Treatment of PTSD: Stress inoculation training with prolonged exposure compared to EMDR

Lee, Christopher; Gavriel, Helen; Drummond, Peter D.; Richards, Jeff; Greenwald, Ricky

doi:10.1002/jclp.10039

Cited by 180 publications

(112 citation statements)

References 32 publications

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“…In addition to the 15 studies included in Benish et al [23], we retrieved seven further studies that fulfilled the inclusion criteria, resulting in a total sample of 22 studies [42,[44][45][46][47][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73] (as the re-assessment of the study selection is an important topic of interest, see Additional file 1 for full references of the excluded studies). In sum, 161 abstracts were thoroughly screened and 46 studies assessed in full-text for eligibility, see Fig.…”

Section: Study Selection and Study Characteristicssupporting

confidence: 41%

The Relative Efficacy of Bona Fide Psychotherapies for Post-Traumatic Stress Disorder: A Meta-Analytical Evaluation of Randomized Controlled Trials

Tran

Gregor

2014

SSRN Journal

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Background: In the treatment of PTSD, meta-analyses suggest comparable efficacy of cognitive behavioural therapies and various trauma focused treatments, but results for other treatments are inconsistent. One meta-analysis found no differences for bona fide therapies, but was critizised for overgeneralization and a biased study sample and relied on an omnibus test of overall effect size heterogeneity that is not widely used.Methods: We present an updated meta-analysis on bona fide psychotherapies for PTSD, contrasting an improved application of the omnibus test of overall effect size heterogeneity with conventional random-effects meta-analyses of specified treatment types against all others. Twenty-two studies were eligible, reporting 24 head-to-head comparisons in randomized controlled trials of 1694 patients. Results: Head-to-head comparison between trauma focused and non-trauma focused treatments revealed a small relative advantage for trauma focused treatments at post-treatment (Hedges' g = 0.14) and at two follow-ups (g = 0.17, g = 0.23) regarding PTSD symptom severity. Controlling and adjusting for influential studies and publication bias, prolonged exposure and exposure therapies (g = 0.19) were slightly more efficacious than other therapies regarding PTSD symptom severity at post-treatment; prolonged exposure had also higher recovery rates (RR = 1.26). Present-centered therapies were slightly less efficacious regarding symptom severity at post-treatment (g = −0.20) and at follow-up (g = −0.17), but equally efficacious as available comparison treatments with regards to secondary outcomes. The improved omnibus test confirmed overall effect size heterogeneity. Conclusions: Trauma focused treatments, prolonged exposure and exposure therapies were slightly more efficacious than other therapies in the treatment of PTSD. However, treatment differences were at most small and far below proposed thresholds of clinically meaningful differences. Previous null findings may have stemmed from not clearly differentiating primary and secondary outcomes, but also from a specific use of the omnibus test of overall effect size heterogeneity that appears to be prone to error. However, more high-quality studies using ITT analyses are still needed to draw firm conclusions. Moreover, the PTSD treatment field may need to move beyond a focus primarily on efficacy so as to address other important issues such as public health issues and the requirements of highly vulnerable populations.

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Section: Study Selection and Study Characteristicssupporting

confidence: 41%

The Relative Efficacy of Bona Fide Psychotherapies for Post-Traumatic Stress Disorder: A Meta-Analytical Evaluation of Randomized Controlled Trials

Tran

Gregor

2014

SSRN Journal

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“…Indeed the meta-analysis by Kazantzis et al, (2010) did not include studies of EMDR, a treatment known for its minimal homework requirements. Studies comparing CBT and EMDR reveal number of sessions to be comparable (Lee, Gavriel, Drummond, Richards, & Greenwald, 2002;Power et al, 2002), as well as treatment outcomes (in some cases EMDR has proven to be superior e.g. Ironson, Freund, Strauss, & Williams, 2002) however hours of homework assigned to the study participants are not.…”

Section: Movement Desensitisation and Reprocessing (Emdr) Or Trauma-fmentioning

confidence: 41%

Cognitive behaviour therapy versus eye movement desensitization and reprocessing for post-traumatic disorder – is it all in the homework then?

