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Psychological treatments for chronic post-traumatic stress disorder: Systematic review and meta-analysis

  • Jonathan I. Bisson (a1), Anke Ehlers (a2), Rosa Matthews (a3), Stephen Pilling (a3), David Richards (a4) and Stuart Turner (a5)...

Abstract

Background

The relative efficacy of different psychological treatments for chronic post-traumatic stress disorder (PTSD) is unclear.

Aims

To determine the efficacy of specific psychological treatments for chronic PTSD.

Method

In a systematic review of randomised controlled trials, eligible studies were assessed against methodological qualitycriteria and data were extracted and analysed.

Results

Thirty-eight randomised controlled trials were included in the meta-analysis. Trauma-focused cognitive-behavioural therapy (TFCBT), eye movement desensitisation and reprocessing (EMDR), stress management and group cognitive-behavioural therapy improved PTSD symptoms more than waiting-list or usual care. There was inconclusive evidence regarding other therapies. There was no evidence of a difference in efficacy between TFCBT and EMDR butthere was some evidence that TFCBT and EMDR were superior to stress management and other therapies, and that stress management was superior to other therapies.

Conclusions

The first-line psychological treatment for PTSD should be trauma-focused (TFCBTor EMDR).

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Copyright

Corresponding author

Dr Jonathan Bisson, Department of Psychological Medicine, Monmouth House, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK. Email: bissonji@cf.ac.uk

Footnotes

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Studies that were part of the meta-analysis.

Declaration of interest

None.

