Hostname: page-component-f554764f5-qhdkw Total loading time: 0 Render date: 2025-04-16T12:48:29.273Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparative effectiveness of psychotherapies in adults with posttraumatic stress disorder: a network meta-analysis of randomised controlled trials

Published online by Cambridge University Press:  11 January 2023

Ninik Yunitri ,
Hsin Chu ,
Xiao Linda Kang ,
Bayu Satria Wiratama ,
Tso-Ying Lee ,
Li-Fang Chang ,
Doresses Liu ,
Christina Yeni Kustanti ,
Kai-Jo Chiang  and
Ruey Chen
...Show all authors
Ninik Yunitri
Affiliation:
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan Mental Health and Psychiatric Nursing Department, Faculty of Nursing, Universitas Muhammadiyah Jakarta, Indonesia
Hsin Chu
Affiliation:
Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Xiao Linda Kang
Affiliation:
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan School of Nursing, University of Pennsylvania, Philadelphia, USA
Bayu Satria Wiratama
Affiliation:
Department of Biostatistics, Epidemiology and Population Health, Universitas Gadjah Mada, Yogyakarta, Indonesia
Tso-Ying Lee
Affiliation:
Nursing Research Center, Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
Li-Fang Chang
Affiliation:
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan Department of Medical Education & Emergency and Critical Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan School of Nursing, National Defense Medical Center, Taipei, Taiwan Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
Doresses Liu
Affiliation:
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
Christina Yeni Kustanti
Affiliation:
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum Yogyakarta, Indonesia
Kai-Jo Chiang
Affiliation:
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan Department of Nursing, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan School of Nursing, National Defense Medical Center, Taipei, Taiwan
Ruey Chen
Affiliation:
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
Philip Tseng
Affiliation:
Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan Brain and Consciousness Research Center, TMU - Shuang Ho Hospital, New Taipei, Taiwan Research Center for Mind, Brain & Learning, National Chengchi University, Taipei, Taiwan
Kuei-Ru Chou*
Affiliation:
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
*
Author for correspondence: Kuei-Ru Chou, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Evidence on the long-term comparative effectiveness of posttraumatic stress disorder (PTSD) psychotherapies in adults remains unknown. Therefore, we performed an extensive network meta-analysis of randomised controlled trials (RCTs) to determine the comparative effectiveness of psychotherapies for people diagnosed with PTSD.

Methods

A comprehensive search was conducted in Cochrane library, Embase, Medline-OVID, PubMed, Scopus, and Psych-Info until March 2021. Studies on the effectiveness of cognitive processing therapy (CPT), cognitive therapy (CT), eye movement desensitisation reprocessing (EMDR), narrative exposure therapy (NET), prolonged exposure (PE), cognitive behavioural therapy (CBT), present-centred therapy (PCT), brief eclectic psychotherapies (BEP), psychodynamic therapy (PDT) or combination therapies compared to no treatment (NT) or treatment as usual (TAU) in adults with PTSD were included. Frequentist and Bayesian approaches were used for analysis in R-software.

Results

We included 98 RCTs with 5567 participants from 18 897 studies. CPT, EMDR, CT, NET, PE, CBT, and PCT were significant to reduce PTSD symptoms (SMD range: −1.53 to −0.75; Certainty: very low to high) at immediate post-treatment and ranked accordingly. Longitudinal analysis found EMDR (1.02) and CPT (0.85) as the significant therapies with large effect size in short-term and long-term follow-up, respectively. NET and CPT showed higher proportion of loss of PTSD diagnosis (RR range: 5.51–3.45) while there were no significant psychotherapies for retention rate compared to NT.

Conclusions:

Our findings provide evidence for improving current guidelines and informing clinical decision-making for PTSD management. However, the best PTSD treatment plan should be tailored to patients' needs, characteristics, and clinician expertise.

