Trauma is the body-mind reaction that occurs when we experience a threat to our physical and/or our psychological safety. Symptoms can include (but are not limited to) sadness, anxiety, shame, insomnia, nightmares, and difficulty concentrating. When allowed to continue, the aftermath of trauma can change a person’s basic perception of their own safety and security in the world, resulting in persistent feelings of vulnerability, helplessness, and fear.
Many people who experience a traumatic event or a series of traumatic events develop post-traumatic stress disorder (PTSD) or complex post-traumatic stress disorder (C-PTSD). These conditions can be chronic and debilitating. Fortunately, effective treatments have been developed for PTSD and C-PTSD (1,2).
During the COVID-19 pandemic, when in-person treatment is often impossible or undesirable, online therapy, or teletherapy, becomes the fallback option for treatment for PTSD, C-PTSD, and other mental health needs.
Teletherapy and Online Therapy for PTSD and C-PTSD
Online therapies have been shown to work for different mental health challenges. In a systematic review of 29 studies, for example, researchers found that online Cognitive Behavioral Therapy (CBT) for major depression was as effective as in-office face to face therapy (4).
Before we offer a therapeutic method for trauma, we need to ensure its effectiveness. Fortunately, prior to the coronavirus outbreak, researchers have examined the effectiveness of telehealth treatment of PTSD. The results were encouraging and showed that therapy delivered through telehealth was as effective as therapy delivered face-to-face for PTSD (3).
To the author’s knowledge, studies investigating the efficacy of telehealth or online therapy for C-PTSD have not yet been made available. However, given the proven effectiveness of online therapy for a wide range of conditions, such as major depression (4), panic disorder, agoraphobia, anxiety disorders (5,6), and PTSD (3), therapists should strongly consider teletherapy or online therapy for C-PTSD during the period where social isolation is mandatory or suggested.
If You Are Experiencing Trauma
Symptoms of trauma occur initially and over time. Initial reactions can include sadness, anxiety, agitation, confusion, emotional numbness, and hyperarousal (fight or flight) autonomic response. More severe reactions to trauma are indicated by the experience of continuous distress without relief even though the person has returned to safety. Intense recollections of the traumatic event, dissociation, and on-going heightened autonomic stress response continue.
Delayed reactions to trauma include sleep disturbances or disorders, nightmares flashbacks, depression, anxiety, and on-going fatigue. Avoidance of reminders of the trauma also occurs (7). While these responses to trauma are normal, in our physiology the stress response is meant to be controlled and regulated. Our bodies and minds are not built to handle long-term, on-going stress response. The consequences of an on-going response to trauma are not confined to mental and emotional health. Our reaction to trauma includes a strong physiological response.
Research has shown that the development of traumatic memories creates a vulnerability because of repeated environmental triggering of the deregulation of a person’s neurobiology. The vulnerability is not limited to behavioral disorders. Chronic illness is associated with a variety of physiological factors associated with stress.The increased stress load that accompanies PTSD increases the risk for a variety of illnesses such as hypertension, musculoskeletal pain, obesity, and cardiovascular disease (8).
If you are experiencing trauma, you do not have to wait until social distancing measures are lifted or relaxed before you can attend therapy sessions. Getting help via secure video and other platforms is a safe way to get the care that you need and prevent on-going and increased damage that can occur because of unresolved and persistent trauma symptoms.
Confidentiality and Privacy in Online Therapy
Confidentiality is just as important in online therapy as it is in traditional forms of therapy. If you are considering online or virtual therapy, be sure you are using secure, private, and HIPAA-compliant platforms for therapy sessions.
Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in behavioral neuroscience, 12, 258.
Dorrepaal, E., Thomaes, K., Smit, J. H., Veltman, D. J., Hoogendoorn, A. W., van Balkom, A. J., & Draijer, N. (2013). Treatment compliance and effectiveness in complex PTSD patients with co-morbid personality disorder undergoing stabilizing cognitive behavioral group treatment: a preliminary study. European journal of psychotraumatology, 4(1), 21171.
Acierno, R., Knapp, R., Tuerk, P., Gilmore, A. K., Lejuez, C., Ruggiero, K., … & Foa, E. B. (2017). A non-inferiority trial of prolonged exposure for posttraumatic stress disorder: in person versus home-based telehealth. Behaviour research and therapy, 89, 57-65.
Ahern, E., Kinsella, S., & Semkovska, M. (2018). Clinical efficacy and economic evaluation of online cognitive behavioral therapy for major depressive disorder: a systematic review and meta-analysis. Expert review of pharmacoeconomics & outcomes research, 18(1), 25-41.
Bouchard, S., Payeur, R., Rivard, V., Allard, M., Paquin, B., Renaud, P., & Goyer, L. (2004). Cognitive behavior therapy for panic disorder with agoraphobia in videoconference: Preliminary results. CyberPsychologu & Behavior, 3(6).
Nordgren, L. B., Hedman, E., Etienne, J., Bodin, J., Kadowaki, Å., Eriksson, S., … & Carlbring, P. (2014). Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: a randomized controlled trial. Behaviour research and therapy, 59, 1-11.
Center for Substance Abuse Treatment. (2014). Understanding the impact of trauma. In Trauma-Informed Care in Behavioral Health Services. Substance Abuse and Mental Health Services Administration (US).
McFARLANE, A. C. (2010). The long‐term costs of traumatic stress: Intertwined physical and psychological consequences. World Psychiatry, 9(1), 3-10.