Exposure therapy for PTSD: A meta-analysis

McLean, Carmen P.; Levy, Hannah C.; Miller, Madeleine L.; Tolin, David F.

doi:10.1016/j.cpr.2021.102115

Cited by 93 publications

(52 citation statements)

References 49 publications

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“…The reduction in reported symptoms of PTSD at three-month follow-up as assessed with both self-report ( d = 1.38) and clinical interview ( d = 1.52) are comparable with the original inpatient treatment programme with effect sizes ranging from 1.31 to 1.64 at post-treatment (van Woudenberg et al, 2018 ). The study’s effect sizes are also comparable with mean effect size in a review of intensive treatment programmes of 1.57 (Sciarrino et al, 2020 ), and spaced treatments 1.2 to 1.5 (Jericho et al, 2022 ; McLean et al, 2022 ). Meta-analyses typically show lower effect sizes for RCT studies than for open trials.…”

Section: Discussionsupporting

confidence: 70%

“…International guidelines and meta-analyses recommend trauma-focused cognitive–behavioural therapy such as Prolonged Exposure Therapy (PE) and Eye Movement Desensitization and Reprocessing therapy (EMDR) as first-line treatments for PTSD (Bisson et al, 2019 ; Lewis, Roberts, Andrew, et al, 2020 ; National Institue for Health and Care Excellence, 2018 ). Recent meta-analyses on randomized controlled trials (RCTs) found large effect sizes between 1.2 and 1.5 when comparing exposure-based therapies (including EMDR and PE) with waitlist (Jericho et al, 2022 ; McLean et al, 2022 ). However, dropout rates of 18–21% indicate that treatment has potential for improvement (Lewis, Roberts, Gibson, et al, 2020 ; Varker et al, 2021 ; both meta-analyses on RCTs).…”

Section: Introductionmentioning

confidence: 99%

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Intensive outpatient treatment for PTSD: an open trial combining prolonged exposure therapy, EMDR, and physical activity

Auren

Klæth

Jensen

et al. 2022

European Journal of Psychotraumatology

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Background: Intensive outpatient treatment could be a promising option for patients with post-traumatic stress disorder (PTSD). Objective: The aim of the study was to test the effectiveness of an eight-day (two-week) intensive treatment for PTSD within a public health care setting (open trial design). Method: Eighty-nine patients were offered the choice between intensive treatment and spaced individual treatment, of which 34 (38.2%) chose the intensive format. Patients were assessed with self-report batteries and interviews at pre-treatment, start of treatment, post-treatment and three-month follow-up. Each day consisted of individual Prolonged Exposure therapy, Eye Movement Desensitization and Reprocessing therapy, group psychoeducation, and physical activity. Therapists rotated between patients. Results: Between 55 and 62% of the patients showed a clinically significant change (recovery) in symptoms of PTSD, and the effect sizes were large ( d = 1.38–1.52). Patients also showed reduction in symptoms of depression and anxiety, along with improved well-being and interpersonal functioning. Changes in social and work functioning were more ambiguous. There were no dropouts, attendance was high, and patients were highly satisfied with the treatment. Conclusions: The intensive programme was an attractive and effective treatment option for patients with PTSD.

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Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Intensive outpatient treatment for PTSD: an open trial combining prolonged exposure therapy, EMDR, and physical activity

Auren

Klæth

Jensen

et al. 2022

European Journal of Psychotraumatology

View full text Add to dashboard Cite

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“…Current PTSD iCBT outcomes and adherence appear weaker than those of 'gold-standard' inperson cognitive and behavioural therapies for PTSD, which are considerably longer and involve extensive therapist guidance (e.g. see McLean et al, 2022). Future studies need to quantify and explain these differences, but it is conceivable that these longer, intensive therapies are more effective at providing a larger 'dose' of tailored treatment than brief iCBT programs.…”

Section: Discussionmentioning

confidence: 99%

Internet-delivered cognitive behaviour therapy for post-traumatic stress disorder: a randomised controlled trial and outcomes in routine care

Allen

Smith

Hobbs

et al. 2022

Behav. Cogn. Psychother.

