Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis

Abstract

Background Complex traumatic events associated with armed conflict, forcible displacement, childhood sexual abuse, and domestic violence are increasingly prevalent. People exposed to complex traumatic events are at risk of not only posttraumatic stress disorder (PTSD) but also other mental health comorbidities. Whereas evidence-based psychological and pharmacological treatments are effective for single-event PTSD, it is not known if people who have experienced complex traumatic events can benefit and tolerate these commonly available treatments. Furthermore, it is not known which components of psychological interventions are most effective for managing PTSD in this population. We performed a systematic review and component network meta-analysis to assess the effectiveness of psychological and pharmacological interventions for managing mental health problems in people exposed to complex traumatic events.

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 ).…”

Effectiveness of a High Intensive Trauma-focused, Family-based Therapy for Youth Exposed to Family Violence: Study Protocol for a Randomized Controlled Trial.

“…Another risk is that, focusing on anxiety provoking details of the traumatic events could be experienced as too burdensome for the participants resulting in avoidance behaviour and higher dropout rates. Previous research however showed that in intensive trauma-focused treatment programs the dropout rate is low (32)(33) or comparable to other treatment conditions (30) and trauma-focused treatments are most effective (29). This study will provide more insight into the added value of parental and systemic component to an intensive trauma treatment and the added value of intensifying treatment.…”

“…In contrast to EMDR, TF-CBT is a multicomponent treatment consisting of non-trauma-focused and trauma-focused components. When treating adults with complex trauma, trauma-focused therapies that include cognitive restructuring and imaginal exposure are most effective (29). In line with this research, a Dutch study (30) recently showed that a) exposure therapy is effective in the treatment of adults with complex trauma and b) adding a non-trauma-focused component (affective and interpersonal regulation training) to the exposure therapy did not result in better outcomes.…”

Latent Class Analysis in Depression, Including Clinical and Functional Variables: Evidence of a Complex Depressive Subtype in Primary Care in Chile

“…Second, patients with depression and CTEs are often refractory to standard treatments [ 27 , 28 ] and need a differential treatment approach [ 68 , 69 ]. Third, there is a lack of recommendations in current clinical guidelines on the importance of recognizing the interpersonal, social, and emotional consequences of patients with MD and interpersonal adversity [ 70 ]. Fourth, health care teams may need to be trained in the trauma-informed care model [ 71 , 72 ].…”