Motor Vehicle Accident Survivors on Five Continents Involved in Lerner�s Internet-Based PTSD Research

by Carol Olechowski

For years, UAlbany Center for Stress and Anxiety Disorders Director Edward B. Blanchard has researched and treated motor vehicle accident survivors who suffer from nightmares, flashbacks, depression, anxiety, and other symptoms of Post Traumatic Stress Disorder (PTSD). Now, accident survivors around the world who fear traveling the highways again are using the �Information Superhighway� to reach out to one of Blanchard�s students, Jonathan Lerner, for help.

Via the Internet, Lerner, who aims to complete his doctoral studies this year, is gathering information that will enable him to assess if MVA survivors are suffering from PTSD and direct them to self-treatment. A comprehensive assessment offered on the Web site www.afterthecrash.com invites respondents to answer questions regarding �demographics, details of the accident, mood, and anxiety,� Lerner explained. �At the conclusion of the assessment, the individual is given a customized feedback report based on the responses. This feedback indicates how likely it is that the person is suffering from depression, travel anxiety, and PTSD.� If an Internet-based intervention seems appropriate, the respondent is given the option of participating in the treatment aspect of the study. If not, the feedback report lists several resources to help the individual find appropriate services.

By January, Lerner had already received input from 112 motor vehicle accident survivors on five continents. While 82 of the respondents were from the U.S., individuals from Australia, Bahrain, Brazil, Canada, China, Germany, Great Britain, Hong Kong, Ireland, Mexico, Switzerland, and Ukraine also responded. The Web site is available only in English, Lerner pointed out, �but as long as a person has Internet access and can read English, he or she can participate.�

Lerner, who earned a B.A. in psychology from SUNY College at Oneonta, is building on his mentor�s earlier work. �There�s already research showing that, when administered by a trained therapist, the treatment developed by Dr. Blanchard is effective in decreasing symptoms and improving functioning in individuals with PTSD related to motor vehicle accidents. The primary question posed by the present study is, can this treatment still be effective if it is converted to a guided self-help intervention and offered over the Internet?� noted Lerner.

The Internet-based treatment offered through www.afterthecrash.com comprises seven separate modules. �Each module focuses on a different set of skills and builds on the previous module. A variety of cognitive and behavioral strategies are provided, including progressive muscle relaxation, cognitive restructuring, and graded imaginal and in vivo exposure. Generally, exposure is conducted in real time and in the actual situation (in vivo), but at times, it is useful simply to imagine being in the situation (imaginal).

�One of the most important components of treatment involves the individual exposing him- or herself to cues and reminders of the accident in a gradual manner, starting with a relatively easy situation and advancing to more challenging situations. As part of the treatment, participants create a list of feared situations, or a fear and avoidance hierarchy, ordered from easiest to hardest.� The hierarchy includes several actions that might range from �sitting in my parked car in the driver�s seat for 15 minutes, doing relaxation exercises� to �driving around a construction site with detours during evening rush hour with my children in the back seat.�

Participants start with the first item of the hierarchy and �stick with it until there is a noticeable decrease in anxiety, then move along to the next treatment module. In addition, the content of each module is tailored for each participant based on his or her assessment and progress to date. It is this dynamic tailoring of content that differentiates www.afterthecrash.
com from other, more static, intervention programs, such as paper-based self-help manuals, or Web sites that simply list information and strategies,� Lerner said.

Has he found differences in the ways Americans and foreign-born study participants respond to the stress that results from MVAs? Not really. �Automobile accidents are a major cause of PTSD in the United States and abroad, and while there may be some differential responding based on cultural factors, the same basic constellation of signs and symptoms characterizes the disorder across these different nations. Studies of treatment for PTSD in other English-speaking countries � England, Australia, Canada � have used the same types of interventions used in the U.S. and have yielded similar results.�

Whether self-treatment will prove effective is �really an empirical question,� said Lerner. �This is the first study to investigate the effectiveness of an Internet-based treatment for motor vehicle accident-related PTSD in a clinical population. To date, there�s strong evidence indicating that a cognitive-behavioral intervention like the one developed by Dr. Blanchard can successfully decrease symptoms of PTSD and improve functioning in individuals who have survived a motor vehicle accident.� There is also preliminary data showing positive clinical outcomes in individuals who have used Internet-based assessment and treatment for other problem areas.

Self-treatment, Lerner conceded, can have drawbacks. �It is often not as effective; it presents more difficulty in addressing multiple problem areas; and it doesn�t offer the same kind of support and encouragement that a therapist can. It also may not be appropriate for more severe or serious manifestations of PTSD.�

The benefits appear to outweigh the disadvantages, though. �Self-help treatments, in general, are less expensive, more accessible, and self-paced. They do not require proximity to urban areas or highly trained clinicians. They are a reasonable alternative for people who are not comfortable talking with a therapist, and they also allay individuals� concerns about confidentiality and privacy,� observed Lerner.

Blanchard observed: �By looking at self-treatment, we are trying to move toward a way of reaching more people and making treatment more available and, we hope, more cost effective. Not having the initial face-to-face evaluation was a concern for us; on the Internet, it is difficult to make a judgment about how truthful a respondent is being. Still, a variety of referrals can be made on the Internet; for instance, we can urge the person to see a mental health provider or a primary care physician to talk about the problem. But we have high hopes for self-managed treatment.