Trauma-focused psychotherapies for post-traumatic stress disorder: A systematic review and network meta-analysis.

Jericho, B; Luo, A; Berle, D

Trauma-focused psychotherapies for post-traumatic stress disorder: A systematic review and network meta-analysis.

Jericho, B Luo, A Berle, D

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Publisher:: Wiley
Publication Type:: Journal Article
Citation:: Acta psychiatrica Scandinavica, 2021
Issue Date:: 2021-09-02

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Field	Value	Language
dc.contributor.author	Jericho, B
dc.contributor.author	Luo, A
dc.contributor.author	Berle, D https://orcid.org/0000-0002-4861-2220
dc.date.accessioned	2021-10-11T05:53:38Z
dc.date.available	2021-08-29
dc.date.available	2021-10-11T05:53:38Z
dc.date.issued	2021-09-02
dc.identifier.citation	Acta psychiatrica Scandinavica, 2021
dc.identifier.issn	0001-690X
dc.identifier.issn	1600-0447
dc.identifier.uri	http://hdl.handle.net/10453/151003
dc.description.abstract	<h4>Introduction</h4>Meta-analytic reviews suggest similar outcomes across trauma-focused psychotherapies for adults with post-traumatic stress disorder (PTSD). However, this conclusion may be premature due to suboptimal statistical-review methodologies. Network meta-analysis (NMA) allows a detailed rank-ordering of the efficacy of established psychotherapy interventions derived from indirect evidence as well as results from direct head-to-head comparisons.<h4>Objective</h4>We sought to determine the efficacy and attrition rates of psychotherapy interventions for PTSD by applying NMA.<h4>Methods</h4>We searched EMBASE, PsychINFO, PTSDPubs and PubMed for randomised controlled trials that compared psychotherapies either head-to-head or against controls for adults with PTSD. A frequentist NMA was used to compare direct and indirect effects to determine the efficacy and attrition rates of psychotherapy interventions.<h4>Results</h4>Of the 5649 papers identified, 82 trials comprising of 5838 patients were included. The network comprised 17 psychotherapies and four control conditions. Network estimates indicated superior efficacy of meta-cognitive therapy and cognitive processing therapy over other psychotherapies (ESs between = 0.26 and 2.32). Written exposure therapy and narrative exposure therapy were associated with lower risk of drop out when considered alongside other psychotherapies. Confidence in the network meta-analytic estimates was considered moderate for both outcomes.<h4>Conclusions</h4>In broad terms, therapeutic commensurability was evident. Nevertheless, with additional studies and larger sample sizes, meta-cognitive and written exposure therapies could indeed differentiate themselves from other approaches as having favourable efficacy and acceptability respectively. These findings may inform clinical decision-making, as well as guide future research for PTSD.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Wiley
dc.relation.ispartof	Acta psychiatrica Scandinavica
dc.relation.isbasedon	10.1111/acps.13366
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	11 Medical and Health Sciences, 17 Psychology and Cognitive Sciences
dc.subject.classification	Psychiatry
dc.title	Trauma-focused psychotherapies for post-traumatic stress disorder: A systematic review and network meta-analysis.
dc.type	Journal Article
utslib.location.activity	United States
utslib.for	11 Medical and Health Sciences
utslib.for	17 Psychology and Cognitive Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Graduate School of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Graduate School of Health/GSH.Clinical Psychology
utslib.copyright.status	open_access	*
dc.date.updated	2021-10-11T05:53:37Z
pubs.publication-status	Published

Abstract:

Introduction

Meta-analytic reviews suggest similar outcomes across trauma-focused psychotherapies for adults with post-traumatic stress disorder (PTSD). However, this conclusion may be premature due to suboptimal statistical-review methodologies. Network meta-analysis (NMA) allows a detailed rank-ordering of the efficacy of established psychotherapy interventions derived from indirect evidence as well as results from direct head-to-head comparisons.

Objective

We sought to determine the efficacy and attrition rates of psychotherapy interventions for PTSD by applying NMA.

Methods

We searched EMBASE, PsychINFO, PTSDPubs and PubMed for randomised controlled trials that compared psychotherapies either head-to-head or against controls for adults with PTSD. A frequentist NMA was used to compare direct and indirect effects to determine the efficacy and attrition rates of psychotherapy interventions.

Results

Of the 5649 papers identified, 82 trials comprising of 5838 patients were included. The network comprised 17 psychotherapies and four control conditions. Network estimates indicated superior efficacy of meta-cognitive therapy and cognitive processing therapy over other psychotherapies (ESs between = 0.26 and 2.32). Written exposure therapy and narrative exposure therapy were associated with lower risk of drop out when considered alongside other psychotherapies. Confidence in the network meta-analytic estimates was considered moderate for both outcomes.

Conclusions

In broad terms, therapeutic commensurability was evident. Nevertheless, with additional studies and larger sample sizes, meta-cognitive and written exposure therapies could indeed differentiate themselves from other approaches as having favourable efficacy and acceptability respectively. These findings may inform clinical decision-making, as well as guide future research for PTSD.

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http://hdl.handle.net/10453/151003