Psychological treatment of post-traumatic stress disorder (PTSD)

 

Characteristics of included studies [ordered by study ID]

Blanchard 2003

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Methods	Randomised controlled trial - bias possible
Participants	98 road traffic accident survivors
Interventions	8-12 sessions TFCBT vs 8-12 sessions supportive psychotherapy vs waiting list
Outcomes	APS, IES,STAI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Blanchard 2003b

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Methods	Randomised controlled trial -bias possible
Participants	98 road traffic accident survivors
Interventions	8-12 sessions TFCBT vs 8-12 sessions supportive psychotherapy vs waiting list
Outcomes	APS, IES,STAI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Brom 1989

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Methods	Randomised controlled trial -bias possible
Participants	112 outpatients. Various traumas, 89 bereaved.
Interventions	14-18 sessions of trauma desensitisatrion, hypnotherapy, psychodynamic therapy or waiting list
Outcomes	"trauma symptoms" on SCL-90, STAI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Bryant 2003

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Methods	Randomised controlled trial - no bias likely
Participants	58 outpatient survivors of non-sexual assaults or road traffic accidents.
Interventions	8 weekly 90 minute sessions of imaginal exposure, imaginal exposure/cognitive restructuring or supportive counselling.
Outcomes	CAPS, IES, STAI, BDI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Carlson 1998

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Methods	Randomised controlled trial - bias possible
Participants	35 males with combat-related PTSD
Interventions	12 bi-weekly sessions of 60-75 minutes EMDR versus 40 minutes biofeedback assisted relaxation versus routine care
Outcomes	Mississippi PTSD scale, IES, STAI, BDI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Classen 2001

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Methods	Randomised controlled trial -bias possible
Participants	52 female child sexual abuse survivors
Interventions	24 ninety minute sessions of trauma-focused or present-focused group therapy vs wait list
Outcomes	TSC-40
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Cloitre 2002

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Methods	Randomised controlled trial -bias possible
Participants	58 female child sexual abuse survivors
Interventions	16 biweekly sessions of 1.5 hours of prolonged exposure and affect regulation versus waiting list
Outcomes	CAPS, BDI, STAI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Cooper 1989

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Methods	Randomised controlled trial
Participants	16 Vietnam veterans. All DSMIIIPTSD
Interventions	6-14 90 minute flooding sessions plus standard treatment versus standard treatment
Outcomes	STAI, BDI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	No	C - Inadequate

---

Devilly 1999

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Methods	Randomised controlled trial
Participants	35 combat veterans with PTSD
Interventions	12 sessions of EMDR versus biofeedback-assisted relaxation versus routine clinical care
Outcomes	Mississippi scale, PTSD symptom scale, IES, STAI, BDI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	D - Not used

---

Echeburua 1997

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Methods	Randomised controlled trial
Participants	20 female sexual aggression survivors
Interventions	6 weekly sessions of graded self-exposure versus relaxation therapy
Outcomes	Global PTSD scale, STAI, BDI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Ehlers 2003

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Methods	Randomised controlled trial - bias possible
Participants	28 survivors of various adulthood discrete traumas. All DSMIV PTSD.
Interventions	Up to 12 weekly trauma focused cognitive therapy sessions versus wait list control.
Outcomes	CAPS, BDI, BAI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Fecteau 1999

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Methods	Randomised controlled trial - bias possible
Participants	Road traffic accidents
Interventions	8-10 hours CBT versus wait list
Outcomes	CAPS, IES, BDI, BAI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	No	C - Inadequate

---

Foa 1991

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Methods	Randomised controlled trial - bias possible
Participants	45 female rape victims. All DSMIIIR PTSD
Interventions	9 1.5 hour sessions of prolonged exposure versus stress innoculation training versus supportive counselling versus waiting list control
Outcomes	PTSD severity, BDI, STAI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	No	C - Inadequate

---

Foa 1991b

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Methods	Randomised controlled trial - bias possible
Participants	45 female rape victims. All DSMIIIR PTSD
Interventions	9 1.5 hour sessions of prolonged exposure versus stress innoculation training versus supportive counselling versus waiting list control
Outcomes	PTSD severity, BDI, STAI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	No	C - Inadequate

