

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