Prevention of chronic PTSD with early cognitive behavioral therapy. A meta-analysis using mixed-effects modeling.
Post-traumatic stress disorder (PTSD) is of great interest to public health, due to the high burden it places on both the individual and society. We meta-analyzed randomized-controlled trials to examine the effectiveness of early trauma-focused cognitive-behavioral treatment (TFCBT) for preventing chronic PTSD. Systematic bibliographic research was undertaken to find relevant literature from on-line databases (Pubmed, PsycINFO, Psyndex, Medline). Using a mixed-effect approach, we calculated effect sizes (ES) for the PTSD diagnoses (main outcome) as well as PTSD and depressive symptoms (secondary outcomes), respectively. Calculations of ES from pre-intervention to first follow-up assessment were based on 10 studies. A moderate effect (ES = 0.54) was found for the main outcome, whereas ES for secondary outcomes were predominantly small (ES = 0.27-0.45). The ES for the main outcome decreased to small (ES = 0.34) from first follow-up to long-term follow-up assessment. The mean dropout rate was 16.7% pre- to post-treatment. There was evidence for the impact of moderators on different outcomes (e.g., the number of sessions on PTSD symptoms). Future studies should include survivors of other trauma types (e.g., burn injuries) rather than predominantly survivors of accidents and physical assault, and should compare early TFCBT with other interventions that previously demonstrated effectiveness.
Criminological Research Institute of Lower Saxony, Lützerodestraße 9, 30161 Hannover, Germany; Technical University Brunswick, Department of Psychology, Humboldtstraße 33, 38106 Brunswick, Germany.
Sören
S
Kliem
Christoph
C
Kröger
D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000150:complications / Q000517:prevention & control / Q000628:therapy; D061345:Early Medical Intervention; D006801:Humans; D008960:Models, Psychological; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000517:prevention & control* / Q000628:therapy*
Acute stress disorder; Meta-analysis; Post-traumatic stress disorder; Trauma-focused cognitive-behavioral treatment