Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis

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.

Methods: We 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.

Results: We included 90 trials, 6560 individuals and 22 interventions. Evidence was of moderate-to-low quality. Eye movement desensitisation and reprocessing [EMDR] (SMD -2.07; 95%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 in reducing PTSD symptoms post-treatment versus 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.

Conclusions: EMDR and TF-CBT appear to be most effective in reducing symptoms and improving remission rates in adults with PTSD. They are also effective in 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.