title: The efficacy of recommended treatments for veterans with PTSD: A metaregression analysis.
abstract: Soldiers and veterans diagnosed with PTSD benefit less from psychotherapy than non-military populations. The current meta-analysis identified treatment predictors for traumatised soldiers and veterans, using data from studies examining guideline recommended interventions, namely: EMDR, exposure, cognitive, cognitive restructuring, cognitive processing, trauma-focused cognitive behavioural, and stress management therapies. A systematic search identified 57 eligible studies reporting on 69 treated samples. Exposure therapy and cognitive processing therapy were more effective than EMDR and stress management therapy. Group-only therapy formats performed worse compared with individual-only formats, or a combination of both formats. After controlling for study design variables, EMDR no longer negatively predicted treatment outcome. The number of trauma-focused sessions, unlike the total number of psychotherapy sessions, positively predicted treatment outcome. We found a relationship between PTSD pretreatment severity levels and treatment outcome, indicating lower treatment gains at low and high PTSD severity levels compared with moderate severity levels. Demographic variables did not influence treatment outcome. Consequently, soldiers and veterans are best served using exposure interventions to target PTSD. Our results did not support a group-only therapy format. Recommended interventions appear less effective at relatively low and high patient PTSD severity levels. Future high-quality studies are needed to determine the efficacy of EMDR.
authors.affiliation: Department of Clinical & Health Psychology, Utrecht University, Utrecht, The Netherlands. Electronic address: J.F.G.Haagen@uu.nl.
authors.forename: Joris F G
authors.initials: JF
authors.lastname: Haagen
authors.affiliation: Foundation Centrum '45 |partner in Arq, Diemen, The Netherlands.
authors.forename: Geert E
authors.initials: GE
authors.lastname: Smid
authors.affiliation: Department of Clinical & Health Psychology, Utrecht University, Utrecht, The Netherlands; Foundation Centrum '45 |partner in Arq, Diemen, The Netherlands.
authors.forename: Jeroen W
authors.initials: JW
authors.lastname: Knipscheer
authors.affiliation: Department of Clinical & Health Psychology, Utrecht University, Utrecht, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands.
authors.forename: Rolf J
authors.initials: RJ
authors.lastname: Kleber
mesh_terms: D006801:Humans; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011613:Psychotherapy / Q000379:methods* / Q000706:statistics & numerical data; D012044:Regression Analysis; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D014728:Veterans / Q000706:statistics & numerical data*
keywords: Meta-analysis; PTSD; Predictor; Prognosis; Treatment outcome; Veterans