Comparative efficacy of treatments for post‐traumatic stress disorder: a meta‐analysis

Abstract

A meta-analysis was conducted on 61 treatment outcome trials for posttraumatic stress disorder (PTSD). Conditions included drug therapies (TCAs, carbamazepine, MAOIs, SSRIs, and BDZs), psychological therapies (behaviour therapy, Eye-Movement Desensitization and Reprocessing (EMDR), relaxation training, hypnotherapy, and dynamic therapy), and control conditions (pill placebo, wait-list controls, supportive psychotherapies, and non-saccade EMDR control). Psychological therapies had significantly lower drop-out rates than pharmacotherapies (14% versus 32%), with attrition being uniformly low across all psychological therapies. In terms of symptom reduction, psychological therapies were more effective than drug therapies, and both were more effective than controls. Among the drug therapies, the SSRIs and carbamazepine had the greatest effect sizes, although the latter was based upon a single trial. Among the psychological therapies, behaviour therapy and EMDR were most effective, and generally equally so. The most effective psychological therapies and drug therapies were generally equally effective. Differences across treatment conditions were generally evident across symptom domains, with little matching of symptom domain to treatment type. However, SSRIs had some advantage over psychological therapies in treating depression. Follow-up results were not available for most treatments, but available data indicates that treatment effects for behaviour therapy and EMDR are maintained at 15-week follow-up.

Post-traumatic stress disorder: A review of recent findings

“…This is supported by a meta-analytic study of methodologically sound psychotherapies that showed exposure therapy to yield better outcomes (larger mean effect size) than EMDR at follow-up [77]. An earlier metaanalysis that compared medications with psychotherapies (61 studies in total), showed psychotherapies (particularly CBT and EMDR) to have the largest effect size, followed by medications, and then control conditions [78]. Among the medications, SSRIs demonstrated greatest efficacy.…”

Alterations in autonomic tone during trauma exposure using eye movement desensitization and reprocessing (EMDR)—Results of a preliminary investigation

“…Sets of dual attention stimulation are repeated until distress is reduced. Clinical efficacy in the treatment of post-traumatic stress disorder (PTSD) has been demonstrated in several controlled studies (Bradley, Greene, Russ, Dutra, & Westen, 2005;Servan-Schreiber, Schooler, Dew, Carter, & Bartone, 2006;Van Etten & Taylor, 1998;van der Kolk et al, 2007); consequently, EMDR has been recommended as an effective treatment for PTSD (American Psychiatric Association, 2004;CREST, 2003;Foa, Keane, & Friedman, 2000).…”

After the Assault: Cognitive Trauma Therapy with a Single Event Trauma Survivor

“…Many different theoretical frameworks have been studied regarding PTSD, and several meta-analytic reviews point to the efficacy of cognitive approaches with assault survivors (Bradley et al 2005;Stapleton et al 2007;Van Etten and Taylor 1998). The most effective approaches for treating PTSD include psychodynamic psychotherapy, cognitive-behavioral, and combinations of these and other adjunctive treatments, such as eye movement desensitization and reprocessing (EMDR; Foa and Meadows 1997;Follette et al 1998;Foy 1992;Friedman et al 2000;Rothbaum et al 2000;Stapleton et al).…”