Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis

Abstract

BackgroundThe 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions.MethodsWe conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality.ResultsFifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = −0.90 (CBT; k = 27, 95% CI −1.11 to −0.68; moderate quality) to g = −1.26 (EMDR; k = 4, 95% CI −2.01 to −0.51; low quality). CBT and EA each had moderate–large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate–large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome.ConclusionsThe development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.

The validity of ICD-11 PTSD and Complex PTSD in East Asian cultures: findings with young adults from China, Hong Kong, Japan, and Taiwan

“…Additionally, the associations between the PTSD and DSO factors with the depression and anxiety factors were also consistent with prior findings, whereby depression was positively associated with DSO symptoms but not PTSD symptoms, and anxiety was positively associated with both PTSD and DSO symptoms but more strongly with the former (Hyland et al, 2017b). These findings are important as they show that PTSD and DSO symptoms, while strongly associated with one another, are differentially related to two clinically relevant exogenous variables, and support recent discussions on how PTSD and DSO symptoms likely require different clinical interventions and treatment approaches Karatzias et al, 2019b). Lastly, gender was not associated with any of the CPTSD factors, and this contradicts with prior reviews supporting biological and behavioural sex differences that heighten risk for PTSD in females (Olff, 2017), and ICD-11 related finding from Western samples (e.g.…”

ICD-11 PTSD and complex PTSD in treatment-seeking Danish veterans: a latent profile analysis

“…Compared to PTSD, CPTSD has different types of symptoms, greater severity and greater functional impairment. Therefore, treatments for CPTSD might require a greater number of interventions and/or longer duration to provide CPTSD patients with an end-state health status equal to that obtained by PTSD patients (Karatzias et al, 2019). Future research should aim at developing and testing new treatment approaches for patients with CPTSD.…”

Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis

“…PTSD is a highly heterogeneous condition (DiMauro, Carter, Folk, & Kashdan, 2014, Murphy, Ross, Busuttil, Greenberg, & Armour, 2019 and work is needed to develop more personalized approaches. We do not have a sufficient understanding of the efficacy of current therapies for those with a diagnosis of ICD-11 complex PTSD (Dorrepaal et al, 2013(Dorrepaal et al, , 2014Karatzias et al, 2019). Further research is needed to evaluate existing therapies among those with complex PTSD, and to modify or develop new therapies, as appropriate.…”