Mytra Haerizadeh1, Jennifer A Sumner2, Jeffrey L Birk3, Christopher Gonzalez4, Reuben Heyman-Kantor5, Louise Falzon6, Liliya Gershengoren7, Peter Shapiro8, Ian M Kronish9. 1. Department of Medicine, Columbia University Irving Medical Center, 630 West 168(th) Street, PH8-105, New York, NY 10032, United States of America. 2. Department of Psychology, University of California at Los Angeles, Los Angeles, CA, United States of America. 3. Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W. 168(th) Street, PH9-311, New York, NY 10032, United States of America. 4. Department of Medicine, Weill Cornell Medical College, New York, NT, United States of America. 5. Department of Psychiatry, Northwestern University, Chicago, IL, United States of America. 6. Center for Personalized Medicine, Northwell Health, New York, NY, United States of America. 7. Department of Psychiatry, New York University, New York, NY, United States of America; Department of Psychiatry, Veterans Affairs New York Harbor Health Care System, New York, NY, United States of America. 8. Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, United States of America. 9. Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W. 168(th) Street, PH9-311, New York, NY 10032, United States of America. Electronic address: ik2293@columbia.edu.
Abstract
OBJECTIVE: Medical events such as myocardial infarction and cancer diagnosis can induce symptoms of posttraumatic stress disorder (PTSD). The optimal treatment of PTSD symptoms in this context is unknown. METHODS: A literature search of 6 biomedical electronic databases was conducted from database inception to November 2018. Studies were eligible if they used a randomized design and evaluated the effect of treatments on medical event-induced PTSD symptoms in adults. A random effects model was used to pool data when two or more comparable studies were available. RESULTS: Six trials met full inclusion criteria. Studies ranged in size from 21 to 81 patients, and included patients with PTSD induced by cardiac events, cancer, HIV, multiple sclerosis, and stem cell transplantation. All trials assessed psychological interventions. Two trials comparing a form of exposure-based cognitive behavioral therapy (CBT) with assessment-only control found that CBT resulted in lower PTSD symptoms [Hedges's g = -0.47, (95% CI -0.82 - -0.12), p = .009]. A third trial compared imaginal exposure (another form of exposure-based CBT) with an attention control and found a trend toward reduced PTSD symptoms. Three trials compared eye movement desensitization and reprocessing (EMDR) with active psychological treatments (imaginal exposure, conventional CBT, and relaxation therapy), and found that EMDR was more effective. CONCLUSION: CBT and EMDR may be promising approaches to reducing PTSD symptoms due to medical events. However, additional trials are needed in this patient population.
OBJECTIVE: Medical events such as myocardial infarction and cancer diagnosis can induce symptoms of posttraumatic stress disorder (PTSD). The optimal treatment of PTSD symptoms in this context is unknown. METHODS: A literature search of 6 biomedical electronic databases was conducted from database inception to November 2018. Studies were eligible if they used a randomized design and evaluated the effect of treatments on medical event-induced PTSD symptoms in adults. A random effects model was used to pool data when two or more comparable studies were available. RESULTS: Six trials met full inclusion criteria. Studies ranged in size from 21 to 81 patients, and included patients with PTSD induced by cardiac events, cancer, HIV, multiple sclerosis, and stem cell transplantation. All trials assessed psychological interventions. Two trials comparing a form of exposure-based cognitive behavioral therapy (CBT) with assessment-only control found that CBT resulted in lower PTSD symptoms [Hedges's g = -0.47, (95% CI -0.82 - -0.12), p = .009]. A third trial compared imaginal exposure (another form of exposure-based CBT) with an attention control and found a trend toward reduced PTSD symptoms. Three trials compared eye movement desensitization and reprocessing (EMDR) with active psychological treatments (imaginal exposure, conventional CBT, and relaxation therapy), and found that EMDR was more effective. CONCLUSION: CBT and EMDR may be promising approaches to reducing PTSD symptoms due to medical events. However, additional trials are needed in this patient population.
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