Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis

Numerous guidelines have been developed over the past decade regarding treatments for Posttraumatic stress disorder (PTSD). However, given differences in guideline recommendations, some uncertainty exists regarding the selection of effective PTSD therapies. The current manuscript assessed the effica...

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Published in:Clinical psychology review Vol. 43; pp. 128 - 141
Main Authors: Cusack, Karen, Jonas, Daniel E., Forneris, Catherine A., Wines, Candi, Sonis, Jeffrey, Middleton, Jennifer Cook, Feltner, Cynthia, Brownley, Kimberly A., Olmsted, Kristine Rae, Greenblatt, Amy, Weil, Amy, Gaynes, Bradley N.
Format: Journal Article
Language:English
Published: United States Elsevier Ltd 01.02.2016
Subjects:
Cognitive Behavioral Therapy - methods
Cognitive Behavioral Therapy - statistics & numerical data
Eye Movement Desensitization Reprocessing - methods
Eye Movement Desensitization Reprocessing - statistics & numerical data
Humans
Implosive Therapy - methods
Implosive Therapy - statistics & numerical data
Meta-analysis
Outcome Assessment, Health Care - statistics & numerical data
Psychotherapy
PTSD
Stress Disorders, Post-Traumatic - therapy
PTSD
Psychotherapy
Meta-analysis
ISSN:0272-7358, 1873-7811, 1873-7811
Online Access:Get full text
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Summary:Numerous guidelines have been developed over the past decade regarding treatments for Posttraumatic stress disorder (PTSD). However, given differences in guideline recommendations, some uncertainty exists regarding the selection of effective PTSD therapies. The current manuscript assessed the efficacy, comparative effectiveness, and adverse effects of psychological treatments for adults with PTSD. We searched MEDLINE, Cochrane Library, PILOTS, Embase, CINAHL, PsycINFO, and the Web of Science. Two reviewers independently selected trials. Two reviewers assessed risk of bias and graded strength of evidence (SOE). We included 64 trials; patients generally had severe PTSD. Evidence supports efficacy of exposure therapy (high SOE) including the manualized version Prolonged Exposure (PE); cognitive therapy (CT), cognitive processing therapy (CPT), cognitive behavioral therapy (CBT)-mixed therapies (moderate SOE); eye movement desensitization and reprocessing (EMDR) and narrative exposure therapy (low–moderate SOE). Effect sizes for reducing PTSD symptoms were large (e.g., Cohen's d ~−1.0 or more compared with controls). Numbers needed to treat (NNTs) were <4 to achieve loss of PTSD diagnosis for exposure therapy, CPT, CT, CBT-mixed, and EMDR. Several psychological treatments are effective for adults with PTSD. Head-to-head evidence was insufficient to determine these treatments' comparative effectiveness, and data regarding adverse events was absent from most studies. •We conducted a meta-analysis of psychological treatments for adults with PTSD.•We examined efficacy, comparative effectiveness, and harms.•Several therapies demonstrated efficacy, with strongest support for exposure.•Evidence was insufficient to determine comparative effectiveness.•Information on adverse events was generally not reported.
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ISSN:0272-7358
1873-7811
1873-7811
DOI:10.1016/j.cpr.2015.10.003