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Comparative effectiveness of psychotherapies in adults with posttraumatic stress disorder: a network meta-analysis of randomised controlled trials

Published online by Cambridge University Press:  11 January 2023

Ninik Yunitri ,
Hsin Chu ,
Xiao Linda Kang ,
Bayu Satria Wiratama ,
Tso-Ying Lee ,
Li-Fang Chang ,
Doresses Liu ,
Christina Yeni Kustanti ,
Kai-Jo Chiang  and
Ruey Chen
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Ninik Yunitri
Affiliation:
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan Mental Health and Psychiatric Nursing Department, Faculty of Nursing, Universitas Muhammadiyah Jakarta, Indonesia
Hsin Chu
Affiliation:
Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Xiao Linda Kang
Affiliation:
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan School of Nursing, University of Pennsylvania, Philadelphia, USA
Bayu Satria Wiratama
Affiliation:
Department of Biostatistics, Epidemiology and Population Health, Universitas Gadjah Mada, Yogyakarta, Indonesia
Tso-Ying Lee
Affiliation:
Nursing Research Center, Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
Li-Fang Chang
Affiliation:
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan Department of Medical Education & Emergency and Critical Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan School of Nursing, National Defense Medical Center, Taipei, Taiwan Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
Doresses Liu
Affiliation:
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
Christina Yeni Kustanti
Affiliation:
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum Yogyakarta, Indonesia
Kai-Jo Chiang
Affiliation:
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan Department of Nursing, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan School of Nursing, National Defense Medical Center, Taipei, Taiwan
Ruey Chen
Affiliation:
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
Philip Tseng
Affiliation:
Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan Brain and Consciousness Research Center, TMU - Shuang Ho Hospital, New Taipei, Taiwan Research Center for Mind, Brain & Learning, National Chengchi University, Taipei, Taiwan
Kuei-Ru Chou*
Affiliation:
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
*
Author for correspondence: Kuei-Ru Chou, E-mail: kueiru@tmu.edu.tw
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Abstract

Background

Evidence on the long-term comparative effectiveness of posttraumatic stress disorder (PTSD) psychotherapies in adults remains unknown. Therefore, we performed an extensive network meta-analysis of randomised controlled trials (RCTs) to determine the comparative effectiveness of psychotherapies for people diagnosed with PTSD.

Methods

A comprehensive search was conducted in Cochrane library, Embase, Medline-OVID, PubMed, Scopus, and Psych-Info until March 2021. Studies on the effectiveness of cognitive processing therapy (CPT), cognitive therapy (CT), eye movement desensitisation reprocessing (EMDR), narrative exposure therapy (NET), prolonged exposure (PE), cognitive behavioural therapy (CBT), present-centred therapy (PCT), brief eclectic psychotherapies (BEP), psychodynamic therapy (PDT) or combination therapies compared to no treatment (NT) or treatment as usual (TAU) in adults with PTSD were included. Frequentist and Bayesian approaches were used for analysis in R-software.

Results

We included 98 RCTs with 5567 participants from 18 897 studies. CPT, EMDR, CT, NET, PE, CBT, and PCT were significant to reduce PTSD symptoms (SMD range: −1.53 to −0.75; Certainty: very low to high) at immediate post-treatment and ranked accordingly. Longitudinal analysis found EMDR (1.02) and CPT (0.85) as the significant therapies with large effect size in short-term and long-term follow-up, respectively. NET and CPT showed higher proportion of loss of PTSD diagnosis (RR range: 5.51–3.45) while there were no significant psychotherapies for retention rate compared to NT.

Conclusions:

Our findings provide evidence for improving current guidelines and informing clinical decision-making for PTSD management. However, the best PTSD treatment plan should be tailored to patients' needs, characteristics, and clinician expertise.

Registration:

PROSPERO CRD42020162143

Keywords

Effectivenessnetwork meta-analysispsychotherapiesPTSD
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 13 , October 2023 , pp. 6376 - 6388
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

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