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

Abstract

Background: Psychological therapies are the recommended first-line treatment for posttraumatic stress disorder (PTSD). Previous systematic reviews have grouped theoretically similar interventions to determine differences between broadly distinct approaches. Consequently, we know little regarding the relative efficacy of the specific manualized therapies commonly applied to the treatment of PTSD. Objective: To determine the effect sizes of manualized therapies for PTSD. Methods: We undertook a systematic review 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: 114 randomized-controlled trials (RCTs) of 8171 participants were included. There was robust evidence that the therapies broadly defined as CBT with a trauma focus (CBT-T), as well as Eye Movement Desensitization and Reprocessing (EMDR), had a clinically important effect. The manualized CBT-Ts with the strongest evidence of effect were Cognitive Processing Therapy (CPT); Cognitive Therapy (CT); and Prolonged Exposure (PE). There was also some evidence supporting CBT without a trauma focus; group CBT with a trauma focus; guided internet-based CBT; and Present Centred Therapy (PCT). There was emerging evidence for a number of other therapies. Conclusions: A recent increase in RCTs of psychological therapies for PTSD, results in a more confident recommendation of CBT-T and EMDR as the first-line treatments. Among the CBT-Ts considered by the review CPT, CT and PE should be the treatments of choice. The findings should guide evidence informed shared decision-making between patient and clinician. Terapias psicológicas para el trastorno de estrés postraumático en adultos: revisión sistemática y metaanálisis Objetivo: determinar los tamaños del efecto de las terapias manualizadas para el TEPT. Métodos: Realizamos una revisión sistemática siguiendo las guías de la Colaboración Cochrane. Se aplicó una definición predeterminada de importancia clínica a los resultados y se evaluó la calidad de la evidencia utilizando el enfoque de calificación de recomendaciones, evaluación, desarrollo y evaluaciones (GRADE). Resultados: se incluyeron 114 ensayos controlados aleatorizados (ECA) de 8.171 participantes. Hubo evidencia robusta de que las terapias ampliamente definidas como TCC con un enfoque de trauma (TCC-T), así como la desensibilización y reprocesamiento POR movimientos oculares (EMDR), tuvieron un efecto clínicamente importante. Las CBT-Ts manualizados con la mayor evidencia de efecto fueron la terapia de procesamiento cognitivo (CPT); Terapia cognitiva (CT); y exposición prolongada (PE). También hubo alguna evidencia que apoya la TCC sin un enfoque traumático; TCC grupal con enfoque en trauma; TCC basada en Internet guiada; y terapia centrada en el presente (PCT). Hubo evidencia emergente para una serie de otras terapias. Conclusiones: Un aumento recie...

Prevalence of post-traumatic symptomatology and anxiety among residential nursing and care home workers following the first COVID-19 outbreak in Northern Italy

“…Only scales with all items completed were considered and entered in the study for statistical analysis. Total scores were interpreted as follows: GAD-7, normal (0-4), mild (5-9), moderate (10)(11)(12)(13)(14) and severe (15)(16)(17)(18)(19)(20)(21) anxiety; IES-R, normal (0-8), mild (9-25), moderate (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43), severe (44-88) PTSD symptomatology. These categories are based on values established in the literature [40,59,66,[76][77][78].…”

“…= 32) passed the set threshold for moderate-to-severe symptoms at the IES-R. Of these, 194 participants (18% of the total After weighting, a prevalence of 22% (s.e. = 1.87; 95% CI [18][19][20][21][22][23][24][25][26]; population size = 1069; design d.f. = 32) was estimated for anxiety and a prevalence of 39% (s.e.…”

Post-Traumatic Stress Disorder Psychological Interventions in Sub-Saharan Africa: Protocol for a Systematic Review of Literature

“…The review will assess the evidence for psychological interventions for PTSD in SSA. This review goes beyond previous reviews on PTSD interventions as it focuses on the unique context of SSA [37][38][39]. Trauma in SSA is interwoven with a unique contextual factors [10] and pooling data from different settings, for example Western and high income settings, may be inappropriate and may not delineate appropriate interventions appropriate for populations in SSA.…”

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

“…背景:治疗创伤后应激障碍 (PTSD) 的非药物学和非心理学方法常常被系统综述和元分析排 除。因此, 我们对其疗效知之甚少。 目的:确定PTSD的非药物和非心理治疗方法的效应量。 方法:我们根据Cochrane协作指南进行了系统综述。将临床重要性的预定义应用于结果, 并 使用'建议, 评估, 发展和评估' (GRADE) 方法评估证据的质量。 结果:纳入了30项各种异质的非心理和非药物干预措施的随机对照试验 (RCT) (成人28例, 儿 童和青少年2例) 。有六种不同方法的新证据 (针灸, 神经反馈, saikokeishikankyoto (一种草 药制剂), 躯体体验, 经颅磁刺激和瑜伽) 。 结论:鉴于可获得的证据水平, 定期提供非药物和非心理干预为时过早, 但有疗效的证据为 那些不响应, 不容忍或不愿接受更多传统循证干预的人提供了替代方案。这项综述应促进 这一领域的进一步研究。 Although a number of psychological and pharmacological treatments have been shown to be effective for the treatment of post-traumatic stress disorder (PTSD) (Hoskins et al, in review;Lewis, Roberts, Andrew, Starling, & Bisson, 2020), treatment resistance is common (Blanchard et al, 2003) and people with PTSD can find some interventions difficult to tolerate (Lewis, Roberts, Gibson, & Bisson, 2020). There is, therefore, a strong imperative to establish more effective and better-tolerated treatments for PTSD, including alternative management approaches to increase choice and address the preference of some people not to take medication or engage in psychological therapy.…”