Non-pharmacological and non-psychological approaches to the treatment of PTSD: results of a systematic review and meta-analyses

Abstract

Background: Non-pharmacological and non-psychological approaches to the treatment of post-traumatic stress disorder (PTSD) have often been excluded from systematic reviews and meta-analyses. Consequently, we know little regarding their efficacy. Objective: To determine the effect sizes of non-pharmacological and non-psychological treatment approaches for PTSD. Method: We undertook a systematic review and meta-analyses following Cochrane Collaboration guidelines. A predetermined definition of clinical importance was applied to the results and the quality of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results: 30 randomised controlled trials (RCTs) of a range of heterogeneous nonpsychological and non-pharmacological interventions (28 in adults, two in children and adolescents) were included. There was emerging evidence for six different approaches (acupuncture, neurofeedback, saikokeishikankyoto (a herbal preparation), somatic experiencing, transcranial magnetic stimulation, and yoga). Conclusions: Given the level of evidence available, it would be premature to offer nonpharmacological and non-psychological interventions routinely, but those with evidence of efficacy provide alternatives for people who do not respond to, do not tolerate or do not want more conventional evidence-based interventions. This review should stimulate further research in this area.

Study quality and efficacy of psychological interventions for posttraumatic stress disorder: a meta-analysis of randomized controlled trials

“…Then, we conducted a systematic search in the databases PsycINFO and Medline for the period between 1 January 2013 and 22 September 2020. Finally, we reviewed the relevant meta-analyses on the efficacy of psychological interventions for adult PTSD published since 2013 (Asmundson et al, 2019 ; Barawi, Lewis, Simon, & Bisson, 2020 ; Bisson, van Gelderen, Roberts, & Lewis, 2020 ; Carpenter et al, 2018 ; Cipriani et al, 2018 ; Coventry et al, 2020 ; Cusack et al, 2016 ; Gallegos, Crean, Pigeon, & Heffner, 2017 ; Gerger et al, 2014 ; Grasser & Javanbakht, 2019 ; Hegberg, Hayes, & Hayes, 2019 ; Hopwood & Schutte, 2017 ; Karatzias et al, 2019 ; Khan et al, 2018 ; Kline, Cooper, Rytwinksi, & Feeny, 2018 ; Kuester, Niemeyer, & Knaevelsrud, 2016 ; Lenz, Haktanir, & Callender, 2017 ; Lewis, Roberts, Andrew, Starling, & Bisson, 2020a ; Lewis, Roberts, Bethell, Robertson, & Bisson, 2018 ; Lewis, Roberts, Gibson, & Bisson, 2020b ; Mahoney, Karatzias, & Hutton, 2019 ; Mavranezouli et al, 2020 ; Montero-Marin, Garcia-Campayo, López-Montoyo, Zabaleta-Del-Olmo, & Cuijpers, 2018 ; Morina, Malek, Nickerson, & Bryant, 2017a ; Niles et al, 2018 ; Schwartze, Barkowski, Strauss, Knaevelsrud, & Rosendahl, 2019 ; Springer, Levy, & Tolin, 2018 ; Tran & Gregor, 2016 ; Van Dis et al, 2020 ; Wilson et al, 2018 ). Inclusion criteria for the meta-analysis were: (1) RCT, (2) treatment targets primarily chronic PTSD, (3) participants older than 17 years, (4) at least ten participants per condition at post-assessment, and (5) at least 70% of the sample was diagnosed with PTSD by means of a structured interview (Bisson et al, 2013 ).…”

Prevention and treatment of PTSD: the current evidence base

“…Non-psychological and non-pharmacological interventions (Bisson, Van Gelderen, Roberts, & Lewis, 2020 ). The final paper provides an overview of the results of the systematic review and meta-analyses that led to the final group of ISTSS recommendations.…”

Sexual assault as a public health problem and other developments in psychotraumatology

“…Pharmacological treatment of PTSD (Hoskins, Bridges, et al, 2021 ) and pharmacologically assisted psychotherapy for adults with PTSD (Hoskins, Sinnerton, et al, 2021 ) provided information on effective medication for PTSD. And finally non-psychological and non-pharmacological interventions were reviewed and, for instance, yoga, neurofeedback, transcranial magnetic stimulation and acupuncture were considered as promising complementary and alternative approaches (Bisson, Van Gelderen, Roberts, & Lewis, 2020 ). The papers were based on systematic reviews and meta-analyses that underpinned the development of the International Society for Traumatic Stress Studies Guidelines.…”