BACKGROUND:

Post-traumatic stress disorder (PTSD) is a distressing condition, which is often treated with psychological therapies. Earlier versions of this review, and other meta-analyses, have found these to be effective, with trauma-focused treatments being more effective than non-trauma-focused treatments. This is an update of a Cochrane review first published in 2005 and updated in 2007.
OBJECTIVES:

To assess the effects of psychological therapies for the treatment of adults with chronic post-traumatic stress disorder (PTSD).
SEARCH METHODS:

For this update, we searched the Cochrane Depression, Anxiety and Neurosis Group's Specialised Register (CCDANCTR-Studies and CCDANCTR-References) all years to 12th April 2013. This register contains relevant randomised controlled trials from: The Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). In addition, we handsearched the Journal of Traumatic Stress, contacted experts in the field, searched bibliographies of included studies, and performed citation searches of identified articles.
SELECTION CRITERIA:

Randomised controlled trials of individual trauma-focused cognitive behavioural therapy (TFCBT), eye movement desensitisation and reprocessing (EMDR), non-trauma-focused CBT (non-TFCBT), other therapies (supportive therapy, non-directive counselling, psychodynamic therapy and present-centred therapy), group TFCBT, or group non-TFCBT, compared to one another or to a waitlist or usual care group for the treatment of chronic PTSD. The primary outcome measure was the severity of clinician-rated traumatic-stress symptoms.
DATA COLLECTION AND ANALYSIS:

We extracted data and entered them into Review Manager 5 software. We contacted authors to obtain missing data. Two review authors independently performed 'Risk of bias' assessments. We pooled the data where appropriate, and analysed for summary effects

Psychological therapies for chronic post‐traumatic stress disorder (PTSD) in adults

https://www.cell.com/neuron/pdf/S0896-6273(16)00020-9.pdf

Paradise Lost: The Neurobiological and Clinical Consequences of Child Abuse and Neglect

Objective Many patients drop out of treatments for posttraumatic stress disorder (PTSD); some clinicians believe that trauma-focused treatments increase dropout Method We conducted a meta-analysis of dropout among active treatments in clinical trials for PTSD (42 studies; 17 direct comparisons) Results The average dropout rate was 18%, but it varied significantly across studies Group modality and greater number of sessions, but not trauma focus, predicted increased dropout When the meta-analysis was restricted to direct comparisons of active treatments, there were no differences in dropout Differences in trauma focus between treatments in the same study did not predict dropout However, trauma-focused treatments resulted in higher dropout compared with present-centered therapy (PCT), a treatment originally designed as a control but now listed as a research-supported intervention for PTSD Conclusion Dropout varies between active interventions for PTSD across studies, but variability is primarily driven by differences between studies There do not appear to be systematic differences across active interventions when they are directly compared in the same study The degree of clinical attention placed on the traumatic event does not appear to be a primary cause of dropout from active treatments However, comparisons of PCT may be an exception to this general pattern, perhaps because of a restriction of variability in trauma focus among comparisons of active treatments More research is needed comparing trauma-focused interventions to trauma-avoidant treatments such as PCT

/pdf/meta-analysis-of-dropout-in-treatments-for-posttraumatic-2v5otgcso9.pdf

Meta-analysis of dropout in treatments for posttraumatic stress disorder.

This study provides a summary of the results of an expert opinion survey initiated by the International Society for Traumatic Stress Studies Complex Trauma Task Force regarding best practices for the treatment of complex posttraumatic stress disorder (PTSD). Ratings from a mail-in survey from 25 complex PTSD experts and 25 classic PTSD experts regarding the most appropriate treatment approaches and interventions for complex PTSD were examined for areas of consensus and disagreement. Experts agreed on several aspects of treatment, with 84% endorsing a phase-based or sequenced therapy as the most appropriate treatment approach with interventions tailored to specific symptom sets. First-line interventions matched to specific symptoms included emotion regulation strategies, narration of trauma memory, cognitive restructuring, anxiety and stress management, and interpersonal skills. Meditation and mindfulness interventions were frequently identified as an effective second-line approach for emotional, attentional, and behavioral (e.g., aggression) disturbances. Agreement was not obtained on either the expected course of improvement or on duration of treatment. The survey results provide a strong rationale for conducting research focusing on the relative merits of traditional trauma-focused therapies and sequenced multicomponent approaches applied to different patient populations with a range of symptom profiles. Sustained symptom monitoring during the course of treatment and during extended follow-up would advance knowledge about both the speed and durability of treatment effects.

/pdf/treatment-of-complex-ptsd-results-of-the-istss-expert-2chb8h371y.pdf

Treatment of complex PTSD: Results of the ISTSS expert clinician survey on best practices.

This brief summarizes the results of a gender impact evaluation study, entitled Controlled trial of psychotherapy for Congolese survivors of sexual violence, conducted during the time period April and July 2011 in Democratic Republic of Congo. The study observed that a total of 65 percent of participants in the therapy group and 52 percent of participants in the individual support group completed all three assessments. Mean scores for combined depression and anxiety improved in the individual-support group (2.2 at baseline, 1.7 at the end of treatment, and 1.5 at 6 months after treatment), but improvements were significantly greater in the therapy group. Approximately 70 percent of participants in the therapy group met our criteria for probable depression or anxiety at baseline, with 10 percent or less meeting the criteria at either follow up assessment. In the individual-support group, the proportions of participants who met the criteria were as follows: 83 percent at baseline, 53 percent at the end of treatment, and 42 percent at 6 months after treatment. Funding for the study derived from USAID Victims of Torture Fund and the World Bank.

/pdf/controlled-trial-of-psychotherapy-for-congolese-survivors-of-3673816tlz.pdf

Controlled trial of psychotherapy for Congolese survivors of sexual violence

ObjectivePosttraumatic stress disorder (PTSD) related to childhood abuse is associated with features of affect regulation and interpersonal disturbances that substantially contribute to impairment. Existing treatments do not address these problems or the difficulties they may pose in the exploration of trauma memories, an efficacious and frequently recommended approach to resolving PTSD. The authors evaluated the benefits and risks of a treatment combining an initial preparatory phase of skills training in affect and interpersonal regulation (STAIR) followed by exposure by comparing it against two control conditions: Supportive Counseling followed by Exposure (Support/Exposure) and skills training followed by Supportive Counseling (STAIR/Support). MethodParticipants were women with PTSD related to childhood abuse (N=104) who were randomly assigned to the STAIR/Exposure condition, Support/Exposure condition (exposure comparator), or STAIR/Support condition (skills comparator) and assessed at posttreatment,...

https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2010.09081247

Stephanie Cherry

Papers

Treatment for PTSD related to childhood abuse: a randomized controlled trial.