The terrorist attacks of September 11, 2001 are now 23 years behind us. In a general sense, they have receded from our collective memory. However, the human health effects of the events of that day linger, and continue to be the subject of research across a variety of disciplines. A MeSH search of the PubMed database between 2022 and 2024 produces 93 results, with publications focusing on a variety of topics, including PTSD, specific health outcomes, and racial and ethnic mortality disparities. In this post we will focus on a 2024 publication focused on the longitudinal effects and treatment of PTSD on those most affected by this event.
An account of a randomized controlled trial on internet-based therapies for World Trade Center workers and survivors with persistent PTSD was published this year in the open-access journal Psychiatry Research. PTSD is prevalent among those exposed to the World Trade Center attacks, with almost half of individuals reporting poor quality of life and life satisfaction, in addition to unmet needs for mental health care. (Feder et al, 2024) Despite the availability of expanded mental health services offered by the CDC’s World Trade Center Health Program, many barriers to access to care remain .
In selecting the two interventions to test, the authors found that while trauma-focused cognitive behavioral therapy (CBT) is one of the most effective and empirically-supported treatments for PTSD, it has a number of limitations, including geographic constraints, stigma, and the limited number of expert practitioners of this type of therapy. Another type of therapy, integrative testimonial therapy (ITT), which presents none of the challenges of trauma-focused CBT, is an Internet-based form of CBT which is conducted via asynchronous patient-therapist written communications. ITT involves patients constructing a chronological narrative of their lives. Prior RCTs found that ITT yielded significant reductions in PTSD among trauma survivors of other historical events.
For the purposes of this study, ITT was compared to therapist-assisted Internet-based modified present-centered therapy (I-MPCT). I-MPCT is a modification of present-centered therapy (PCT), which has been found to be modestly less or as effective as trauma-focused PTSD therapies, with lower dropout rates. The authors hypothesized that ITT would have a greater impact on reduction of PTSD symptoms of those affected by the events of September 11, 2001. Participants in the trial came from several categories, including both traditional responders (e.g. police officers and firefighters), non-traditional responders (e.g. construction workers and volunteers), and survivors.
Both therapies included three modules of guided writing exercises (or “narratives”) which were interspersed with written feedback from the therapist. Both types of therapy had patients write eleven narratives in total, each taking 45 minutes to complete. For each therapy modality, patients contributed biographical information, wrote about their current life circumstances, and/or discussed problems. The effectiveness of each therapy modality was assessed through a self-reported scale.
Both therapy modalities showed significant reduction in chronic PTSD symptoms and depressive symptoms, and improved quality of life across the board. In post-treatment, both therapies showed significant impact on PTSD, and represent promising treatment options for this particular population.
References
Feder, A., Kowalchyk, M. L., Brinkman, H. R., Cahn, L., Aaronson, C. J., Böttche, M., Presseau, C., Fred-Torres, S., Markowitz, J. C., Litz, B. T., Yehuda, R., Knaevelsrud, C., & Pietrzak, R. H. (2024). Randomized controlled trial of two internet-based written therapies for world trade center workers and survivors with persistent PTSD symptoms. Psychiatry Research, 336, 115885–115885. https://doi.org/10.1016/j.psychres.2024.115885
