Does CBT have lasting effects in the treatment of PTSD after one year of follow-up? A systematic review of randomized controlled trials

Macedo, Tânia; Barbosa, Marllon R.; Rodrigues, Helga; Coutinho, Evandro Silva Freire; Figueira, Ivan; Ventura, Paula

doi:10.1590/2237-6089-2017-0153

Cited by 9 publications

(5 citation statements)

References 24 publications

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“…A number of meta-analyses and systematic reviews have supported the effectiveness of psychological treatments, especially CBT, for people with PTSD ( 26 ). Our previous randomized controlled studies also suggested that CBT was effective at reducing PTSD symptoms ( 27 , 28 ). In this follow-up study, we found that CBT emerged as a significant predictor of a reduction in PTSD symptoms, explaining a significant 33.6% of the variance.…”

Section: Discussionmentioning

confidence: 87%

Changes Over Time in Post-traumatic Stress Disorder Among Children Who Survived the 2008 Wenchuan Earthquake and Predictive Variables

et al. 2021

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Background: This study examines changes over time in post-traumatic stress disorder (PTSD) among children who survived the 2008 Wenchuan earthquake and the relevant predictive variables.Methods: A total of 203 children and adolescents were investigated 24 months after the earthquake, and 151 children and adolescents completed the 1-year follow-up study. Participants completed the Children's Revised Impact of Event Scale (CRIES-13), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Connor-Davidson Resilience Scale (CD-RISC). Hierarchical linear regression analysis was used to evaluate the predictors of changes in PTSD severity.Results: Eighty percent of the children still had some PTSD symptoms 2 years after the Wenchuan earthquake, and 66.25% of the children had symptoms that lasted 3 years. In the model predicting PTSD symptom severity, the loss of family members and child burial explained a significant 21.9% of the variance, and depression explained a significant 16.7% of the variance. In the model predicting changes in PTSD severity, the change scores for resilience and depression explained a significant 18.7% of the variance, and cognitive behavioral therapy (CBT) explained a significant 33.6% of the variance.Conclusions: PTSD symptoms in children and adolescents can persist for many years after trauma. In addition to using psychological interventions to improve PTSD symptoms, improvements in depression and resilience should also be considered.

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Section: Discussionmentioning

confidence: 87%

Changes Over Time in Post-traumatic Stress Disorder Among Children Who Survived the 2008 Wenchuan Earthquake and Predictive Variables

et al. 2021

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“…Other possible explanations or contributory factors are the slightly lower levels of education and greater physical comorbidity in the GSH group; both have previously been found to influence treatment outcome. 16,53 Further improvement after face-to-face CBT-TF has been found before 85 and has been hypothesised to be due to ongoing trauma processing and practise of techniques learnt in treatment.…”

Section: Results In the Context Of Other Researchmentioning

confidence: 97%

Pragmatic randomised controlled trial of guided self-help versus individual cognitive behavioural therapy with a trauma focus for post-traumatic stress disorder (RAPID)