Footnotes

References

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*Blanchard, E. B., Hickling, E. J., Devineni, T., et al (2003) A controlled evaluation of cognitive behavioural therapy for posttraumatic stress in motor vehicle accident survivors. Behaviour Research and Therapy, 41, 7996.
Bradley, R., Greene, J., Russ, E., et al (2005) A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162, 214227.
*Brom, D., Kleber, R. J. & Defares, P. B. (1989) Brief psychotherapy for posttraumatic stress disorders. Journal of Consulting and Clinical Psychology, 57, 607612.
*Bryant, R. A., Moulds, M. L., Guthrie, R. M., et al (2003) Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 71, 706712.
*Carlson, J., Chemtob, C. M., Rusnak, K., et al (1998) Eye movement desensitization and reprocessing (EMDR): treatment for combat-related post-traumatic stress disorder. Journal of Traumatic Stress, 11, 324.
*Classen, C., Butler, L. D., Koopman, C., et al (2001) Supportive-expressive group therapy and distress in patients with metastatic breast cancer. A randomised clinical intervention trial. Archives of General Psychiatry, 58, 494501.
*Cloitre, M., Koenen, K. C., Cohen, L. R., et al (2002) Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology, 70, 10671074.
Cohen, J. (1988) Statistical Power Analysis for the Behavioral Sciences. Erlbaum.
*Cooper, N. A. & Clum, G. A. (1989) Imaginal flooding as a supplementary treatment for PTSD in combat veterans: a controlled study. Behavior Therapy, 20, 381391.
DerSimonian, R. & Laird, N. (1986) Meta-analysis in clinical trials. Controlled Clinical Trials, 7, 177188.
*Devilly, G. J. & Spence, S. H. (1999) The relative efficacy and treatment distress of EMDR and a cognitive-behaviour trauma treatment protocol in the amelioration of posttraumatic stress disorder. Journal of Anxiety Disorders, 13, 131157.
*Echeburua, E., de Corral, P., Zubizarreta, I., et al (1997) Psychological treatment of chronic posttraumatic stress disorder in victims of sexual aggression. Behavior Modification, 21, 433–56.
*Ehlers, A., Clark, D., Hackmann, A., et al (2005) Cognitive therapy for posttraumatic stress disorder: development and evaluation. Behaviour Research and Therapy, 43, 413431.
*Fecteau, G. & Nicki, R. (1999) Cognitive behavioural treatment of posttraumatic stress disorder after motor vehicle accident. Behavioural and Cognitive Psychotherapy, 27, 201214.
*Foa, E. B., Rothbaum, B. O., Riggs, D. S., et al (1991) Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counseling. Journal of Consulting and Clinical Psychology, 59, 715723.
*Foa, E. B., Dancu, C. V., Hembree, E. A., et al (1999) A comparison of exposure therapy, stress inoculation training, and their combination in reducing posttraumatic stress disorder in female assault victims. Journal of Consulting and Clinical Psychology, 67, 194200.
Foa, E. B., Keane, T. & Friedman, M. (2000) Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies. Guilford.
Foa, E. B., Zoellner, L. A., Feeny, N. C., et al (2002) Does imaginal exposure exacerbate PTSD symptoms? Journal of Consulting and Clinical Psychology, 70, 10221028.
*Gersons, B. P., Carlier, I. V., Lamberts, R. D., et al (2000) Randomized clinical trial of brief eclectic psychotherapy for police officers with posttraumatic stress disorder. Journal of Traumatic Stress, 13, 333347.
Hackmann, A., Ehlers, A., Speckens, A., et al (2004) Characteristics and contentofintrusive memories of PTSD and their changes with treatment. Journal of Traumatic Stress, 17, 211240.
Higgins, J. P.T. & Thompson, S.G. (2002) Quantifying heterogeneity in a meta-analysis. Statistics in Medicine, 21, 15391558.
*Ironson, G. I., Freund, B., Strauss, J. L., et al (2002) Comparison of two treatments for traumatic stress: a community-based study of EMDR and prolonged exposure. Journal of Clinical Psychology, 58, 113128.
*Jensen, J. A. (1994) An investigation of eye movement desensitization and reprocessing (EMDR) as a treatment for posttraumatic stress disorder (PTSD) symptoms of Vietnam combat veterans. Behavior Therapy, 25, 311325.
*Keane, T. M., Fairbank, J. A., Caddell, J. M., et al (1989) Implosive (flooding) therapy reduces symptoms of PTSD in Vietnam combat veterans. Behavior Therapy, 20, 245260.
*Krakow, B., Hollifield, M., Johnston, L., et al (2001) Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial. JAMA, 286, 537545.
*Kubany, E. S., Hill, E. E. & Owens, J. A. (2003) Cognitive trauma therapy for battered women with PTSD: preliminary findings. Journal of Traumatic Stress, 16, 8191.
*Kubany, E. S., Hill, E. E. & Owens, J. A. (2004) Cognitive trauma therapy for battered women with PTSD (CTT-BW). Journal of Consulting and Clinical Psychology, 72, 318.
*Lange, A., Rietdijk, D., Hudcovicova, M., et al (2003) Interapy: a controlled randomized trial of the standardized treatment of post traumatic stress through the internet. Journal of Consulting and Clinical Psychology, 71, 901909.