---

Foa 1991c

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Methods	Randomised controlled trial -bias possible
Participants	45 female rape victims. All DSMIIIR PTSD
Interventions	9 1.5 hour sessions of prolonged exposure versus stress innoculation training versus supportive counselling versus waiting list control
Outcomes	PTSD severity, BDI, STAI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	No	C - Inadequate

---

Foa 1999

---

Methods	Randomised controlled trial - bias possible
Participants	96 female sexual assault victims (69 sexual assault)
Interventions	9 sessions (2 x 2 hours, 7 x 1.5 hours) prolonged exposure versus stress innoculation training versus combination PIE-SIT versus waiting list
Outcomes	PSS-I, BDI, STAI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	No	C - Inadequate

---

Foa 1999b

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Methods	Randomised controlled trial - bias possible
Participants	96 female sexual assault victims (69 sexual assault)
Interventions	9 sessions (2 x 2 hours, 7 x 1.5 hours) prolonged exposure versus stress innoculation training versus combination PIE-SIT versus waiting list
Outcomes	PSS-I, BDI, STAI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	No	C - Inadequate

---

Gersons 2000

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Methods	Randomised controlled trial -bias possible
Participants	42 police officers. DSMIIIR PTSD. Various workplace traumas.
Interventions	16x60 minute sessions of brief eclectic therapy
Outcomes	SI-PTSD, SCL-90
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Ironson 2002

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Methods	Randomised controlled tiral - bias possible
Participants	22 victims of various traumas with DSMIIIR PTSD
Interventions	3 preparatory sessions fby 1-3 sessions of EMDR or prolonged exposure
Outcomes	PSS-SR, BDI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	D - Not used

---

Jensen 1994

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Methods	Randomised controlled trial - bias possible
Participants	25 vietnam veterans with PTSD
Interventions	3 sessions of EMDR usually within 10 days or usual care
Outcomes	SI-PTSD
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	D - Not used

---

Keane 1989

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Methods	Randomised controlled trial -bias possible
Participants	24 Vietnam veterans. DSMIIIR PTSD
Interventions	14-16 sessions implosive (flooding) versus waiting list control
Outcomes	MMPI - PTSD subscale, BDI, STAI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Krakow 2001

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Methods	Randomised controlled trial - no bias likely
Participants	169 female sexual assault survivors. 95% DSMIIIR PTSD
Interventions	2x3 hours and 1x1 hour sessions of group imagery rehearsal versus waiting list.
Outcomes	PSS
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	No	C - Inadequate

---

Kubany 2003

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Methods	Randomised controlled trial - bias possible
Participants	42 female survivors of assault.
Interventions	8-11 biweekly 90 minute sessions of cognitive trauma therapy vs wait list
Outcomes	CAPS, BDI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	No	C - Inadequate

---

Kubany 2004

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Methods	Randomised controlled trial -bias possible
Participants	85 female survivors of assault
Interventions	8-11 biweekly 90 minute sessions of cognitive trauma therapy vs wait list
Outcomes	CAPS, BDI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Lee 2002

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Methods	Randomised controlled trial - bias possible
Participants	24 DSMIV PTSD sufferers from various traumas
Interventions	Seven weekly 90 minute sessions of stress innoculation training with prolonged exposure versus EMDR
Outcomes	SI-PTSD, IES, BDI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	D - Not used

---

Marcus 1997/2004

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Methods	Randomised controlled trial - bias possible
Participants	67 DSMIIIR PTSD. Various traumas.
Interventions	Variable number of 50 minute sessions of EMDR versus standard care
Outcomes	IES, MPTSD, BDI, STAI, SCL-90
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	D - Not used

---

Marks 1998

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Methods	Randomised controlled trial - no bias likely
Participants	87 DSMIIIR PTSD. Various traumas
Interventions	10 x 90 minute sessions of exposure vs cognitive restructuring vs exposure and cognitive restructuring vs relaxation therapy
Outcomes	CAPS, IES, BDI, STAI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Neuner 2004

