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

  • Belsher BE & al.
  • Cochrane Database Syst Rev
  • 18 Nov 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

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.