Comparative effectiveness of psychotherapies in adults with posttraumatic stress disorder: A network meta-analysis of randomized controlled trials (Psychological Medicine)

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

A network meta-analysis of randomised controlled trials (RCTs) to determine the comparative effectiveness of psychotherapies for people diagnosed with PTSD.

Article 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″

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Yunitri, N., Chu, H., Kang, X. L., Wiratama, B. S., Lee, T-Y., Chang, L-F., Liu, D., Kustanti, C. Y., Chiang, K-J., Chen, R., Tseng, P., & Chou, K-R. (2023). Comparative effectiveness of psychotherapies in adults with posttraumatic stress disorder: A network meta-analysis of randomized controlled trials. Psychological Medicine, 53(13), 6376-6388. https://doi.org/10.1017/S0033291722003737

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‘Psychological Medicine is a leading international journal in the fields of psychiatry, clinical psychology and the related basic sciences. The journal includes original articles reporting key research being undertaken worldwide, together with literature reviews and shorter editorials by distinguished scholars.”

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Comparative effectiveness of psychotherapies in adults with posttraumatic stress disorder: A network meta-analysis of randomized controlled trials (Psychological Medicine)