Ifigeneia Mavranezouli1,2, Odette Megnin-Viggars1,2, Caitlin Daly3, Sofia Dias3, Nicky J Welton3, Sarah Stockton2, Gita Bhutani4,5, Nick Grey6,7, Jonathan Leach8, Neil Greenberg9, Cornelius Katona10,11, Sharif El-Leithy12, Stephen Pilling1,2,13. 1. Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, LondonWC1E 7HB, UK. 2. National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, LondonSE1 1SZ, UK. 3. Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, BristolBS8 2PS, UK. 4. Lancashire & South Cumbria NHS Foundation Trust, Bamber Bridge, PrestonPR5 6AW, UK. 5. University of Liverpool, LiverpoolL69 3BX, UK. 6. Sussex Partnership NHS Foundation Trust, Aldrington House, 35 New Church Road, Hove, BN3 4AG, UK. 7. School of Psychology, University of Sussex, Sussex House, Brighton, BN1 9RH, UK. 8. Davenal House Surgery, BromsgroveB61 0DD, UK. 9. King's Centre for Military Health Research, King's College London, Weston Education Centre, 10 Cutcombe Road, LondonSE5 9RJ, UK. 10. Helen Bamber Foundation, Bruges Place, 15-20 Baynes Street, LondonNW1 0TF, UK. 11. Division of Psychiatry, University College London, 6th Floor, Wings A and B, Maple House, 149 Tottenham Court Road, LondonW1T 7NF, UK. 12. Traumatic Stress Service, Springfield Hospital, LondonSW17 7DJ, UK. 13. Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, LondonNW1 0PE, UK.
Abstract
BACKGROUND: Post-traumatic stress disorder (PTSD) is a potentially chronic and disabling disorder affecting a significant minority of people exposed to trauma. Various psychological treatments have been shown to be effective, but their relative effects are not well established. METHODS: We undertook a systematic review and network meta-analyses of psychological interventions for adults with PTSD. Outcomes included PTSD symptom change scores post-treatment and at 1-4-month follow-up, and remission post-treatment. RESULTS: We included 90 trials, 6560 individuals and 22 interventions. Evidence was of moderate-to-low quality. Eye movement desensitisation and reprocessing (EMDR) [standardised mean difference (SMD) -2.07; 95% credible interval (CrI) -2.70 to -1.44], combined somatic/cognitive therapies (SMD -1.69; 95% CrI -2.66 to -0.73), trauma-focused cognitive behavioural therapy (TF-CBT) (SMD -1.46; 95% CrI -1.87 to -1.05) and self-help with support (SMD -1.46; 95% CrI -2.33 to -0.59) appeared to be most effective at reducing PTSD symptoms post-treatment v. waitlist, followed by non-TF-CBT, TF-CBT combined with a selective serotonin reuptake inhibitor (SSRI), SSRIs, self-help without support and counselling. EMDR and TF-CBT showed sustained effects at 1-4-month follow-up. EMDR, TF-CBT, self-help with support and counselling improved remission rates post-treatment. Results for other interventions were either inconclusive or based on limited evidence. CONCLUSIONS: EMDR and TF-CBT appear to be most effective at reducing symptoms and improving remission rates in adults with PTSD. They are also effective at sustaining symptom improvements beyond treatment endpoint. Further research needs to explore the long-term comparative effectiveness of psychological therapies for adults with PTSD and also the impact of severity and complexity of PTSD on treatment outcomes.
BACKGROUND:Post-traumatic stress disorder (PTSD) is a potentially chronic and disabling disorder affecting a significant minority of people exposed to trauma. Various psychological treatments have been shown to be effective, but their relative effects are not well established. METHODS: We undertook a systematic review and network meta-analyses of psychological interventions for adults with PTSD. Outcomes included PTSD symptom change scores post-treatment and at 1-4-month follow-up, and remission post-treatment. RESULTS: We included 90 trials, 6560 individuals and 22 interventions. Evidence was of moderate-to-low quality. Eye movement desensitisation and reprocessing (EMDR) [standardised mean difference (SMD) -2.07; 95% credible interval (CrI) -2.70 to -1.44], combined somatic/cognitive therapies (SMD -1.69; 95% CrI -2.66 to -0.73), trauma-focused cognitive behavioural therapy (TF-CBT) (SMD -1.46; 95% CrI -1.87 to -1.05) and self-help with support (SMD -1.46; 95% CrI -2.33 to -0.59) appeared to be most effective at reducing PTSD symptoms post-treatment v. waitlist, followed by non-TF-CBT, TF-CBT combined with a selective serotonin reuptake inhibitor (SSRI), SSRIs, self-help without support and counselling. EMDR and TF-CBT showed sustained effects at 1-4-month follow-up. EMDR, TF-CBT, self-help with support and counselling improved remission rates post-treatment. Results for other interventions were either inconclusive or based on limited evidence. CONCLUSIONS: EMDR and TF-CBT appear to be most effective at reducing symptoms and improving remission rates in adults with PTSD. They are also effective at sustaining symptom improvements beyond treatment endpoint. Further research needs to explore the long-term comparative effectiveness of psychological therapies for adults with PTSD and also the impact of severity and complexity of PTSD on treatment outcomes.
Authors: Ifigeneia Mavranezouli; Odette Megnin-Viggars; Nick Grey; Gita Bhutani; Jonathan Leach; Caitlin Daly; Sofia Dias; Nicky J Welton; Cornelius Katona; Sharif El-Leithy; Neil Greenberg; Sarah Stockton; Stephen Pilling Journal: PLoS One Date: 2020-04-30 Impact factor: 3.240
Authors: Danielle A C Oprel; Chris M Hoeboer; Maartje Schoorl; Rianne A de Kleine; Marylene Cloitre; Ingrid G Wigard; Agnes van Minnen; Willem van der Does Journal: Eur J Psychotraumatol Date: 2021-01-15