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Background: Despite its potential scalability, little is known about the outcomes of internet-based cognitive behaviour therapy (iCBT) for post-traumatic stress disorder (PTSD) when it is provided with minimal guidance from a clinician. Aim: To evaluate the outcomes of minimally guided iCBT for PTSD in a randomised control trial (RCT, Study 1) and in an open trial in routine community care (Study 2). Method: A RCT compared the iCBT course (n=21) to a waitlist control (WLC, n=19) among participants diagnosed with PTSD. The iCBT group was followed up 3 months post-treatment. In Study 2, treatment outcomes were evaluated among 117 adults in routine community care. PTSD symptom severity was the primary outcome in both studies, with psychological distress and co-morbid anxiety and depressive symptoms providing secondary outcomes. Results: iCBT participants in both studies experienced significant reductions in PTSD symptom severity from pre- to post-treatment treatment (within-group Hedges’ g=.72–1.02), with RCT findings showing maintenance of gains at 3-month follow-up. The WLC group in the RCT also significantly improved, but Study 1 was under-powered and the medium between-group effect favouring iCBT did not reach significance (g=0.64; 95% CI, –0.10–1.38). Conclusions: This research provides preliminary support for the utility of iCBT for PTSD when provided with minimal clinician guidance. Future studies are needed to clarify the effect of differing levels of clinician support on PTSD iCBT outcomes, as well as exploring how best to integrate iCBT into large-scale, routine clinical care of PTSD.

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“…Exposure represents the gold standard for treating PTSD, regardless of the type of traumatisation (McLean et al, 2022 ; Rauch et al, 2012 ) and can be delivered in different ways (e.g. Narrative Exposure Therapy, Written Exposure Therapy, Prolonged Exposure).…”

Section: Introductionmentioning

confidence: 99%

Internet-based imagery rescripting intervention for adult survivors of institutional childhood abuse in the former German Democratic Republic – a pilot study

Wagner

Grafiadeli

Martın

et al. 2022

European Journal of Psychotraumatology

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Background: From 1949 to 1990, about 500,000 children and adolescents in the former German Democratic Republic (GDR) were placed in institutional care. Many of these individuals experienced physical and sexual abuse as well as general maltreatment. While this population group is in great need of psychosocial support, few low-threshold interventions aimed at the needs of adult survivors of institutional childhood abuse exist. Objective: This pilot study examines the efficacy of an internet-based imagery rescripting intervention in reducing psychopathological symptoms, within a population of survivors of institutional abuse from state childcare institutions, in the former GDR. Additionally, a case study is presented, depicting the treatment of a woman suffering from PTSD after having been institutionalised in the former GDR. Method: Participants received 10 internet-based writing assignments, based on the principles of imagery rescripting, specifically tailored to the needs of survivors of institutional childhood abuse in the GDR. The participants received personalised feedback on their assignments. Symptoms of posttraumatic stress disorder (PTSD), complex posttraumatic stress disorder (CPTSD), depression, and anxiety were assessed at pre- and post-treatment. Results: A total of 15 participants completed the intervention (mean age 56.2 years; 66.7% female). Paired t -tests showed a significant reduction of PTSD, CPTSD, depression, and anxiety symptoms. Large effect sizes were found for PTSD ( d = 1.26), CPTSD ( d = .97), depression ( d = 1.08) and anxiety ( d = 1.20). Conclusion: The results of this pilot study provide preliminary evidence for the efficacy and feasibility of the intervention in treating psychopathological symptoms in survivors of institutional abuse in the GDR. The case study additionally demonstrates the applicability of the intervention. A randomised controlled trial should be applied to further evaluate the intervention and its effects. Trial registration: .

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Exposure therapy for PTSD: A meta-analysis

Cited by 93 publications

References 49 publications

Intensive outpatient treatment for PTSD: an open trial combining prolonged exposure therapy, EMDR, and physical activity

Intensive outpatient treatment for PTSD: an open trial combining prolonged exposure therapy, EMDR, and physical activity

Internet-delivered cognitive behaviour therapy for post-traumatic stress disorder: a randomised controlled trial and outcomes in routine care

Internet-based imagery rescripting intervention for adult survivors of institutional childhood abuse in the former German Democratic Republic – a pilot study

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