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Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis
- Ifigeneia Mavranezouli, Odette Megnin-Viggars, Caitlin Daly, Sofia Dias, Nicky J. Welton, Sarah Stockton, Gita Bhutani, Nick Grey, Jonathan Leach, Neil Greenberg, Cornelius Katona, Sharif El-Leithy, Stephen Pilling
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- Journal:
- Psychological Medicine / Volume 50 / Issue 4 / March 2020
- Published online by Cambridge University Press:
- 17 February 2020, pp. 542-555
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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.
MethodsWe 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.
ResultsWe 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.
ConclusionsEMDR 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.
Contributors
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- By J. William Allwood, Eleni T. Bairaktari, Jean-Pierre Bellocq, Malika A. Benahmed, Hanne Christine Bertram, Zaver M. Bhujwalla, Ulrich Braumann, Juan Casado-Vela, Marta Cascante, Arancha Cebrián, Albert Chen, Man Ho Choi, Bong Chul Chung, Yuen-Li Chung, Morten Rahr Clausen, Patrick J. Cozzone, Ralph J. DeBerardinis, Julien Detour, Santiago Díaz-Moralli, Warwick B. Dunn, Karim Elbayed, Udo Engelke, Teresa W.-M. Fan, Ana M. Gil, Kristine Glunde, Markus Godejohann, Teresa Gómez del Pulgar, Royston Goodacre, Angelina Goudswaard, Gonçalo Graça, Richard W. Gross, Herbert H. Hill, Ralph E. Hurd, Alessio Imperiale, Kimberly A. Kaplan, Neil L. Kelleher, Michael A. Kiebish, Ann M. Knolhoff, Christina E. Kostara, Juan Carlos Lacal, Andrew N. Lane, Martin O. Leach, Norbert W. Lutz, Elizabeth Maher, Craig R. Malloy, Isaac Marin-Valencia, Laura Menchén, Bruce Mickey, Fanny Mochel, Éva Morava, François-Marie Moussallieh, Izzie J. Namer, Peter Nemes, Ioanna Ntai, Geoffrey S. Payne, Marie-France Penet, Martial Piotto, Stanislav S. Rubakhin, Elsa Sánchez-López, A. Dean Sherry, Bindesh Shrestha, Jonathan V. Sweedler, Akos Vertes, Mark R. Viant, Ralf J. M. Weber, Ron Wehrens, Ron A. Wevers, Catherine L. Winder, David S. Wishart, Kui Yang, Yi-Fen Yen
- Edited by Norbert W. Lutz, Jonathan V. Sweedler, University of Illinois, Urbana-Champaign, Ron A. Wevers
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- Book:
- Methodologies for Metabolomics
- Published online:
- 05 January 2013
- Print publication:
- 21 January 2013, pp viii-xii
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six - Lockdown! Resilience, resurgence, and the stage-set city
- Edited by Rowland Atkinson, University of Sheffield, Gesa Helms, University of Glasgow
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- Book:
- Securing an Urban Renaissance
- Published by:
- Bristol University Press
- Published online:
- 15 September 2022
- Print publication:
- 11 July 2007, pp 91-106
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Summary
For almost a week in February 2005, a large section of the newly regenerated south bank of the River Tyne, in Gateshead, was entirely sectioned off from the rest of the Newcastle-Gateshead conurbation by metal fencing, armed police, closed circuit television (CCTV) cameras and road closures. The headline in the Newcastle Chronicle was ‘Lockdown!’ (Smith, 2005), and so it seemed to be. This is an increasingly familiar experience in many British cities: Brighton and Manchester had experienced much the same the year before, Edinburgh would later in the same year. In the former, as in Gateshead, it was the annual conference of the ruling Labour Party, in Edinburgh, the G8 summit.
This chapter examines the Gateshead ‘lockdown’ and traces this particular event back through three linked and increasingly intertwined contextual threads: disaster preparedness; urban management through territorial defence; and surveillance. It argues that these threads are being woven together in an emerging conception of urban resilience, a combination of security and recovery from disaster that is becoming increasingly central to urban policy, and furthermore that this urban resilience is itself being woven into concepts of urban competitiveness linked to regeneration, one aspect of which being the need for security of the elite-driven urban redevelopment agenda that relies heavily on attracting such ‘meetings tourism’ as both evidence and product of regional, national, or even global urban economic status. It argues that the intertwining of these trajectories in the resurgent city concept heralds an era of a renewed pragmatic and open control of the city by hyper-mobile transnational ‘kinetic elites’ who, while participating little in the slow, difficult, and more dangerous spaces of ordinary people, are able to move rapidly in and through urban spaces with little risk to themselves (Slotterdijk, 1998; Murakami Wood & Graham, 2006). However, it also argues that such controls, like the perambulatory mediaeval court, and like the regeneration strategies they seek to protect, are in many ways superficial and image-centred, or what Williams (2004) calls, the city “not so much materialised, as staged” (p 229), and that this undermines many of the claims to resilience.
Angiotensin-converting enzyme genotype affects the response of human skeletal muscle to functional overload
- Jonathan Folland, Ben Leach, Tom Little, Kate Hawker, Saul Myerson, Hugh Montgomery, David Jones
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- Journal:
- Experimental Physiology / Volume 85 / Issue 5 / September 2000
- Published online by Cambridge University Press:
- 02 November 2000, pp. 575-579
- Print publication:
- September 2000
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The response to strength training varies widely between individuals and is considerably influenced by genetic variables, which until now, have remained unidentified. The deletion (D), rather than the insertion (I), variant of the human angiotensin-converting enzyme (ACE) genotype is an important factor in the hypertrophic response of cardiac muscle to exercise and could also be involved in skeletal muscle hypertrophy - an important factor in the response to functional overload. Subjects were 33 healthy male volunteers with no experience of strength training. We examined the effect of ACE genotype upon changes in strength of quadriceps muscles in response to 9 weeks of specific strength training (isometric or dynamic). There was a significant interaction between ACE genotype and isometric training with greater strength gains shown by subjects with the D allele (mean ± S.E.M.: II, 9.0 ± 1.7 %; ID, 17.6 ± 2.2 %; DD, 14.9 ± 1.3 %, ANOVA, P 0.05). A consistent genotype and training interaction (ID DD II) was observed across all of the strength measures, and both types of training. ACE genotype is the first genetic factor to be identified in the response of skeletal muscle to strength training. The association of the ACE I/D polymorphism with the responses of cardiac and skeletal muscle to functional overload indicates that they may share a common mechanism. These findings suggest a novel mechanism, involving the renin-angiotensin system, in the response of skeletal muscle to functional overload and may have implications for the management of conditions such as muscle wasting disorders, prolonged bed rest, ageing and rehabilitation, where muscle weakness may limit function. Experimental Physiology (2000) 85.5, 575-579.