Cochrane review: present-centered therapy for post-traumatic stress disorder

Takeaway

• Present-centered therapy (PCT) was more effective in reducing post-traumatic stress disorder (PTSD) severity than control conditions.
• PCT was not as effective as trauma-focused cognitive-behavioural therapy (TF-CBT) in reducing post-treatment PTSD severity.
• However, treatment dropout rates reduced with PCT compared with TF-CBT.

Why this matters

• Findings are consistent with current clinical practice guidelines that suggest PCT may be an effective alternative treatment for PTSD when individual TF-CBT is not readily available or preferred.

Study design

• Cochrane review included 12 randomised controlled trials (n=1837) that compared the effects of PCT vs TF-CBT and control condition (standard care, wait list [WL], minimal attention [MA] or repeated assessment).
• Primary outcomes: reduction in PTSD symptoms severity (Clinician-Administered PTSD Scale [CAPS]) and treatment dropout rates.
• Funding: The National Institute for Health Research.

Key results

• At post-treatment, PCT vs WL/MA was more effective in reducing PTSD symptom severity (standardised mean difference [SMD], -0.84; 95% CI, -1.10 to -0.59).
• TF-CBT vs PCT group had reduction in PTSD symptoms severity (MD, 6.83; 95% CI, 1.90-11.76).
• No difference was observed in CAPS scores between PCT and TF-CBT groups at 6-month (MD, 1.59; 95% CI, −0.46 to 3.63) and 12-month (MD, 1.22; 95% CI, −2.17 to 4.61) follow-ups.
• TF-CBT was associated with a reduction in PTSD symptoms severity compared with PCT (SMD, 0.32; 95% CI, 0.08-0.56; I², 69%), with smaller effect size differences at 6 (SMD, 0.17; 95% CI, 0.05-0.29) and 12 (SMD, 0.17; 95% CI, 0.03-0.31) months.
• Treatment dropout rates reduced by 14% with PCT compared with TF-CBT (risk difference, −0.14; 95% CI, −0.18 to −0.10).
• No differences were observed in self-reported PTSD (MD, 4.50; 95% CI, 3.09-5.90) and depression (MD, 1.78; 95% CI, −0.23 to 3.78) symptoms between PCT and TF-CBT groups.

Limitations

• Heterogeneity among studies.
• Risk for selection and publication bias.