title: Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis.
abstract: Numerous guidelines have been developed over the past decade regarding treatments for Posttraumatic stress disorder (PTSD). However, given differences in guideline recommendations, some uncertainty exists regarding the selection of effective PTSD therapies. The current manuscript assessed the efficacy, comparative effectiveness, and adverse effects of psychological treatments for adults with PTSD. We searched MEDLINE, Cochrane Library, PILOTS, Embase, CINAHL, PsycINFO, and the Web of Science. Two reviewers independently selected trials. Two reviewers assessed risk of bias and graded strength of evidence (SOE). We included 64 trials; patients generally had severe PTSD. Evidence supports efficacy of exposure therapy (high SOE) including the manualized version Prolonged Exposure (PE); cognitive therapy (CT), cognitive processing therapy (CPT), cognitive behavioral therapy (CBT)-mixed therapies (moderate SOE); eye movement desensitization and reprocessing (EMDR) and narrative exposure therapy (low-moderate SOE). Effect sizes for reducing PTSD symptoms were large (e.g., Cohen's d ~-1.0 or more compared with controls). Numbers needed to treat (NNTs) were <4 to achieve loss of PTSD diagnosis for exposure therapy, CPT, CT, CBT-mixed, and EMDR. Several psychological treatments are effective for adults with PTSD. Head-to-head evidence was insufficient to determine these treatments' comparative effectiveness, and data regarding adverse events was absent from most studies.
authors.affiliation: Raymond G. Murphy VA Medical Center, Albuquerque, NM, United States. Electronic address: Karen.cusack@va.gov.
authors.forename: Karen
authors.initials: K
authors.lastname: Cusack
authors.affiliation: University of North Carolina (UNC) Department of Medicine, Chapel Hill, NC, United States; UNC, Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC, United States.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Jonas
authors.affiliation: UNC Department of Psychiatry, Chapel Hill, NC, United States.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Forneris
authors.affiliation: UNC, Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC, United States.
authors.forename: Candi
authors.initials: C
authors.lastname: Wines
authors.affiliation: UNC Department of Social Medicine, Chapel Hill, NC, United States; UNC Department of Family Medicine, Chapel Hill, NC, United States.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Sonis
authors.affiliation: UNC, Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC, United States.
authors.forename: Jennifer Cook
authors.initials: JC
authors.lastname: Middleton
authors.affiliation: University of North Carolina (UNC) Department of Medicine, Chapel Hill, NC, United States; UNC, Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC, United States.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Feltner
authors.affiliation: UNC Department of Psychiatry, Chapel Hill, NC, United States.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Brownley
authors.affiliation: Triangle Institute (RTI) International, Research Triangle Park, NC, United States.
authors.forename: Kristine Rae
authors.initials: KR
authors.lastname: Olmsted
authors.affiliation: Triangle Institute (RTI) International, Research Triangle Park, NC, United States.
authors.forename: Amy
authors.initials: A
authors.lastname: Greenblatt
authors.affiliation: University of North Carolina (UNC) Department of Medicine, Chapel Hill, NC, United States.
authors.forename: Amy
authors.initials: A
authors.lastname: Weil
authors.affiliation: UNC, Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC, United States; UNC Department of Psychiatry, Chapel Hill, NC, United States.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Gaynes
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods / Q000706:statistics & numerical data*; D057169:Eye Movement Desensitization Reprocessing / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007171:Implosive Therapy / Q000379:methods / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*
keywords: Meta-analysis; PTSD; Psychotherapy