Posttraumatic 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, a lack of consensus exists 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.
"Clinical guidelines and government health policies increasingly recommend stepped care approaches to address mental health disorders - with a view to improve treatment accessibility through online and e-health technology," says lead researcher Dr Larissa Roberts, Research Fellow at Flinders' College of Human Sciences and Culture.
The Flinders researchers' approach had two treatment steps - This Way Up, being an online self-guided therapy; and Cognitive Processing Therapy (CPT), a standard format therapy, adopting pre-specified 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 to CPT on the clinician-rated PTSD measure after treatment, or for depression at all time points through the treatment program.
However, CPT had less clients drop out during the treatment program (26% versus 43%) and better self-reported PTSD outcomes than stepped care.
Both groups demonstrated significant improvements in PTSD, depression, and quality of life throughout treatment and at 6-months after treatment.
"The reduced cost of the stepped care approach, as compared to using CPT alone, along with the online nature of the stepped treatments, shows promise to help increase the accessibility of PTSD treatments to clients," says Flinders University co-researcher Professor Reg Nixon.
"The stepped care approach was feasible, even among participants with high symptom severity and complexities."
Further research is needed to tailor the stepped care approach to reduce dropout and maximize treatment outcomes for individuals seeking treatment for PTSD, along with identifying which clients will benefit from initially receiving low-intensity therapies.
- The This Way Up program is available online with the support of a clinician at https://thiswayup.org.au/
The research - "Online stepped care for the treatment of posttraumatic stress disorder: A randomized controlled noninferiority trial", by Larissa Roberts and Reginald Nixon - has been published in Behaviour Research and Therapy. DOI: 10.1016/j.brat.2026.105166
