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

• Published in: European journal of psychotraumatology Vol. 11; no. 1; p. 1729633
• Main Authors: Lewis, Catrin, Roberts, Neil P., Andrew, Martin, Starling, Elise, Bisson, Jonathan I.
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 01.01.2020; Taylor & Francis Ltd; Taylor & Francis Group
• Subjects: Meta-analysis; Post traumatic stress disorder; psychological therapy; PTSD; Reviews that informed the ISTSS guidelines update; revisión sistemática; Systematic review; TEPT; terapia psicológica; This review informed the latest ISTSS treatment guidelines. It summarises the current evidence-base in relation to the effect of specific therapies for PTSD; 心理治疗; 系统评价; PTSD; This review informed the latest ISTSS treatment guidelines. It summarises the current evidence-base in relation to the effect of specific therapies for PTSD; systematic review; psychological therapy
• ISSN: 2000-8066; 2000-8198; 2000-8066
• DOI: 10.1080/20008198.2020.1729633

Background: Psychological therapies are the recommended first-line treatment for post-traumatic 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 pre-determined 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.