Long-term outcomes of psychological treatment for posttraumatic stress disorder: a systematic review and meta-analysis.

Maxi Weber,Annett Lotzin,Birgit Kleim,Thomas Ehring,Jürgen Barth,Sarah Schumacher,Ingo Schäfer,Wiebke Hannig

doi:10.1017/s003329172100163x

Abstract

Several types of psychological treatment for posttraumatic stress disorder (PTSD) are considered well established and effective, but evidence of their long-term efficacy is limited. This systematic review and meta-analysis aimed to investigate the long-term outcomes across psychological treatments for PTSD. MEDLINE, Cochrane Library, PTSDpubs, PsycINFO, PSYNDEX, and related articles were searched for randomized controlled trials with at least 12 months of follow-up. Twenty-two studies (N = 2638) met inclusion criteria, and 43 comparisons of cognitive behavioral therapy (CBT) were available at follow-up. Active treatments for PTSD yielded large effect sizes from pretest to follow-up and a small controlled effect size compared with non-directive control groups at follow-up. Trauma-focused treatment (TFT) and non-TFT showed large improvements from pretest to follow-up, and effect sizes did not significantly differ from each other. Active treatments for comorbid depressive symptoms revealed small to medium effect sizes at follow-up, and improved PTSD and depressive symptoms remained stable from treatment end to follow-up. Military personnel, low proportion of female patients, and self-rated PTSD measures were associated with decreased effect sizes for PTSD at follow-up. The findings suggest that CBT for PTSD is efficacious in the long term. Future studies are needed to determine the lasting efficacy of other psychological treatments and to confirm benefits beyond 12-month follow-up.

Highlights

Posttraumatic stress disorder (PTSD) is a highly prevalent and chronic mental disorder (Kessler et al, 2017), associated with personal (Schnurr, Lunney, Bovin, & Marx, 2009) and societal costs (McGowan, 2019)
We examined whether (1) psychological treatment differed from control groups and whether (2) Trauma-focused treatment (TFT) differed from non-TFT in posttraumatic stress disorder (PTSD) severity and comorbid depressive symptoms at long-term follow-up
Note. 95% CI = 95% confidence intervals, g = Hedges’ g, k = number of comparisons, PTSD = posttraumatic stress disorder, TFT = trauma-focused treatment. ap-value of Hedges’ g. bp-value of Q-statistics

Summary

Introduction

Posttraumatic stress disorder (PTSD) is a highly prevalent and chronic mental disorder (Kessler et al, 2017), associated with personal (Schnurr, Lunney, Bovin, & Marx, 2009) and societal costs (McGowan, 2019). Trauma-focused treatment (TFT) mainly focusses on processing the individual’s memory of the trauma and/or its meaning. Trauma-focused cognitive behavioral therapy (TF-CBT) typically incorporate psychoeducation, homework, relaxation, and cognitive and/or behavioral-based components (e.g. cognitive therapy, Ehlers & Clark, 2000; cognitive processing therapy, Resick & Schnicke, 1992; prolonged exposure, Foa & Rothbaum, 1998; Foa, Hembree, & Rothbaum, 2007; narrative exposure therapy, Schauer, Neuner, & Elbert, 2011). Techniques of non-TF-CBT comprise, inter alia, anxiety management, relaxation, stress management, social skills training, positive thinking, assertiveness training, or thought stopping

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