Registration:

PROSPERO CRD42020162143

Keywords

Effectivenessnetwork meta-analysispsychotherapiesPTSD
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 13 , October 2023 , pp. 6376 - 6388
Check for updates
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Adams, L. Y. (2018). Fast fact about PTSD: A guide for nurses and other health care professionals. New York, NY: Springer Publishing Company.Google Scholar
American Psychological Association. (2017). Cognitive Processing Therapy (CPT). Retrieved from https://www.apa.org/ptsd-guideline/treatments/cognitive-processing-therapy.Google Scholar
Asmundson, G. J. G., Thorisdottir, A. S., Roden-Foreman, J. W., Baird, S. O., Witcraft, S. M., Stein, A. T., … Powers, M. B. (2019). A meta-analytic review of cognitive processing therapy for adults with posttraumatic stress disorder. Cognitive Behaviour Therapy, 48(1), 1–14. https://doi.org/10.1080/16506073.2018.1522371.CrossRefGoogle ScholarPubMed
Bisson, J. I., Roberts, N. P., Andrew, M., Cooper, R., & Lewis, C. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews (12). https://doi.org/10.1002/14651858.CD003388.pub4.CrossRefGoogle ScholarPubMed
Card, P. (2017). VA/DoD clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder. Retrieved from https://www.healthquality.va.gov/guidelines/MH/ptsd/VADoDPTSDCPGFinal012418.pdf.Google Scholar
Chaimani, A., & Salanti, G. (2012). Using network meta-analysis to evaluate the existence of small-study effects in a network of interventions. Research Synthesis Methods, 3(2), 161–176. https://doi.org/10.1002/jrsm.57.CrossRefGoogle Scholar
Chen, L., Zhang, G., Hu, M., & Liang, X. (2015). Eye movement desensitization and reprocessing versus cognitive-behavioral therapy for adult posttraumatic stress disorder: Systematic review and meta-analysis. The Journal of Nervous and Mental Disease, 203(6), 443–451. https://doi.org/10.1097/nmd.0000000000000306.CrossRefGoogle ScholarPubMed
Cohen, J. (2013). Statistical power analysis for the behavioral sciences. New York, NY: Routledge.CrossRefGoogle Scholar
Courtois, C. A., Brown, L. S., Cook, J., Fairbank, J. A., Friedman, M., Gone, J. P., … Kurtzman, H. (2017). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults American Psychological Association Guideline Development Panel for the Treatment of PTSD in Adults Adopted as APA Policy February 24, 2017.Google Scholar
Cusack, K., Jonas, D. E., Forneris, C. A., Wines, C., Sonis, J., Middleton, J. C., … Gaynes, B. N. (2016). Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis. Clinical Psychology Review, 43, 128–141. https://doi.org/10.1016/j.cpr.2015.10.003.CrossRefGoogle ScholarPubMed
Dacosta-Sánchez, D., González-Ponce, B. M., Fernández-Calderón, F., Sánchez-García, M., & Lozano, O. M. (2022). Retention in treatment and therapeutic adherence: How are these associated with therapeutic success? An analysis using real-world data. International Journal of Methods in Psychiatric Research, 31(4), e1929. https://doi.org/10.1002/mpr.1929.CrossRefGoogle ScholarPubMed
Faraone, S. V. (2008). Interpreting estimates of treatment effects: Implications for managed care. Pharmacy and Therapeutics, 33(12), 700.Google ScholarPubMed
Forman-Hoffman, V., Middleton, J. C., Feltner, C., Gaynes, B. N., Weber, R. P., Bann, C., … Green, J. (2018). Psychological and pharmacological treatments for adults with posttraumatic stress disorder: A systematic review update [Internet]. Rockville, MD: Agency for Healthcare Research and Quality (US); (Comparative Effectiveness Review, No. 207.). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK525132/.CrossRefGoogle ScholarPubMed
