COVID-19 and Mental Health (CMH) Initiative: Research

COVID-19 Physical Distancing and Post-Traumatic Stress Injury: A Rapid Review of Virtual Trauma-Focused Therapy for Military, Veterans and Public Safety Personnel

Key Messages

  • Preliminary evidence for DH and TAPs: encouraging but limited
  • Advantages: convenience, accessibility, cost effectiveness, stigma reduction, and similar efficacy and drop-out rate to in-person delivery.
  • Barriers: technology, privacy, the therapeutic relationship, ease of client disengagement, incompatibility of elements of therapy with technology, clinician perspectives, safety.
  • Recommendations: ensure technology quality and security, intentional rapport, progress and commitment to therapy, revised therapy standards and practices, and risk and safety protocol.
  • Use of DH during pandemic response: While DH solutions are necessary, a cautious approach is warranted before widespread adoption of DH for TAPs, until more evidence-based literature is available.

Lay Summary

Advantages, barriers and recommendations were identified from 38 articles subjected to full text review, highlights of which follow.

Advantages included the 1) convenience and cost-effectiveness of remotely accessing teletherapy (especially for clients in rural areas), 2) comfort for clients of engaging from their home, 3) stigma reduction as a result of not having to physically go to a MH facility, 4) unchanged treatment efficacy or dropout rates when DH was used. Based on review findings, DH has several potential benefits over in-person therapy. For clients open to using DH, clinical outcomes may not differ.

Barriers included 1) technological issues and disruptions, 2) inconsistent access to secure high quality internet connections, 3) lack of openness to using DH by some clients, 4) privacy concerns associated with the home environment, 5) ease of client disengagement from a session and enablement of avoidant behaviours, 6) challenges associated with establishing a therapeutic alliance and managing intervention activities (i.e., homework), and 7) challenges managing safety and risk remotely, particularly regarding suicide risk.

Recommendations related to DH use for delivering evidence-based psychotherapy to TAPs include: 1) address technological issues, 2) supplement interventions to increase patient comfort, 3) consider ways for MH practitioners to establish and maintain rapport and trust, 4) provide additional supports and flexibility to clients as required to support progress and commitment to therapy, 5) review previously established standards and practices of delivering certain psychotherapeutic interventions to improve suitability for DH, and 6) consider issues related to risk and safety due to the remote and independent nature of telehealth.


  • Mental health
  • Trauma
  • Post-traumatic stress injuries
  • PTSD
  • Military
  • Veteran
  • Public safety personnel
  • First responders
  • Digital health
  • Psychotherapy


  • Nominated Principal Applicant: Suzette Brémault-Phillips, PhD, OT, University of Alberta
  • Chelsea Jones, MScOT, PhD (cand.)
  • Antonio Miguel Cruz, PhD, Eng.
  • Lorraine Smith-MacDonald, PhD
  • Emily Cruikshank, MEd, PhD (cand.)
  • Delaram Baghooi, MSc (cand.)
  • Avneet Kaur Chohan, BSc, MScOT (cand.)
  • Alexa Laidlaw, BSc, MScOT (cand.)
  • Allison White, BSW, MScOT (cand.)
  • Olga Winkler, MD
  • Lisa Burback, MD
  • Phillip R. Sevigny, PhD
  • Liz Dennett, MLIS
  • Martin Ferguson-Pell, PhD
  • Andrew Greenshaw, PhD

For more information, please contact: Suzette Brémault-Phillips,

Related Syntheses

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Healthcare, Front-line Workers and Public Safety Personnel


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