Psychological interventions are equally effective for both single-event-related and multiple-event-related post-traumatic stress disorder (PTSD). These results, published in The Lancet Psychiatry, indicate that the efficacy of these therapies is not diminished by exposure to multiple traumatic events, which may help inform treatment plans.
Given that exposure to multiple traumatic events — relative to a single exposure — is associated with increased PTSD severity and impairment, it is unclear whether PTSD psychological treatment efficacy varies by trauma frequency. Therefore, investigators sought to evaluate the efficacy of psychological therapies for treating adults with multiple-event-related PTSD vs single-event-related PTSD.
The investigators conducted a systematic review and meta-analysis of publication databases from inception through mid-April 2023 for randomized controlled trials (RCTs) that compared a psychological intervention and a control condition among adult participants with PTSD, based on International Classification of Diseases (ICD) codes or Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. The primary outcomes of interest were short-term efficacy (treatment endpoint), mid-term efficacy (up to 5 months), and long-term efficacy (greater than 5 months) of PTSD symptoms treatment relative to a given comparator.
The investigators included 137 RCTs for the meta-analysis, for a pooled sample size of 10,692 patients with PTSD. On average, patients were 40.2 (SD, 9.0) years of age and 54% were women. Psychological intervention types included trauma-focused cognitive behavior therapy (CBT), eye movement desensitization and reprocessing, other trauma-focused psychological interventions, and non-trauma-focused psychological intervention.
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This meta-analysis indicates that widespread claims regarding limited efficacy and suitability of trauma-focused interventions for patients with multiple-event-related PTSD are counter to the evidence.
Relative to passive control conditions, the investigators found that psychological interventions for PTSD were highly effective for both single-event-related PTSD (Hedges g, 1.04; 95% CI, 0.77-1.31; I2=43%) and multiple-event-related PTSD (Hedges g, 1.13; 95% CI, 0.90-1.35; I2=87%). Further, they observed no between-group difference in efficacy for single-event vs multiple-event PTSD (P =.78).
When compared with active control conditions, the investigators noted that psychological interventions were moderately effective for single-event-related PTSD (Hedges g, 0.78; 95% CI, 0.15-1.40; I2=63.83%) and multiple-event-related PTSD (Hedges g, 0.44; 95% CI, 0.32-0.56; I2=50.71). Again, there was no between-group difference in treatment efficacy (P =.20).
Overall, the quality of evidence was moderate to high. Between-study heterogeneity was substantial, although similar results were found in outlier-corrected analysis and the investigators noted robust results in analyses of follow-up data and in various sensitivity analyses (90% cutoff for multiple-trauma trials).
“We found strong evidence that psychological interventions are highly effective treatments for PTSD in patients with a history of multiple traumatic events,” the investigators concluded. Review authors wrote, “This meta-analysis indicates that widespread claims regarding limited efficacy and suitability of trauma-focused interventions for patients with multiple-event-related PTSD are counter to the evidence.”
The meta-analysis findings may be limited due to the wide-range of included treatments and lack of metrics beyond standardized mean differences.
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