Psychotherapy and Psychosomatics

Log in to MyKarger to check if you already have access to this content.

Buy FullText & PDF Unlimited re-access via MyKarger Unrestricted printing, no saving restrictions for personal use read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.

Save over 20% compared to the individual article price.

Learn more

Access via DeepDyve Unlimited fulltext viewing Of this article Organize, annotate And mark up articles Printing And downloading restrictions apply

Select

Subscribe Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use read more

Subcription rates

Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview

Received: August 23, 2022
Accepted: October 27, 2022
Published online: December 09, 2022

Number of Print Pages: 11
Number of Figures: 1
Number of Tables: 2

ISSN: 0033-3190 (Print)
eISSN: 1423-0348 (Online)

For additional information: https://www.karger.com/PPS

Abstract

Background: Participants are allowed to stay on their prescribed psychotropic medication in most trials examining psychological interventions for adult post-traumatic stress disorder (PTSD). Objectives: We aimed to conduct the first meta-analysis investigating the potential influence of such concurrent medication on efficacy. Method: To this end, we searched Medline, PsycINFO, Web of Science, and PTSDpubs from inception to April 21, 2022, for trials meeting the following criteria: (1) randomized controlled trial (RCT), (2) PTSD as primary treatment focus, (3) interview-based PTSD baseline rate ≥70%, (4) N ≥ 20, (5) mean age ≥18 years. Trials were excluded when intake of psychotropics was not (sufficiently) reported. Results: Most published trials did not report on the intake of psychotropic medication. A total of 75 RCTs (N = 4,901 patients) met inclusion criteria. Trauma-focused cognitive behavior therapy (TF-CBT) was the most well-researched intervention. Short-term efficacy of psychological treatments did not differ by the proportion of participants taking concurrent psychotropic medication during psychological treatment in all but one analysis. In trials comparing TF-CBT and active control conditions at posttreatment, TF-CBT was more effective when most participants were concurrently medicated (g = 0.87, 95% CI 0.53–1.22) rather than unmedicated (g = 0.27; 95% CI 0.01–0.54, p = 0.017), with younger age (b1 = −0.04, p = 0.008) and higher proportion of females (b1 = 0.01, p = 0.014) being associated with higher efficacy only in trials with high proportions of medicated participants. No differences in efficacy by proportions of participants taking concurrent psychotropic medication were found at follow-up. Conclusions: Results suggest that psychological interventions are effective for PTSD irrespective of concurrent intake of psychotropics.