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Methods	Randomised controlled trial - bias possible
Participants	43 Sudanese refugees. All diagnosed with PTSD.
Interventions	4 sessions of narrative exposure therapy versus 4 sessions of supportive counselling versus one session of psychoeducation
Outcomes	PDS
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	No	C - Inadequate

---

Peniston 1991

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Methods	Randomised controlled trial - bias possible
Participants	16 Vietnam combat veterans with DSMIII PTSD.
Interventions	48 x 30 minute sessions of EMG assisted desensitisation vs no treatment
Outcomes	nightmare and flashback frequency
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Power 2002

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Methods	Randomised controlled trial - bias possible
Participants	105 outpatients with DSMIV PTSD. Various traumas.
Interventions	10 x 90 minute weekly sessions of EMDR versus exposure plus cognitive restructuring versus wait list.
Outcomes	CAPS, HAM-A, MADRS
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	A - Adequate

---

Resick 2002

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Methods	Randomised controlled trial - no bias likely
Participants	121 female rape victims with DSMIV PTSD
Interventions	13 hours of cognitive processing therapy or exposure biweekly over six weeks versus minimal attention.
Outcomes	CAPS, PSS, BDI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Resick 2002b

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Methods	Randomised controlled trial - no bias likely
Participants	121 female rape victims with DSMIV PTSD
Interventions	13 hours of cognitive processing therapy or exposure biweekly over six weeks versus minimal attention.
Outcomes	CAPS, PSS, BDI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Rothbaum

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Methods	Randomised controlled trial - no bias likely
Participants	74 female rape victims with DSMIV PTSD
Interventions	Nine bi-weekly 90 minute sessions of PE or EMDR versus wait list
Outcomes	CAPS, IES, PSS, STAIS, STAIT, BDI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Rothbaum 1997

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Methods	Randomised controlled trial - bias possible
Participants	21 female sexual assault victims with DSMIIIR PTSD
Interventions	3 weekly 90 minute sessions of EMDR versus wait list control
Outcomes	PSS, IES, BDI, STAI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	D - Not used

---

Scheck 1998

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Methods	Randomised controlled trial - no bias likely
Participants	60 16-25 year old female victims of various traumas. 77% DSMIV PTSD
Interventions	Two usually weekly sessions of EMDR versus active listening
Outcomes
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	D - Not used

---

Schnurr 2003

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Methods	Randomised controlled trial - no bias likely
Participants	360 male Vietnam veterans with DSMIV PTSD
Interventions	Weekly present-focused group CBT for 30 weeks versus weekly trauma-ficused CBT group therapy for 30 weeks.
Outcomes	CAPS, GHQ, SF36
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Taylor 2003

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Methods	Randomised controlled trial - bias possible
Participants	60 outpatients. Various traumas. DSMIV PTSD.
Interventions	8 ninety minute sessions of exposure therapy, EMDR or relaxation training.
Outcomes	CAPS, PDS, BDI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Vaughan 1994

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Methods	Randomised controlled trial - no bias likely
Participants	36 various traumas. 78% DSMIIIR PTSD.
Interventions	3-5 50 minute sessions of image habituation training, EMDR or applied muscular relaxation versus waiting list
Outcomes	PTSD structured interview, IES, STAI, BDI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Vaughan 1994b

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Methods	Randomised controlled trial - no bias likely
Participants	36 various traumas. 78% DSMIIIR PTSD.
Interventions	3-5 50 minute sessions of image habituation training, EMDR or applied muscular relaxation versus waiting list
Outcomes	PTSD structured interview, IES, STAI, BDI
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Vaughan 1994c

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Methods	Randomised controlled trial - no bias likely
Participants	36 various traumas. 78% DSMIIIR PTSD.
Interventions
Outcomes
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	D - Not used

---

Zlotnick 1997

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Methods	Randomised controlled trial - bias possible
Participants	48 female sexual abuse survivors. All DSMIIIR PTSD.
Interventions	15 2-hour sessions of group affective management versus waiting list control
Outcomes	DTS
Notes	medication and individual psychological treatment continued during study
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

 

Characteristics of excluded studies [ordered by study ID]

