title: A meta-analytic review of exposure in group cognitive behavioral therapy for posttraumatic stress disorder.
abstract: Although the efficacy of exposure is well established in individual cognitive behavioral treatments for posttraumatic stress disorder (PTSD), some clinicians and researchers have expressed concerns regarding the use of in-session disclosure of trauma details through imaginal exposure in group cognitive behavioral therapy (GCBT) for PTSD. Thus, the aim of the present study was to conduct a systematic review of the empirical support for GCBT in the treatment of PTSD and to compare GCBT protocols that encourage the disclosure of trauma details via in-session exposure to GCBT protocols that do not include in-session exposure. Randomized controlled trials that assessed the efficacy of GCBT for PTSD were included in the meta-analysis. A total of 651 participants with PTSD were included in the 12 eligible GCBT treatment conditions (5 conditions included in-group exposure, 7 conditions did not include in-group exposure). The overall pre-post effect size of GCBT for PTSD (ES=1.13 [SE=0.22, 95% CI: 0.69 to 1.56, p<.001]). suggests that GCBT is an effective intervention for individuals with PTSD. No significant differences in effect sizes were found between GCBT treatments that included in-group exposure and those that did not. Although the attrition rate was higher in treatments that included exposure in-group, this rate is comparable to attrition rates in individual CBT treatments and pharmacotherapy for PTSD. The results from this meta-analysis suggest that concerns about the potentially negative impact of group exposure may be unwarranted, and support the use of exposure-based GCBT as a promising treatment option for PTSD.
authors.affiliation: Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA.
authors.forename: T L
authors.initials: TL
authors.lastname: Barrera
authors.forename: J M
authors.initials: JM
authors.lastname: Mott
authors.forename: R F
authors.initials: RF
authors.lastname: Hofstein
authors.forename: E J
authors.initials: EJ
authors.lastname: Teng
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D011615:Psychotherapy, Group / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D016896:Treatment Outcome