Gerger, H., Munder, T., Gemperli, A., Nüesch, E., Trelle, S., Jüni, P., & Barth, J. (2014). Integrating fragmented evidence by network meta-analysis: Relative effectiveness of psychological interventions for adults with post-traumatic stress disorder. Psychological Medicine, 44(15), 3151–3164. https://doi.org/10.1017/s0033291714000853.CrossRefGoogle ScholarPubMed
Greenberg, N., Megnin-Viggars, O., & Leach, J. (2019). Occupational health professionals and 2018 NICE post-traumatic stress disorder guidelines. Occupational Medicine, 69(6), 397–399.CrossRefGoogle ScholarPubMed
Hutton, B., Salanti, G., Caldwell, D. M., Chaimani, A., Schmid, C. H., Cameron, C., … Moher, D. (2015). The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations. Annals of Internal Medicine, 162(11), 777–784. https://doi.org/10.7326/m14-2385.CrossRefGoogle ScholarPubMed
Kanters, S., Ford, N., Druyts, E., Thorlund, K., Mills, E. J., & Bansback, N. (2016). Use of network meta-analysis in clinical guidelines. Bulletin of the World Health Organization, 94(10), 782. https://doi.org/10.2471/blt.16.174326.CrossRefGoogle ScholarPubMed
Kayrouz, R., Dear, B. F., Kayrouz, B., Karin, E., Gandy, M., & Titov, N. (2018). Meta-analysis of the efficacy and acceptability of cognitive-behavioural therapy for Arab adult populations experiencing anxiety, depression or post-traumatic stress disorder. Cognitive Behaviour Therapy, 47(5), 412–430. https://doi.org/10.1080/16506073.2018.1445124.CrossRefGoogle ScholarPubMed
Lakens, D. (2013). Calculating and reporting effect sizes to facilitate cumulative science: A practical primer for t tests and ANOVAs. Frontiers in Psychology, 4, 863. https://doi.org/10.3389/fpsyg.2013.00863.CrossRefGoogle Scholar
Lely, J. C., Smid, G. E., Jongedijk, R. A., Knipscheer, J. W., & Kleber, R. J. (2019). The effectiveness of narrative exposure therapy: A review, meta-analysis and meta-regression analysis. European Journal of Psychotraumatology, 10(1), 1550344. https://doi.org/10.1080/20008198.2018.1550344.CrossRefGoogle ScholarPubMed
Lenz, A. S., Haktanir, A., & Callender, K. (2017). Meta-analysis of trauma-focused therapies for treating the symptoms of posttraumatic stress disorder. Journal of Counseling & Development, 95(3), 339–353. https://doi.org/10.1002/jcad.12148.CrossRefGoogle Scholar
Lenz, A. S., & Hollenbaugh, K. M. (2015). Meta-analysis of trauma-focused cognitive behavioral therapy for treating PTSD and co-occurring depression among children and adolescents. Counseling Outcome Research and Evaluation, 6(1), 18–32. https://doi.org/10.1177/2150137815573790.CrossRefGoogle Scholar
Lin, L. (2019). Use of prediction intervals in network meta-analysis. JAMA Network Open, 2(8), e199735. https://doi.org/10.1001/jamanetworkopen.2019.9735.CrossRefGoogle ScholarPubMed
Lu, G., & Ades, A. E. (2004). Combination of direct and indirect evidence in mixed treatment comparisons. Statistics in Medicine, 23(20), 3105–3124. https://doi.org/10.1002/sim.1875.CrossRefGoogle ScholarPubMed
Mavranezouli, I., Megnin-Viggars, O., Daly, C., Dias, S., Stockton, S., Meiser-Stedman, R., … Pilling, S. (2020a). Research review: Psychological and psychosocial treatments for children and young people with post-traumatic stress disorder: A network meta-analysis. Journal of Child Psychology and Psychiatry, 61(1), 18–29. https://doi.org/10.1111/jcpp.13094.CrossRefGoogle Scholar
Mavranezouli, I., Megnin-Viggars, O., Daly, C., Dias, S., Welton, N. J., Stockton, S., … Pilling, S. (2020b). Psychological treatments for post-traumatic stress disorder in adults: A network meta-analysis. Psychological Medicine, 50(4), 542–555. https://doi.org/10.1017/s0033291720000070.CrossRefGoogle ScholarPubMed
McHugh, M. L. (2012). Interrater reliability: The kappa statistic. Biochemia Medica, 22(3), 276–282.CrossRefGoogle ScholarPubMed
McLean, C. P., & Foa, E. B. (2011). Prolonged exposure therapy for post-traumatic stress disorder: A review of evidence and dissemination. Expert Review of Neurotherapeutics, 11(8), 1151–1163. https://doi.org/10.1586/ern.11.94.CrossRefGoogle ScholarPubMed
