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Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis

Lewis, Catrin, Roberts, Neil, Andrew, Martin, Starling, Elise and Bisson, Jonathan 2020. Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis. European Journal of Psychotraumatology 11 (1) , 1729633. 10.1080/20008198.2020.1729633

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Abstract

Background: Psychological therapies are the recommended first-line treatment for posttraumatic stress disorder (PTSD). Previous systematic reviews have grouped theoretically similar interventions to determine differences between broadly distinct approaches. Consequently, we know little regarding the relative efficacy of the specific manualised therapies commonly applied to the treatment of PTSD. Objective: To determine the effect sizes of manualised therapies for PTSD. Methods: We undertook a systematic review following Cochrane Collaboration guidelines. A pre determined definition of clinical importance was applied to the results and the quality of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results: 114 randomised controlled trials (RCTs) of 8171 participants were included. There was robust evidence that the therapies broadly defined as CBT with a trauma focus (CBT-T), as well as Eye Movement Desensitisation and Reprocessing (EMDR), had a clinically important effect. The manualised CBT-Ts with the strongest evidence of effect were Cognitive Processing Therapy (CPT); Cognitive Therapy (CT); and Prolonged Exposure (PE). There was also some evidence supporting CBT without a trauma focus; group CBT with a trauma focus; guided internet-based CBT; and Present Centred Therapy (PCT). There was emerging evidence for a number of other therapies. Conclusions: A recent increase in RCTs of psychological therapies for PTSD, results in a more confident recommendation of CBT-T and EMDR as the first-line treatments. Among the CBTTs considered by the review CPT, CT and PE should be the treatments of choice. The findings should guide evidence informed shared decision making between patient and clinician.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Taylor & Francis
ISSN: 2000-8066
Date of First Compliant Deposit: 19 February 2020
Date of Acceptance: 24 January 2020
Last Modified: 15 May 2020 08:06
URI: http://orca.cf.ac.uk/id/eprint/129819

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