© 2022 S. Karger AG, Basel

References Kessler RC, Aguilar-Gaxiola S, Alonso J, Benjet C, Bromet EJ, Cardoso G, et al. Trauma and PTSD in the WHO world mental health surveys. Eur J Psychotraumatol. 2017;8(Suppl 5):1353383. Bryant RA. Post-traumatic stress disorder: a state-of-the-art review of evidence and challenges. World Psychiatry. 2019;18(3):259–69. Martin A, Naunton M, Kosari S, Peterson G, Thomas J, Christenson JK. Treatment guidelines for PTSD: a systematic review. J Clin Med. 2021;10(18):4175. Morina N, Hoppen TH, Kip A. Study quality and efficacy of psychological interventions for posttraumatic stress disorder: a meta-analysis of randomized controlled trials. Psychol Med. 2021;51(8):1260–70. Lewis C, Roberts NP, Andrew M, Starling E, Bisson JI. Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis. Eur J Psychotraumatol. 2020;11(1):1729633. Kline AC, Cooper AA, Rytwinksi NK, Feeny NC. Long-term efficacy of psychotherapy for posttraumatic stress disorder: a meta-analysis of randomized controlled trials. Clin Psychol Rev. 2018;59:30–40. Karatzias T, Murphy P, Cloitre M, Bisson J, Roberts N, Shevlin M, et al. Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis. Psychol Med. 2019;49(11):1761–75. Fonzo GA, Goodkind MS, Oathes DJ, Zaiko YV, Harvey M, Peng KK, et al. Selective effects of psychotherapy on frontopolar cortical function in PTSD. Am J Psychiatry. 2017;174(12):1175–84. Resick PA, Wachen JS, Mintz J, Young-McCaughan S, Roache JD, Borah AM, et al. A randomized clinical trial of group cognitive processing therapy compared with group present-centered therapy for PTSD among active duty military personnel. J Consult Clin Psychol. 2015;83(6):1058–68. Ehlers A, Hackmann A, Grey N, Wild J, Liness S, Albert I, et al. A randomized controlled trial of 7-day intensive and standard weekly cognitive therapy for PTSD and emotion-focused supportive therapy. Am J Psychiatry. 2014;171(3):294–304. Markowitz JC, Petkova E, Neria Y, van Meter PE, Zhao Y, Hembree E, et al. Is exposure necessary? A randomized clinical trial of interpersonal psychotherapy for PTSD. Am J Psychiatry. 2015;172(5):430–40. Acarturk C, Konuk E, Cetinkaya M, Senay I, Sijbrandij M, Gulen B, et al. The efficacy of eye movement desensitization and reprocessing for post-traumatic stress disorder and depression among Syrian refugees: results of a randomized controlled trial. Psychol Med. 2016;46(12):2583–93. Gersons BPR, Carlier IVE, Lamberts RD, van der Kolk BA. Randomized clinical trial of brief eclectic psychotherapy for police officers with posttraumatic stress disorder. J Trauma Stress. 2000;13(2):333–47. Cipriani A, Williams T, Nikolakopoulou A, Salanti G, Chaimani A, Ipser J, et al. Comparative efficacy and acceptability of pharmacological treatments for post-traumatic stress disorder in adults: a network meta-analysis. Psychol Med. 2018;48(12):1975–84. Merz J, Schwarzer G, Gerger H. Comparative efficacy and acceptability of pharmacological, psychotherapeutic, and combination treatments in adults with posttraumatic stress disorder: a network meta-analysis. JAMA Psychiatry. 2019;76(9):904–13. Cuijpers P, Oud M, Karyotaki E, Noma H, Quero S, Cipriani A, et al. Psychologic treatment of depression compared with pharmacotherapy and combined treatment in primary care: a network meta-analysis. Ann Fam Med. 2021;19(3):262–70. Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF III. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. Focus. 2014;12(3):347–58. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9. Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C. Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev. 2013;13(12):CD003388. Vaughan K, Armstrong MS, Gold R, O’Connor N, Jenneke W, Tarrier N. A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in post-traumatic stress disorder. J Behav Ther Exp Psychiatry. 1994;25(4):283–91. Mueser KT, Rosenberg SD, Xie H, Jankowski MK, Bolton EE, Lu W, et al. A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness. J Consult Clin Psychol. 2008;76(2):259–71. Lehavot K, Millard SP, Thomas RM, Yantsides K, Upham M, Beckman K, et al. A randomized trial of an online, coach-assisted self-management PTSD intervention tailored for women veterans. J Consult Clin Psychol. 2021;89(2):134–42. Resick PA, Nishith P, Weaver TL, Astin MC, Feuer CA. A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. J Consult Clin Psychol. 2002;70(4):867–79. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan: a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. Chambless DL, Hollon SD. Defining empirically supported therapies. J Consult Clin Psychol. 1998;66(1):7–18. Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions. Chichester, UK: Wiley-Blackwell; 2009. Cuijpers P, van Straten A, Bohlmeijer E, Hollon SD, Andersson G. The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size. Psychol Med. 2010;40(2):211–23. Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, et al. The development of a clinician-administered PTSD Scale. J Trauma Stress. 1995;8(1):75–90. Lobbestael J, Leurgans M, Arntz A. Inter-rater reliability of the structured clinical interview for DSM-IV Axis I disorders (SCID I) and Axis II disorders (SCID II). Clin Psychol Psychother. 2011;18(1):75–9. Lipsey MW, Wilson DB. Practical meta-analysis. Thousand Oaks, CA: SAGE Publ; 2009. Cohen J Statistical power analysis for the behavioral sciences. 2nd ed. Hoboken, NJ: Taylor and Francis; 2013. IntHout J, Ioannidis JPA, Rovers MM, Goeman JJ. Plea for routinely presenting prediction intervals in meta-analysis. BMJ Open. 2016;6(7):e010247. Kraemer HC, Kupfer DJ. Size of treatment effects and their importance to clinical research and practice. Biol Psychiatry. 2006;59(11):990–6. Sterne JAC, Sutton AJ, Ioannidis JPA, Terrin N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011;343:d4002. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455–63. Viechtbauer W Conducting meta-analyses in R with the metafor package. J Stat Soft. 2010;36(3):1–48. R Core Team. R: a language and environment for statistical computing; 2015. Available from: http://www.R-project.org/. Tabachnick BG, Fidell LS. Using multivariate statistics. 6th ed. Boston, MA: Pearson; 2013. Article / Publication Details

First-Page Preview

Received: August 23, 2022
Accepted: October 27, 2022
Published online: December 09, 2022

Number of Print Pages: 11
Number of Figures: 1
Number of Tables: 2

ISSN: 0033-3190 (Print)
eISSN: 1423-0348 (Online)

For additional information: https://www.karger.com/PPS

Copyright / Drug Dosage / Disclaimer Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.