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What Works Best for Posttraumatic Stress – A Fresh Meta-Analysis

11 Sep

This study may be an indirect chide to the research community for continuing to lean toward studies on the effectiveness of exposure therapy and CBT for PTS when EMDR (eye movement desensitization & reprocessing) may perform even better.
In a review and meta-analysis out of Sao Paolo, Brazil, investigators compared cognitive-behavioral therapy (CBT) to cognitive therapy (CT) and exposure therapy (ET) for the treatment of posttraumatic stress (PTSD).

Studies were gathered from the Cochrane, Embase and Medline databases. Studies were required to be randomized controlled trials (RCT’s), published between 2006 and 2012, comparing CBT, CT, or ET with (1) each other, (2) other active treatments (e.g., EMDR, counseling, supportive therapy), or (3) assessment-only or wait list conditions. The main outcome measures were diagnostic changes and symptomatic remission.

The final sample contained 29 articles.  CBT, CT, and ET were each shown to be efficacious treatments when compared to wait list/no treatment conditions, and no differences were found between these methods.

Comparison with other active treatments favored exposure therapy.  Both studies that compared CBT and EMDR (eye movement desensitization and reprocessing) favored the EMDR.

The analysis concludes that CBT and its components still appear to be equally efficacious in improving PTSD symptoms and diagnosis.  Even so, there is a tendency for researchers to focus on exposure therapy. Additionally, EMDR shows promising results when compared to CBT.  Further research should clarify the lasting effects, efficiency, and other comparative benefits of each protocol..

Citation: Mello PG, Silva GR, Donat JC, Kristensen CH. An update on the efficacy of cognitive-behavioral therapy, cognitive therapy, and exposure therapy for posttraumatic stress disorder. International Journal of Psychiatry in Medicine. 2013;46 (4):pages 339-57.

Belleruth Naparstek

Psychotherapist, author and guided imagery pioneer Belleruth Naparstek is the creator of the popular Health Journeys guided imagery audio series. Her latest book on imagery and posttraumatic stress, Invisible Heroes: Survivors of Trauma and How They Heal (Bantam Dell), won the Spirituality & Health Top 50 Books Award.