*Lee, C., Gavriel, H., Drummond, P., et al (2002) Treatment of post-traumatic stress disorder: a comparison of stress inoculation training with prolonged exposure and eye movement desensitization and reprocessing. Journal of Clinical Psychology, 58, 10711089.
*Marcus, S., Marquis, P. & Sakai, C. (1997) Controlled study of treatment of PTSD using EMDR in an HMO setting. Psychotherapy, 34, 307315.
*Marks, I., Lovell, K., Noshirvani, H., et al (1998) Treatment of post traumatic stress disorder by exposure and/or cognitive restructuring: a controlled study. Archives of General Psychiatry, 55, 317325.
Moher, D., Pharn, B., Jones, A., et al (1998) Does quality of reports of randomised trials affect estimates of intervention efficacy in meta-analyses? Lancet, 352, 609613.
National Collaborating Centre for Mental Health (2004) Clinical Guideline 23. Depression: Management of Depression in Primary and Secondary Care. National Institute for Clinical Excellence.
National Collaborating Centre for Mental Health (2005) Clinical Guideline 26. Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care. National Institute for Clinical Excellence.
National Collaborating Centre for Primary Care (2004) Clinical Guideline 22. Anxiety: Management of Anxiety (Panic Disorder, With or Without Agoraphobia, and Generalized Anxiety Disorder) in Adults in Primary, Secondary and Community Care. National Institute for Clinical Excellence.
*Neuner, F., Schauer, M., Klaschik, C., et al (2004) A comparison of narrative exposure therapy, supportive counselling and psychoeducation for treating posttraumatic stress disorder in an African refugee settlement. Journal of Consulting and Clinical Psychology, 72, 579587.
*Paunovic, N. & Ost, L.G. (2001) Cognitive-behaviour therapy vs exposure therapy in the treatment of PTSD in refugees. Behaviour Research and Therapy, 39, 11831197.
*Peniston, E. G. & Kulkosky, P. J. (1991) Alpha-theta brainwave neuro-feedback therapy for Vietnam veterans with combat-re ated post-traumatic stress disorder. Medical Psychotherapy, 4, 4760.
Pitman, R. K., Altman, B., Greenwald, E., et al (1991) Psychiatric complications during flooding therapy for post-traumatic stress disorder. Journal of Clinical Psychiatry, 52, 1720.
*Power, K., McGoldrick, T., Brown, K., et al (2002) A controlled comparison of eye movement desensitisation and reprocessing versus exposure plus cognitive restructuring versus waiting list in the treatment of post-traumatic stress disorder. Clinical Psychology and Psychotherapy, 9, 299318.
*Resick, P. A., Nishith, P., Weaver, T. L., et al (2002) A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology, 70, 867879.
*Rothbaum, B. (1997) A controlled study of eye movement desensitization and reprocessing in the treatment of post-traumatic stress disordered sexual assault victims. Bulletin of the Menninger Clinic, 61, 317334.
*Rothbaum, B. O., Astin, M. C. & Marsteller, F. (2005) Prolonged exposure vs. EMDR for PTSD rape victims. Journal of Traumatic Stress, 18, 607616.
*Scheck, M., Schaeffer, J. A. & Gillette, C. (1998) Brief psychological intervention with traumatized young women: the efficacy of eye movement desensitization and reprocessing. Journal of Traumatic Stress, 11, 2444.
*Schnurr, P. P., Friedman, M. J., Foy, D. W., et al (2003) Randomized trial of trauma-focused group therapy for posttraumatic stress disorder: results from a Department of Veterans' Affairs cooperative study. Archives of General Psychiatry, 60, 481489.
*Tarrier, N., Pilgrim, H., Sommerfield, C., et al (1999a) A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 67, 1318.
*Tarrier, N., Sommerfield, C., Pilgrim, H., et al (1999b) Cognitive therapy or imaginal exposure in the treatment of post-traumatic stress disorder. Twelve month follow-up. British Journal of Psychiatry, 175, 571575.
*Taylor, S., Thordarson, D. S., Maxfield, L., et al (2003) Comparative efficacy, speed, and adverse effects of three PTSD treatments: exposure therapy, EMDR and relaxation training. Journal of Consulting and Clinical Psychology, 71, 330338.
Van Etten, M. L. & Taylor, S. (1988) Comparative efficacy of treatments for post-traumatic stress disorder: a meta-analysis. Clinical Psychology and Psychotherapy, 5, 126145.
*Vaughan, K., Armstrong, M. S., Gold, R., et al (1994) A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in post-traumatic stress disorder. Journal of Behavior Therapy and Experimental Psychiatry, 25, 283291.
*Zlotnick, C., Shea, T. M., Rosen, K., et al (1997) An affect-management group for women with posttraumatic stress disorder and histories of childhood sexual abuse. Journal of Traumatic Stress, 10, 425436.

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Psychological treatments for chronic post-traumatic stress disorder: Systematic review and meta-analysis

  • Jonathan I. Bisson (a1), Anke Ehlers (a2), Rosa Matthews (a3), Stephen Pilling (a3), David Richards (a4) and Stuart Turner (a5)...

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