title: Determining what works in the treatment of PTSD.
abstract: Many researchers accept that trauma-focused treatments are superior to non-trauma focused treatments for Post-Traumatic Stress Disorder (PTSD). However, Benish, Imel, and Wampold (2008) recently published a meta-analysis of clinical trials directly comparing 'bona fide' PTSD treatments that failed to reject the null hypothesis that PTSD treatments are similarly effective. They concluded that the results of previous meta-analysis may have been influenced by several confounds, including the use of control treatments, to make conclusions about the relative efficacy of specific PTSD treatments. Ehlers et al. (2010) claim that the selection procedures of the Benish et al. meta-analysis were biased and cite results from individual studies and previous meta-analyses that suggest trauma-focused psychological treatments are superior to non-trauma focused treatments. We first offer a review and justification of the coding criteria and procedure used in Benish et al. In addition, we discuss the appropriateness of utilizing treatments designed to control for non-specifics or common factors such as 'supportive therapy' for determining the relative efficacy of specific PTSD treatments. Finally, we note several additional confounds, such as therapist effects, allegiance, and alteration of legitimate protocols, in PTSD research and describe conceptual problems involved in the classification scheme used to determine the "trauma focus" of interventions, which lead to inappropriate conclusions about what works in the treatment of PTSD.
authors.affiliation: University of Wisconsin, Madison, USA. wampold@education.wisc.edu
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Wampold
authors.forename: Zac E
authors.initials: ZE
authors.lastname: Imel
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Laska
authors.forename: Steven
authors.initials: S
authors.lastname: Benish
authors.forename: Scott D
authors.initials: SD
authors.lastname: Miller
authors.forename: Christoph
authors.initials: C
authors.lastname: Flückiger
authors.forename: Aaron C
authors.initials: AC
authors.lastname: Del Re
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Baardseth
authors.forename: Stephanie
authors.initials: S
authors.lastname: Budge
mesh_terms: D015982:Bias; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D006801:Humans; D015201:Meta-Analysis as Topic; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D016896:Treatment Outcome