Bisson,

Ariti,

Cullen

et al. 2023

Health Technol Assess

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Background Guided self-help has been shown to be effective for other mental conditions and, if effective for post-traumatic stress disorder, would offer a time-efficient and accessible treatment option, with the potential to reduce waiting times and costs. Objective To determine if trauma-focused guided self-help is non-inferior to individual, face-to-face cognitive-behavioural therapy with a trauma focus for mild to moderate post-traumatic stress disorder to a single traumatic event. Design Multicentre pragmatic randomised controlled non-inferiority trial with economic evaluation to determine cost-effectiveness and nested process evaluation to assess fidelity and adherence, dose and factors that influence outcome (including context, acceptability, facilitators and barriers, measured qualitatively). Participants were randomised in a 1 : 1 ratio. The primary analysis was intention to treat using multilevel analysis of covariance. Setting Primary and secondary mental health settings across the United Kingdom’s National Health Service. Participants One hundred and ninety-six adults with a primary diagnosis of mild to moderate post-traumatic stress disorder were randomised with 82% retention at 16 weeks and 71% at 52 weeks. Nineteen participants and ten therapists were interviewed for the process evaluation. Interventions Up to 12 face-to-face, manualised, individual cognitive-behavioural therapy with a trauma focus sessions, each lasting 60–90 minutes, or to guided self-help using Spring, an eight-step online guided self-help programme based on cognitive-behavioural therapy with a trauma focus, with up to five face-to-face meetings of up to 3 hours in total and four brief telephone calls or e-mail contacts between sessions. Main outcome measures Primary outcome: the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, at 16 weeks post-randomisation. Secondary outcomes: included severity of post-traumatic stress disorder symptoms at 52 weeks, and functioning, symptoms of depression, symptoms of anxiety, alcohol use and perceived social support at both 16 and 52 weeks post-randomisation. Those assessing outcomes were blinded to group assignment. Results Non-inferiority was demonstrated at the primary end point of 16 weeks on the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [mean difference 1.01 (one-sided 95% CI −∞ to 3.90, non-inferiority p = 0.012)]. Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, score improvements of over 60% in both groups were maintained at 52 weeks but the non-inferiority results were inconclusive in favour of cognitive-behavioural therapy with a trauma focus at this timepoint [mean difference 3.20 (one-sided 95% confidence interval −∞ to 6.00, non-inferiority p = 0.15)]. Guided self-help using Spring was not shown to be more cost-effective than face-to-face cognitive-behavioural therapy with a trauma focus although there was no significant difference in accruing quality-adjusted life-years, incremental quality-adjusted life-years −0.04 (95% confidence interval −0.10 to 0.01) and guided self-help using Spring was significantly cheaper to deliver [£277 (95% confidence interval £253 to £301) vs. £729 (95% CI £671 to £788)]. Guided self-help using Spring appeared to be acceptable and well tolerated by participants. No important adverse events or side effects were identified. Limitations The results are not generalisable to people with post-traumatic stress disorder to more than one traumatic event. Conclusions Guided self-help using Spring for mild to moderate post-traumatic stress disorder to a single traumatic event appears to be non-inferior to individual face-to-face cognitive-behavioural therapy with a trauma focus and the results suggest it should be considered a first-line treatment for people with this condition. Future work Work is now needed to determine how best to effectively disseminate and implement guided self-help using Spring at scale. Trial registration This trial is registered as ISRCTN13697710. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/192/97) and is published in full in Health Technology Assessment; Vol. 27, No. 26. See the NIHR Funding and Awards website for further award information.

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“…Studies have shown that CBT is effective in the post-treatment phase of PTSD, indicating that its effects endure [68]. In addition, cognitive control network activity is increased in patients with major depression and PTSD, suggesting that CBT may have a beneficial effect on the severity of symptoms [69].…”

Section: Research Question 6 [Rq6]mentioning

confidence: 99%

Clinical Efficacy of Psychotherapeutic Interventions for Post-Traumatic Stress Disorder in Children and Adolescents: A Systematic Review and Analysis

Gkintoni,

Kourkoutas,

Yotsidi

et al. 2024

Children

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Background: This systematic review aggregates research on psychotherapeutic interventions for Post-Traumatic Stress Disorder (PTSD) in children and adolescents. PTSD in this demographic presents differently from adults, necessitating tailored therapeutic approaches. In children and adolescents, PTSD arises from exposure to severe danger, interpersonal violence, or abuse, leading to significant behavioral and emotional disturbances that jeopardize long-term development. The review focuses on describing PTSD within two age groups, children (6 to 12 years) and adolescents (12 to 18 years), while evaluating the effectiveness of various clinical interventions aimed at this condition. Methods: Utilizing the PRISMA guidelines, this review systematically examines studies that assess clinical interventions for PTSD in the younger population. Results: Key symptoms of PTSD in children and adolescents include avoidance, overstimulation, flashbacks, depression, and anxiety. The review identifies several effective treatments, including Cognitive Behavioral Therapy (CBT), Trauma-Focused CBT (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), Systemic Therapy, Play Therapy, Exposure Therapy, Relaxation Techniques, and Psychodynamic Psychotherapy. Particularly, TF-CBT is highlighted as the most effective and commonly used method in treating childhood and adolescent PTSD, as supported by most of the studies reviewed. Conclusions: A significant outcome of this study is the short-term effectiveness of CBT in reducing PTSD symptoms in children and adolescents. The findings underline the importance of psychotherapeutic interventions and mark a substantial advancement in understanding PTSD in young populations. It is crucial for practitioners to integrate various psychotherapeutic strategies into their practice to improve patient outcomes and treatment efficacy.

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Does CBT have lasting effects in the treatment of PTSD after one year of follow-up? A systematic review of randomized controlled trials

Cited by 9 publications

References 24 publications

Changes Over Time in Post-traumatic Stress Disorder Among Children Who Survived the 2008 Wenchuan Earthquake and Predictive Variables

Changes Over Time in Post-traumatic Stress Disorder Among Children Who Survived the 2008 Wenchuan Earthquake and Predictive Variables

Pragmatic randomised controlled trial of guided self-help versus individual cognitive behavioural therapy with a trauma focus for post-traumatic stress disorder (RAPID)

Clinical Efficacy of Psychotherapeutic Interventions for Post-Traumatic Stress Disorder in Children and Adolescents: A Systematic Review and Analysis

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