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Study	Reason for exclusion
Chemtob 1997	Treatment designed for anger versus PTSD with anger measures used as primary outcomes
Echeburua 1996	Trauma < 3 months before entry into study
Frank 1988	Not a true RCT
Gidron 1996	Not psychological treatment
Lange 2003	No formal diagnosis of PTSD made
Paunovic 2001	TFCBT vs TFCBT
Shapiro 1988	Absence of standardised traumatic stress measures
Tarrier 1999	Compared trauma focused cognitve therpay with exposure therapy therefore both treatments = TFCBT.
Watson 1997	Considered three different types of relaxation training with no other comparison group
Wilson 1995	< 50% PTSD at entry to study

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Comparison 1. Trauma Focused CBT/ Exposure Therapy vs Waitlist/Usual Care

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Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Severity of PTSD symptoms

16

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

---

1.1 Clinician

14

649

Std. Mean Difference (IV, Random, 95% CI)

-1.40 [-1.89, -0.91]

---

1.2 Self-report

9

428

Std. Mean Difference (IV, Random, 95% CI)

-1.68 [-2.14, -1.22]

---

1.3 Clinician PTSD severity higher quality studies only (sensitivity analysis)

9

493

Std. Mean Difference (IV, Random, 95% CI)

-1.61 [-2.16, -1.06]

---

1.4 Clinician PTSD severity lower quality studies only (sensitivity analysis)

5

156

Std. Mean Difference (IV, Random, 95% CI)

-1.02 [-1.84, -0.20]

---

1.5 Clinician PTSD severity female only studies (subgroup analysis)

7

404

Std. Mean Difference (IV, Random, 95% CI)

-1.94 [-2.53, -1.34]

---

1.6 Clinician PTSD severity non-veteran studies (subgroup analysis)

13

625

Std. Mean Difference (IV, Random, 95% CI)

-1.49 [-1.99, -0.99]

---

1.7 Clinician PTSD severity mixed gender studies (subgroup analyses)

7

245

Std. Mean Difference (IV, Random, 95% CI)

-0.83 [-1.26, -0.41]

---

 2 Depression

14

625

Std. Mean Difference (IV, Random, 95% CI)

-1.26 [-1.69, -0.82]

---

 3 Anxiety

11

Std. Mean Difference (IV, Fixed, 95% CI)

Subtotals only

---

3.1 Self report

11

415

Std. Mean Difference (IV, Fixed, 95% CI)

-0.99 [-1.20, -0.78]

---

 4 Leaving the study early due to any reason

15

861

Risk Ratio (M-H, Fixed, 95% CI)

1.42 [1.05, 1.94]

---

 5 PTSD diagnosis after treatment

15

756

Risk Ratio (M-H, Random, 95% CI)

0.45 [0.35, 0.58]

---

 

Comparison 2. Stress Management Therapy vs Waitlist/Usual Care

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Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Severity of PTSD symptoms - Clinician

3

Std. Mean Difference (IV, Fixed, 95% CI)

Subtotals only

---

1.1 Clinician

3

86

Std. Mean Difference (IV, Fixed, 95% CI)

-1.14 [-1.62, -0.67]

---

 2 Severity of PTSD symptoms - Self-report

1

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

---

2.2 Self-report

1

24

Std. Mean Difference (IV, Random, 95% CI)

0.33 [-0.47, 1.14]

---

 3 Depression

4

109

Std. Mean Difference (IV, Fixed, 95% CI)

-0.73 [-1.12, -0.33]

---

 4 Anxiety

3

82

Std. Mean Difference (IV, Fixed, 95% CI)

-0.77 [-1.23, -0.31]

---

 5 Leaving the study early due to any reason

4

121

Risk Ratio (M-H, Fixed, 95% CI)

2.19 [0.71, 6.73]

---

 6 PTSD diagnosis after treatment

4

121

Risk Ratio (M-H, Random, 95% CI)

0.65 [0.50, 0.86]

---

 

Comparison 3. Other Therapies vs Waitlist/Usual Care

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Severity of PTSD symptoms - clinician

2

72

Std. Mean Difference (IV, Fixed, 95% CI)

-0.43 [-0.90, 0.04]

---

 2 Severity of PTSD symptoms - self report

2

132

Std. Mean Difference (IV, Fixed, 95% CI)