Merz, J., Schwarzer, G., & Gerger, H. (2019). Comparative efficacy and acceptability of pharmacological, psychotherapeutic, and combination treatments in adults with posttraumatic stress disorder: A network meta-analysis. JAMA Psychiatry, 76(9), 904–913. https://doi.org/10.1001/jamapsychiatry.2019.0951.CrossRefGoogle ScholarPubMed
Moreno-Alcázar, A., Treen, D., Valiente-Gómez, A., Sio-Eroles, A., Perez, V., Amann, B. L., & Radua, J. (2017). Efficacy of eye movement desensitization and reprocessing in children and adolescent with post-traumatic stress disorder: A meta-analysis of randomized controlled trials. Frontiers in Psychology, 8, 1750. https://doi.org/10.3389/fpsyg.2017.01750.CrossRefGoogle ScholarPubMed
Morina, N., Wicherts, J. M., Lobbrecht, J., & Priebe, S. (2014). Remission from post-traumatic stress disorder in adults: A systematic review and meta-analysis of long term outcome studies. Clinical Psychology Review, 34(3), 249–255. https://doi.org/10.1016/j.cpr.2014.03.002.CrossRefGoogle ScholarPubMed
Najavits, L. M. (2015). The problem of dropout from “gold standard” PTSD therapies. F1000prime Reports, 7, 1–8. https://doi.org/10.12703/p7-43.CrossRefGoogle ScholarPubMed
Norcross, J. C., & Wampold, B. E. (2019). Relationships and responsiveness in the psychological treatment of trauma: The tragedy of the APA clinical practice guideline. Psychotherapy, 56(3), 391. https://doi.org/10.1037/pst0000228.CrossRefGoogle ScholarPubMed
Phelps, A. J., Lethbridge, R., Brennan, S., Bryant, R. A., Burns, P., Cooper, J. A., … Silove, D. (2022) Australian guidelines for the prevention and treatment of posttraumatic stress disorder: Updates in the third edition. Australian & New Zealand Journal of Psychiatry, 56(3), 230–247. https://doi.org/10.1177/00048674211041917.CrossRefGoogle ScholarPubMed
Power, K., McGoldrick, T., Brown, K., Buchanan, R., Sharp, D., Swanson, V., & Karatzias, A. (2002). A controlled comparison of eye movement desensitization and reprocessing versus exposure plus cognitive restructuring versus waiting list in the treatment of post-traumatic stress disorder. Clinical Psychology & Psychotherapy, 9(5), 299–318. https://doi.org/https://doi.org/10.1002/cpp.341.CrossRefGoogle Scholar
Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., & Foa, E. B. (2010). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical Psychology Review, 30(6), 635–641. https://doi.org/10.1016/j.cpr.2010.04.007.CrossRefGoogle ScholarPubMed
R Core Team (2020) R (version 4.4.2) [computer software]. Vienna, Austria: R Core Team. Retrieved from https://www.R-project.org/.Google Scholar
Rücker, G., & Schwarzer, G. (2015). Ranking treatments in frequentist network meta-analysis works without resampling methods. BMC Medical Research Methodology, 15(1), 1–9. https://doi.org/10.1186/s12874-015-0060-8.CrossRefGoogle ScholarPubMed
Salanti, G., Del Giovane, C., Chaimani, A., Caldwell, D. M., & Higgins, J. P. (2014). Evaluating the quality of evidence from a network meta-analysis. PloS One, 9(7), e99682. https://doi.org/10.1371/journal.pone.0099682.CrossRefGoogle ScholarPubMed
Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures (2nd ed.). New York, NY: Guilford Press.Google Scholar
Zhou, Y., Sun, L., Wang, Y., Wu, L., Sun, Z., Zhang, F., & Liu, W. (2020). Developments of prolonged exposure in treatment effect of post-traumatic stress disorder and controlling dropout rate: A meta-analytic review. Clinical Psychology & Psychotherapy, 27(4), 449–462. https://doi.org/10.1002/cpp.2443.CrossRefGoogle Scholar
Supplementary material: File

Yunitri et al. supplementary material

Yunitri et al. supplementary material

Download Yunitri et al. supplementary material(File)
File 576.3 KB