Lee

2012

European Review of Applied Psychology

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The aim of the present meta-analysis was to determine whether there are any differences between eye movement desensitisation and reprocessing (EMDR) and trauma-focused cognitive behaviour therapy (TFCBT) for post-traumatic stress disorder (PTSD) with respect to efficacy and efficiency. We performed a comprehensive literature search using several electronic search engines as well as manual searches of other review papers. Eight original studies involving 227 participants were identified in this manner. The results showed no difference between EMDR or TFCBT on measures of PTSD. However, there was a significant advantage for EMDR over TFCBT in reducing depression (Hedge's g= .63). The analysis also indicated a difference in the prescribed homework between the treatments.Meta-regression analyses were conducted to examine the relationship between hours of homework and gains in depression and PTSD symptoms. Conclusions were confounded by differences between the treatments. These findings are discussed in terms of efficacy and cost-effectiveness. Conflict of interest:The second author receives payments for CBT and EMDR trainings.

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“…O. Rothbaum, 1997), standard care (Marcus, Marquis, & Sakai, 1997), fluoxetine or placebo pills (van der Kolk et al, 2007). Other studies have also reported significant improvements in comorbid depression where treatment with EMDR was at least as effective as, but not significantly different from, cognitive behavioral therapy (CBT) (Narimani, Ahari, & Rajabi, 2010) or prolonged exposure (Ironson, Freund, Strauss, & Williams, 2002;Lee, Gavriel, Drummond, Richards, & Greenwald, 2002;Rothbaum, Astin, & Marsteller, 2005). Only one RCT found that comorbid depression did not improve when PTSD was treated with EMDR, relaxation or biofeedback (Silver, Brooks, & Obenchain, 1995).…”

Section: Ptsd With Comorbid Depressionsupporting

confidence: 39%

“…In this review, none of the papers reported power or sample size calculations being done before the study took place to determine recruitment numbers and, as such, many could be argued to be underpowered, although only one (Lee et al, 2002) mentions this as a potential limitation. Sample sizes ranged from 18 (Rothbaum, 1997) to 88 (van der Kolk et al, 2007).…”

Section: Ptsd With Comorbid Depressionmentioning

confidence: 43%

Is EMDR an Evidenced-Based Treatment for Depression? A Review of the Literature

Wood

Ricketts

2013

J EMDR Prac Res

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Is EMDR an evidenced-based treatment for depression? A review of the literature. AbstractIt is not unusual for proponents of EMDR to claim it can be used to treat a great many mental health problems. Depression is an illness that affects the lives of millions across the world; the costs are high, economically and socially, and depression can be devastating for the individual. Despite this, depression is not well treated, so a desire to find other treatments is admirable. However, these treatments must be evidence based and while there is some evidence that EMDR may be a promising new approach, it cannot currently be described as an evidenced-based treatment for depression. There are studies under way across Europe that may produce the evidence needed to expand the recommendations for using EMDR with more than just post traumatic stress disorder.

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Treatment of PTSD: Stress inoculation training with prolonged exposure compared to EMDR

Cited by 180 publications

References 32 publications

The Relative Efficacy of Bona Fide Psychotherapies for Post-Traumatic Stress Disorder: A Meta-Analytical Evaluation of Randomized Controlled Trials

The Relative Efficacy of Bona Fide Psychotherapies for Post-Traumatic Stress Disorder: A Meta-Analytical Evaluation of Randomized Controlled Trials

Cognitive behaviour therapy versus eye movement desensitization and reprocessing for post-traumatic disorder – is it all in the homework then?

Is EMDR an Evidenced-Based Treatment for Depression? A Review of the Literature

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