The impact of trauma‐focused psychotherapy for posttraumatic stress disorder on interpersonal functioning: A systematic review and meta‐analysis of randomized clinical trials

Abstract

Interpersonal functioning is a common concern for people with postttraumatic stress disorder (PTSD) but is not a key target of most trauma‐focused psychotherapies (TFPs). We preregistered and undertook a systematic review and meta‐analysis of randomized clinical trials (RCTs) examining the efficacy of TFPs for improving interpersonal functioning. Studies were identified through the PTSD Trials Standardized Data Repository, scholarly databases, and the solicitation of unpublished data from the PTSD research community following current PRISMA guidelines. We used random effects meta‐analysis to estimate within‐group change (i.e., pre‐ to posttreatment) in interpersonal functioning. Meta‐analytic findings yielded a medium total effect of TFP on interpersonal functioning, g = 0.54, 95% CI [0.37, 0.72], with high between‐study heterogeneity. Sensitivity analyses yielded substantively equivalent point estimates when outliers were excluded, g = 0.55, and when only the most well‐established individual TFPs were included, g = 0.57. In contrast, allocation to a control condition was associated with little average change in interpersonal functioning, g = 0.04 [‐0.12, 0.21]. Formal tests did not yield clear evidence of publication bias. Bias‐corrected estimates varied but centered around a medium effect, gs = 0.41–1.11. There was a medium‐to‐large association between change in interpersonal functioning and change in PTSD symptoms, rs = ‐.35–‐.44. The extant literature on TFPs and interpersonal functioning is small and heterogeneous, indicating the need for more focused attention on this outcome. Results suggest that, on average, TFPs are moderately efficacious for improving interpersonal functioning; however, additional treatment may be needed to meet the desired level of improvement

A systematic review and meta-analysis of predictors of response to trauma-focused psychotherapy for posttraumatic stress disorder.

“…To this end, a more comprehensive definition of treatment response is encouraged in future reviews (e.g., specific functional impairment outcomes) such that the true burden of this condition is more appropriately captured. This need is underscored by recent evidence which suggests that T-F psychotherapy may confer moderate gains in a range of functioning factors (Bonfils et al, 2022; Swerdlow et al, 2023), highlighting a need for more focused attention to functional outcomes of treatment rather than focusing only on symptom reduction. Sixth, trials that combined T-F and non-T-F conditions in observed predictor analyses were excluded as our research question focused on the role of predictors of T-F psychotherapy.…”

Introduction to the special section on social relationships and posttraumatic stress disorder treatment: Harnessing the power of significant relationships

“…A limitation of the studies presented here is an overreliance on particular types of dyads: The study samples overwhelmingly included male veterans or SMs and their female civilian romantic partners, and participants were overwhelmingly White. Important exceptions to this general rule include the meta‐analysis by Swerdlow and colleagues (2023), which took a broader measure of changes in interpersonal functioning rather than limiting their analysis to romantic relationships; the Lewis et al. (2023) sample, which consisted of civilians rather than military personnel; and the Howard et al.…”

Trauma-informed parenting intervention for veterans: A preliminary uncontrolled trial of Strength at Home–Parents.

“…These difficulties are an important and potentially modifiable intergenerational pathway through which parental trauma and psychopathology lead to negative child outcomes (Castro-Vale et al, 2020; Leen-Feldner et al, 2013; Roberts et al, 2012). Interpersonal difficulties appear to be reciprocally related to PTSD symptoms over time and can persist even when PTSD symptoms decrease (Lord et al, 2020; Swerdlow et al, 2023). This suggests a need for targeted and trauma-informed interventions to address interpersonal difficulties.…”