-0.61 [-0.98, -0.24]

---

 3 Depression

2

Std. Mean Difference (IV, Fixed, 95% CI)

Subtotals only

---

3.1 Self report

2

72

Std. Mean Difference (IV, Fixed, 95% CI)

-0.25 [-0.71, 0.22]

---

 4 Anxiety - Self report

3

153

Std. Mean Difference (IV, Fixed, 95% CI)

-0.48 [-0.82, -0.14]

---

 5 Leaving the study early due to any reason

3

166

Risk Ratio (M-H, Fixed, 95% CI)

3.82 [1.19, 12.29]

---

 6 PTSD diagnosis after treatment

3

166

Risk Ratio (M-H, Random, 95% CI)

0.79 [0.53, 1.18]

---

 

Comparison 4. Group CBT vs Waitlist/Usual Care

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Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Severity of PTSD symptoms - clinician	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only
2 Severity of PTSD symptoms - self-report	2	71	Std. Mean Difference (IV, Fixed, 95% CI)	-0.71 [-1.20, -0.22]
3 Leaving the study early due to any reason	3	271	Risk Ratio (M-H, Fixed, 95% CI)	1.00 [0.64, 1.56]
4 PTSD diagnosis after treatment	1	48	Risk Ratio (M-H, Fixed, 95% CI)	0.56 [0.31, 1.01]

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Comparison 5. Trauma Focused CBT/ Exposure Therapy vs Stress Management Therapy

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Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Severity of PTSD Symptoms - clinician	6	239	Std. Mean Difference (IV, Random, 95% CI)	-0.27 [-0.71, 0.16]
2 Severity of PTSD symptoms - self report	3	127	Std. Mean Difference (IV, Fixed, 95% CI)	-0.37 [-0.74, 0.01]
3 Severity of PTSD symptoms - clinician - follow-up (2-5 months)	5	127	Std. Mean Difference (IV, Fixed, 95% CI)	-0.48 [-0.84, -0.12]
4 Severity of PTSD symptoms - self report - follow-up (2-5 months)	2	54	Std. Mean Difference (IV, Fixed, 95% CI)	-0.44 [-0.99, 0.10]
5 Depression	5	161	Std. Mean Difference (IV, Fixed, 95% CI)	-0.25 [-0.57, 0.08]
6 Depression - follow-up (2-5 months)	5	147	Std. Mean Difference (IV, Fixed, 95% CI)	-0.28 [-0.62, 0.06]
7 Anxiety	4	127	Std. Mean Difference (IV, Fixed, 95% CI)	-0.12 [-0.49, 0.26]
8 Anxiety - Follow-up (2-5 months)	4	117	Std. Mean Difference (IV, Fixed, 95% CI)	-0.19 [-0.58, 0.20]
9 Leaving the study early due to any reason	6	284	Risk Ratio (M-H, Fixed, 95% CI)	1.17 [0.69, 2.00]
10 PTSD diagnosis after treatment	6	284	Risk Ratio (M-H, Fixed, 95% CI)	0.78 [0.61, 0.99]

---

 

Comparison 6. Trauma Focused CBT/Exposure Therapy vs Other Therapies (supportive counselling/hypnotherapy/psychodynamic)

