Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis.
- Karatzias T Edinburgh Napier University, School of Health & Social Care,Edinburgh,UK.
- Murphy P Edinburgh Napier University, School of Health & Social Care,Edinburgh,UK.
- Cloitre M Department of Psychiatry and Behavioral Sciences,Stanford University,California,USA.
- Bisson J Cardiff University, School of Medicine,Cardiff,UK.
- Roberts N Cardiff University, School of Medicine,Cardiff,UK.
- Shevlin M Ulster University, School of Psychology,Derry,UK.
- Hyland P National College of Ireland, School of Business,Dublin,Ireland.
- Maercker A Department of Psychology, Psychopathology and Clinical Interventions,University of Zurich,Zurich,Switzerland.
- Ben-Ezra M School of Social Work, Ariel University,Ariel,Israel.
- Coventry P Department of Health Sciences and Centre for Reviews and Dissemination,University of York,York,UK.
- Mason-Roberts S Edinburgh Napier University, School of Health & Social Care,Edinburgh,UK.
- Bradley A Edinburgh Napier University, School of Health & Social Care,Edinburgh,UK.
- Hutton P Edinburgh Napier University, School of Health & Social Care,Edinburgh,UK.
- 2019-03-13
Published in:
- Psychological medicine. - 2019
CPTSD
Childhood trauma
meta-analysis
psychological therapies
randomised controlled trials
systematic review
Cognitive Behavioral Therapy
Eye Movement Desensitization Reprocessing
Humans
Implosive Therapy
International Classification of Diseases
Randomized Controlled Trials as Topic
Stress Disorders, Post-Traumatic
English
BACKGROUND
The 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions.
METHODS
We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality.
RESULTS
Fifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = -0.90 (CBT; k = 27, 95% CI -1.11 to -0.68; moderate quality) to g = -1.26 (EMDR; k = 4, 95% CI -2.01 to -0.51; low quality). CBT and EA each had moderate-large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate-large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome.
CONCLUSIONS
The development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.
The 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions.
METHODS
We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality.
RESULTS
Fifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = -0.90 (CBT; k = 27, 95% CI -1.11 to -0.68; moderate quality) to g = -1.26 (EMDR; k = 4, 95% CI -2.01 to -0.51; low quality). CBT and EA each had moderate-large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate-large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome.
CONCLUSIONS
The development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1017/S0033291719000436
- PMID 30857567
- Persistent URL
- https://folia.unifr.ch/global/documents/128596
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