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Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis

Published online by Cambridge University Press:  17 February 2020

Ifigeneia Mavranezouli Open the ORCID record for Ifigeneia Mavranezouli [Opens in a new window] ,
Odette Megnin-Viggars ,
Caitlin Daly ,
Sofia Dias ,
Nicky J. Welton ,
Sarah Stockton ,
Gita Bhutani ,
Nick Grey ,
Jonathan Leach  and
Neil Greenberg
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Ifigeneia Mavranezouli*
Affiliation:
Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, LondonWC1E 7HB, UK National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, LondonSE1 1SZ, UK
Odette Megnin-Viggars
Affiliation:
Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, LondonWC1E 7HB, UK National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, LondonSE1 1SZ, UK
Caitlin Daly
Affiliation:
Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, BristolBS8 2PS, UK
Sofia Dias
Affiliation:
Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, BristolBS8 2PS, UK
Nicky J. Welton
Affiliation:
Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, BristolBS8 2PS, UK
Sarah Stockton
Affiliation:
National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, LondonSE1 1SZ, UK
Gita Bhutani
Affiliation:
Lancashire & South Cumbria NHS Foundation Trust, Bamber Bridge, PrestonPR5 6AW, UK University of Liverpool, LiverpoolL69 3BX, UK
Nick Grey
Affiliation:
Sussex Partnership NHS Foundation Trust, Aldrington House, 35 New Church Road, Hove, BN3 4AG, UK School of Psychology, University of Sussex, Sussex House, Brighton, BN1 9RH, UK
Jonathan Leach
Affiliation:
Davenal House Surgery, BromsgroveB61 0DD, UK
Neil Greenberg
Affiliation:
King's Centre for Military Health Research, King's College London, Weston Education Centre, 10 Cutcombe Road, LondonSE5 9RJ, UK
Cornelius Katona
Affiliation:
Helen Bamber Foundation, Bruges Place, 15-20 Baynes Street, LondonNW1 0TF, UK Division of Psychiatry, University College London, 6th Floor, Wings A and B, Maple House, 149 Tottenham Court Road, LondonW1T 7NF, UK
Sharif El-Leithy
Affiliation:
Traumatic Stress Service, Springfield Hospital, LondonSW17 7DJ, UK
Stephen Pilling
Affiliation:
Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, LondonWC1E 7HB, UK National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, LondonSE1 1SZ, UK Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, LondonNW1 0PE, UK
*
Author for correspondence: Ifigeneia Mavranezouli, E-mail: i.mavranezouli@ucl.ac.uk
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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.

Keywords

Interventionsnetwork meta-analysispost-traumatic stress disordersystematic review
Type
Review Article
Information
Psychological Medicine , Volume 50 , Issue 4 , March 2020 , pp. 542 - 555
Copyright
© The Author(s) 2020. Published by Cambridge University Press

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Footnotes

*

Current affiliation: Centre for Reviews and Dissemination, University of York, Heslington, York YO10 5DD, UK.

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