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Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Severity of PTSD symptoms - clinician	3	120	Std. Mean Difference (IV, Fixed, 95% CI)	-0.81 [-1.19, -0.42]
2 Severity of PTSD symptoms - clinician - follow-up (3 months)	2	70	Std. Mean Difference (IV, Fixed, 95% CI)	-0.65 [-1.13, -0.16]
3 Severity of PTSD symptoms - self report	3	176	Std. Mean Difference (IV, Random, 95% CI)	-1.18 [-2.32, -0.03]
4 Severity of PTSD symptoms - self report - follow-up (2-5 months)	2	131	Std. Mean Difference (IV, Random, 95% CI)	-0.28 [-1.04, 0.48]
5 Depression - self report	3	120	Std. Mean Difference (IV, Fixed, 95% CI)	-0.65 [-1.03, -0.28]
6 Anxiety - self report	4	197	Std. Mean Difference (IV, Random, 95% CI)	-0.47 [-1.11, 0.17]
7 Depression - self-report - follow-up (2-5 months)	2	72	Std. Mean Difference (IV, Fixed, 95% CI)	-0.53 [-1.00, -0.05]
8 Anxiety - self-report - follow-up (2-5 months)	3	149	Std. Mean Difference (IV, Fixed, 95% CI)	-0.27 [-0.60, 0.07]
9 PTSD diagnosis after treatment	5	286	Risk Ratio (M-H, Fixed, 95% CI)	0.71 [0.56, 0.89]
10 Leaving the study early due to any reason	5	290	Risk Ratio (M-H, Fixed, 95% CI)	1.14 [0.68, 1.90]
11 Severity of PTSD symptoms - clinician - follow-up (6-9 months)	1	45	Std. Mean Difference (IV, Fixed, 95% CI)	-1.85 [-2.59, -1.11]
12 Severity of PTSD symptoms - self-report - follow-up (6-9 months)	1	45	Std. Mean Difference (IV, Fixed, 95% CI)	-1.72 [-2.45, -1.00]
13 Depression - follow-up (6-9 months)	1	45	Std. Mean Difference (IV, Fixed, 95% CI)	-1.08 [-1.74, -0.42]
14 Anxiety - follow-up (6-9 months)	1	45	Std. Mean Difference (IV, Fixed, 95% CI)	-1.18 [-1.85, -0.51]

---

 

Comparison 7. Stress Management Therapy vs Other Therapies

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Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Severity of PTSD symptoms - Clincian	1	25	Std. Mean Difference (IV, Fixed, 95% CI)	-1.22 [-2.09, -0.35]
2 Anxiety - Self-report	1	25	Std. Mean Difference (IV, Fixed, 95% CI)	-0.51 [-1.32, 0.29]
3 Depression - Self-report	1	25	Std. Mean Difference (IV, Fixed, 95% CI)	-0.51 [-1.31, 0.30]
4 Severity of PTSD symptoms - clinician - follow-up (3 months)	1	18	Std. Mean Difference (IV, Fixed, 95% CI)	-0.38 [-1.31, 0.55]
5 Anxiety - self-report - follow-up (3 months)	1	18	Std. Mean Difference (IV, Fixed, 95% CI)	-0.68 [-1.64, 0.28]
6 Depression - self-report - follow-up (3 months)	1	18	Std. Mean Difference (IV, Fixed, 95% CI)	-0.48 [-1.42, 0.46]
7 PTSD diagnosis after treatment	1	31	Risk Ratio (M-H, Fixed, 95% CI)	0.58 [0.30, 1.11]
8 Leaving the study early due to any reason	1	31	Risk Ratio (M-H, Fixed, 95% CI)	0.82 [0.20, 3.46]

---

 

Comparison 8. Group CBT (trauma focused) vs Group CBT (non-trauma focused)

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Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Severity of PTSD symptoms	1	325	Std. Mean Difference (IV, Fixed, 95% CI)	-0.12 [-0.34, 0.10]
2 Leaving the study early due to any reason	1	360	Risk Ratio (M-H, Fixed, 95% CI)	1.38 [1.00, 1.90]
3 PTSD diagnosis after treatment	1	360	Risk Ratio (M-H, Fixed, 95% CI)	0.98 [0.83, 1.16]

---

 

Comparison 9. EMDR vs Waitlist/Usual Care

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Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Severity of PTSD symptoms - Clinician	5	162	Std. Mean Difference (IV, Fixed, 95% CI)	-1.51 [-1.87, -1.15]
2 Severity of PTSD symptoms - self report	5	156	Std. Mean Difference (IV, Random, 95% CI)	-1.07 [-2.04, -0.10]
3 Depression	5	160	Std. Mean Difference (IV, Fixed, 95% CI)	-1.48 [-1.84, -1.12]
4 Anxiety	5	156	Std. Mean Difference (IV, Fixed, 95% CI)	-1.10 [-1.45, -0.76]
5 Leaving study early due to any reason	6	217	Odds Ratio (M-H, Fixed, 95% CI)	1.33 [0.64, 2.74]
6 PTSD diagnosis after treatment	6	209	Risk Ratio (M-H, Random, 95% CI)	0.47 [0.25, 0.85]

