Online Therapy for Posttraumatic Stress Symptoms in WTC Responders and Survivors

Some people who live through traumatic experiences, such as the 9/11 WTC attacks or their
aftermath, suffer from mental and physical problems that occur as a result of the incident
and can persist over time. These problems are known as post-traumatic stress reactions or
symptoms, and may include sleep disturbances, feelings of guilt and shame, persistent
nightmares or upsetting memories of the incident, avoidance of reminders that might trigger
upsetting memories, loss of interest in activities, concentration difficulties, and feeling
distant from other people.

People who experience persistent PTSD symptoms often receive treatment in person in an
outpatient clinic. However, recent findings suggest that Internet-based treatment can also
yield positive treatment effects. The Internet offers people the opportunity to receive
psychological support from home. For some people, it is easier to communicate without direct
visual contact with another person about their experiences. Despite the distance, people can
reflect on their situation or concerns with the help of a personal therapist.

As mentioned above, this study is for WTC responders who are not currently receiving
psychotherapy/ counseling. After completing the online consent form and an initial online
questionnaire, participants complete a telephone assessment conducted by a member of the team
at Mount Sinai Medical Center. If you are eligible and agree to participate, you will be
randomly assigned (as by the flip of a coin) to receive one of two therapies: Internet-based
cognitive-behavioral therapy or Internet-based supportive therapy. Each participant is
assigned a personal therapist from the team at Mount Sinai to work with throughout the
treatment. In this study, communication between participant and therapist is conducted
exclusively across the Internet, in written form, through the secure Web platform housed at
Mount Sinai. The treatment involves written exchanges between participant and therapist over
the course of approximately six weeks. Through guided writing, online therapy aims to help
WTC responders process their traumatic experiences or better manage current life problems. In
this study, the researchers aim to find out if Internet-based therapy can help WTC responders
who are still experiencing PTSD symptoms.

Inclusion Criteria:

- Men and women who have worked or volunteered as rescue, recovery or clean-up workers
at the WTC site following the 9/11 attacks, or who were living as a resident or
working as an employee within the NYC disaster area during the 9/11 attacks, and who:

- are currently still experiencing significant posttraumatic stress symptoms related to
what they witnessed or lived through during the 9/11 attacks or their WTC recovery
work and:

- are not currently receiving psychotherapy or counseling

- do not have psychosis, a psychotic disorder, or bipolar disorder

- have not had recent alcohol or drug use problems

- are not experiencing suicidal thoughts,thoughts of harming others, or significant
dissociative symptoms.

Exclusion Criteria:

- are currently taking antipsychotic medication, lithium or valproic acid.

- have a current uncontrolled medical illness, neurological disorder affecting the
central nervous system, or history of head injury