Researchers from Leipzig University in Germany mounted a pilot to see if treatment over the internet, with therapist support, could remediate trauma symptoms suffered by Iraqi civilians in conflict areas.  (Web-based treatment is badly needed, as ongoing violence has driven many of Iraq’s physicians and mental health professionals out of the country.)

A therapist-supported cognitive-behavioral treatment manual* that has been evaluated in Western countries was translated into Arabic and culturally adapted to the population. 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 post-treatment. All treatment effect sizes were in the large range, indicating a significant improvement in mental health symptoms and quality of life.
In conclusion, 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.

*The intervention administered in the study (Lange et al., 2003a) is comprised of three treatment phases: (a) self-confrontation, (b) cognitive reappraisal, and © social sharing. For its application in Iraq, the “Interapy” approach was translated and culturally adapted. The website (“Ilajnafsy” means “psychological help”) provides information about PTSD, online diagnosis, and the treatment program. Potential patients can log in and complete the screening questionnaires online. The screening consists of a set of standardized clinical questionnaires covering all relevant disorders. Patients admitted to the program are then given two weekly, 45-minute writing assignments over a 5-week period (10 essays in total). Ilajnafsy is provided by native Arabic-speaking psychotherapists or psychiatrists living in Iraq or neighboring countries (e.g., Palestine, Syria, the Emirates) or in Europe. The therapists were trained in the Interapy approach in 7-day workshops. All therapists participate in weekly supervision sessions and contribute to an online supervision forum implemented on the website.

Citation:  Wagner B, Schulz W, Knaevelsrud C. Efficacy of an Internet-based intervention for posttraumatic stress disorder in Iraq: a pilot study. Psychiatry Research. 2012 Jan 30;195(1-2):85-8. Epub 2011 Aug 2. [email protected]