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Comparison 10. EMDR vs Trauma Focused CBT

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Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Severity of PTSD symptoms - clinician	6	187	Std. Mean Difference (IV, Random, 95% CI)	0.03 [-0.50, 0.55]
2 Severity of PTSD symptoms - clinicain - follow-up (2-5 months)	3	76	Std. Mean Difference (IV, Fixed, 95% CI)	-0.14 [-0.60, 0.32]
3 Severity of PTSD symptoms - self report	7	206	Std. Mean Difference (IV, Random, 95% CI)	-0.17 [-0.59, 0.26]
4 Depression	7	206	Std. Mean Difference (IV, Random, 95% CI)	-0.32 [-0.90, 0.26]
5 Depression - follow-up (2-5 months)	5	111	Std. Mean Difference (IV, Fixed, 95% CI)	-0.09 [-0.47, 0.29]
6 Anxiety	4	136	Std. Mean Difference (IV, Fixed, 95% CI)	-0.08 [-0.42, 0.26]
7 Anxiety - follow-up (2-5 months)	2	48	Std. Mean Difference (IV, Fixed, 95% CI)	0.24 [-0.33, 0.81]
8 Leaving study early due to any reason	7	268	Risk Ratio (M-H, Fixed, 95% CI)	0.83 [0.55, 1.26]
9 PTSD diagnosis after treatment	7	260	Odds Ratio (M-H, Fixed, 95% CI)	1.01 [0.61, 1.66]
10 Severity of PTSD symptoms - self-report - follow-up (2-5 months)	5	111	Std. Mean Difference (IV, Fixed, 95% CI)	-0.01 [-0.39, 0.37]

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Comparison 11. EMDR vs Stress Management Therapy

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Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Severity of PTSD symptoms - clinician	2	53	Std. Mean Difference (IV, Fixed, 95% CI)	-0.35 [-0.90, 0.19]
2 Severity of PTSD symptoms - clinician - follow-up (2-5 months)	3	71	Std. Mean Difference (IV, Fixed, 95% CI)	-0.59 [-1.08, -0.09]
3 Severity of PTSD symptoms - self report	3	75	Std. Mean Difference (IV, Fixed, 95% CI)	-0.40 [-0.86, 0.06]
4 Depression	3	75	Std. Mean Difference (IV, Fixed, 95% CI)	-0.67 [-1.14, -0.20]
5 Depression - follow-up (2-5 months)	3	75	Std. Mean Difference (IV, Fixed, 95% CI)	-0.23 [-0.70, 0.23]
6 Anxiety	2	45	Std. Mean Difference (IV, Fixed, 95% CI)	-0.75 [-1.36, -0.13]
7 Anxiety - follow-up (2-5 months)	2	45	Std. Mean Difference (IV, Random, 95% CI)	-0.42 [-2.21, 1.37]
8 Leaving the study early due to any reason	3	84	Risk Ratio (M-H, Fixed, 95% CI)	1.03 [0.37, 2.88]
9 PTSD diagnosis after treatment	3	84	Risk Ratio (M-H, Fixed, 95% CI)	0.69 [0.46, 1.04]
10 Severity of PTSD symptoms - self-report - follow-up (2-5 months)	3	75	Std. Mean Difference (IV, Fixed, 95% CI)	-0.52 [-0.98, -0.05]

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Comparison 12. EMDR vs Other Therapies

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Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Severity of PTSD symptoms - self report	2	124	Std. Mean Difference (IV, Fixed, 95% CI)	-0.84 [-1.21, -0.47]
2 Depression	2	127	Std. Mean Difference (IV, Fixed, 95% CI)	-0.67 [-1.03, -0.32]
3 Anxiety	2	126	Std. Mean Difference (IV, Fixed, 95% CI)	-0.72 [-1.08, -0.36]
4 Leaving study early due to any reason	2	127	Risk Ratio (M-H, Fixed, 95% CI)	1.48 [0.26, 8.54]
5 PTSD diagnosis after treatment	1	67	Risk Ratio (M-H, Fixed, 95% CI)	0.40 [0.19, 0.84]

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