A Cochrane review [Abstract] 1 included 70 studies with a total of 4761 participants. Studies included individuals traumatised by combat (n=13), sexual assault (n=13), war/persecution (n=6), road traffic accidents (n=4), earthquake (n=3), childhood sexual abuse (n=3) and political detainment, terrorism, sexual or physical assault and serving in the police force one study in each. The remainder of the studies included individuals traumatised by various traumatic events (n=24). All studies included individuals at least 3 months after the trauma, but the range was large, from 3 months to over 40 years. The treatment methods in studies were were individual TFCBT (n=49) , non-TFCBT (n=8), eye movement desensitisation and reprocessing (n=16), group TFCBT (n=10), group non-TFCBT (n=1) and other therapies (n=9: supportive counselling, present-centred therapy, hypnotherapy and psychodynamic therapy). The included trials comparedpsychological therapy vs. waitlist or usual care control and psychological therapy vs. other psychological therapy. The first primary outcome was reduction in the severity of post-traumatic stress disorder (PTSD) symptoms, using a standardised measure rated by a clinician. For this outcome, individual trauma-focused cognitive behavioural therapy (TFCBT) and eye movement desensitisation and reprocessing (EMDR) were more effective than waitlist/usual care (SMD -1.62; 95% CI -2.03 to -1.21; 28 studies; n = 1256 and SMD -1.17; 95% CI -2.04 to -0.30; 6 studies; n = 183, respectively). There was no statistically significant difference between individual TFCBT and EMDR immediately post-treatment although there was some evidence that individual TFCBT and EMDR were superior to non-TFCBT at follow-up, and that individual TFCBT, EMDR and non-TFCBT were more effective than other therapies. Non-TFCBT was more effective than waitlist/usual care and other therapies (SMD -1.22, -1.76 to -0.69; 4 trials, n=106). Other therapies were superior to waitlist/usual care control as was group TFCBT. There was some evidence of greater drop-out (the second primary outcome for this review) in active treatment groups.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment, high drop-out rate) and inconsistency (hetrogeneity in patients and interventions).
Primary/Secondary Keywords