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Post-traumatic stress disorder (PTSD) is estimated to affect 3.9% of the global population, and stepped care can improve access to PTSD treatments by matching clients to a treatment type that best suits their needs. However, there is a lack of consensus about what treatments should be used, the criteria for stepping clients up to a higher-intensity treatment and who should start with higher-intensity treatment.

To address this gap and provide guidance for clinical decision-making, a trial conducted by Flinders University researchers evaluated an online stepped care approach for PTSD. The work is published in the journal Behaviour Research and Therapy.

"Clinical guidelines and government health policies increasingly recommend stepped care approaches to address mental health disorders—with a view to improving treatment accessibility through online and e-health technology," says lead researcher Dr. Larissa Roberts, a research fellow at Flinders' College of Human Sciences and Culture.

The Flinders researchers' approach had two treatment steps—This Way Up, an online self-guided therapy, and cognitive processing therapy (CPT), a standard-format therapy—with prespecified criteria for stepping up between treatment steps.

Stepped care was evaluated in comparison with CPT delivered via telehealth among 84 adults with PTSD and subthreshold PTSD.

The stepped care treatment cost 8%–10% less to deliver than CPT, while achieving similar improvements on the clinician-rated PTSD measure after treatment and in depression at all time points through the treatment program.

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