Two trauma-focused therapies, cognitive processing therapy (CPT) and prolonged exposure were found to be the most frequently studied psychotherapies for military-related PTSD. Five RCTs of CPT (481 patients) and 4 RCTs of prolonged exposure (402 patients) met the inclusion criteria.
Focusing on intent-to-treat outcomes, within-group post-treatment effect sizes for CPT and prolonged exposure were large (Cohen d range, 0.78-1.10). CPT and prolonged exposure also outperformed waitlist and treatment-as-usual control conditions.
Forty-nine percent to 70% of participants receiving CPT and prolonged exposure attained clinically meaningful symptom improvement (defined as a 10- to 12-point decrease in interviewer-assessed or self-reported symptoms).
However, mean post-treatment scores for CPT and prolonged exposure remained at or above clinical criteria for PTSD, and approximately two-thirds of patients receiving CPT or prolonged exposure retained their PTSD diagnosis after treatment (range, 60%-72%).
CPT and prolonged exposure were marginally superior compared with non-trauma-focused psychotherapy comparison conditions.
The meta-analysis concludes that in military and veteran populations, trials of the first-line trauma-focused interventions CPT and prolonged exposure have shown clinically meaningful improvements for many patients with PTSD.
However, non-response rates have been high, many patients continue to have symptoms, and trauma-focused interventions show only marginally superior results compared with active control conditions.
The investigators conclude that there is a need for improvement in existing PTSD treatments and for the development and testing of novel evidence-based treatments, both trauma-focused and non-trauma-focused
Citation: Steenkamp MM1, Litz BT2, Hoge CW3, Marmar CR1. Psychotherapy for Military-Related PTSD: A Review of Randomized Clinical Trials. JAMA. 2015 Aug 4;314 (5): pp. 489-500. doi: 10.1001/jama.2015.8370.
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