scholarly journals Challenging Beliefs about the Psychotherapy of Post-Traumatic Stress Disorder (PTSD)

2019 ◽  
Vol 4 ◽  
Author(s):  
Louise Gaston
Keyword(s):  
Clinical Trials ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Randomized Clinical Trials ◽  
Stress Disorder ◽  
Behavioural Therapy ◽  
Post Traumatic Stress ◽  
Therapeutic Modalities ◽  
Post Traumatic ◽  
Almost All

Clinical guidelines for treating post-traumatic stress disorder (PTSD) have recommended using cognitive-behavioural therapy (CBT) only. This is not surprising given that almost all randomized clinical trials were conducted by CBT researchers examining the efficacy of CBT. The two types of standardized CBT -- trauma-focused and non-trauma-focused – were both found to be equally efficacious for treating PTSD. However, their observed efficacy is limited -- only partial PTSD remission in only 50% of informed and selected volunteers. Beyond a limited efficacy, claims of high efficacy are often made for trauma-focused CBT, although these modalities were repeatedly found to be associated with attrition and iatrogenic effects. Whenever dynamic and supportive therapies were included in controlled clinical trials, these therapeutic modalities were provided in non-representative ways. Furthermore, any differential findings between therapies disappeared at follow-up, invaliding any conclusion about the superiority of CBT. Only one randomized clinical trial had compared the efficacy of dynamic therapy vs. CBT for treating PTSD, but no differential efficacy was found (Brom et al., 1989). Taken together, these findings suggest that there is a pro- CBT bias in funding, research, and guidelines in the field of PTSD. This pro-CBT bias needs to be acknowledged and corrected. In the meantime, clinicians need to rely on their own judgment, using integrative approaches for treating PTSD in a flexible manner.

scholarly journals The effect of flexible cognitive–behavioural therapy and medical treatment, including antidepressants on post-traumatic stress disorder and depression in traumatised refugees: pragmatic randomised controlled clinical trial

2016 ◽  
Vol 208 (3) ◽  
pp. 252-259 ◽  
Author(s):  
Caecilie Böck Buhmann ◽  
Merete Nordentoft ◽  
Morten Ekstroem ◽  
Jessica Carlsson ◽  
Erik Lykke Mortensen
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Behavioural Therapy ◽  
Controlled Clinical Trial ◽  
Post Traumatic Stress ◽  
Cognitive Behavioural ◽  
Randomised Controlled Clinical Trial ◽  
Post Traumatic ◽  
Randomised Controlled

BackgroundLittle evidence exists on the treatment of traumatised refugees.AimsTo estimate treatment effects of flexible cognitive–behavioural therapy (CBT) and antidepressants (sertraline and mianserin) in traumatised refugees.MethodRandomised controlled clinical trial with 2×2 factorial design (registered with Clinicaltrials.gov, NCT00917397, EUDRACT no. 2008-006714-15). Participants were refugees with war-related traumatic experiences, post-traumatic stress disorder (PTSD) and without psychotic disorder. Treatment was weekly sessions with a physician and/or psychologist over 6 months.ResultsA total of 217 of 280 patients completed treatment (78%). There was no effect on PTSD symptoms, no effect of psychotherapy and no interaction between psychotherapy and medicine. A small but significant effect of treatment with antidepressants was found on depression.ConclusionsIn a pragmatic clinical setting, there was no effect of flexible CBT and antidepressants on PTSD, and there was a small-to-moderate effect of antidepressants and psychoeducation on depression in traumatised refugees.

scholarly journals Risk of Bias in Randomized Clinical Trials on Psychological Therapies for Post-Traumatic Stress Disorder in Adults

2018 ◽  
Vol 2 ◽  
pp. 247054701877906 ◽  
Author(s):  
Juliana Martins Scalabrin ◽  
Marcelo F. Mello ◽  
Walter Swardfager ◽  
Hugo Cogo-Moreira
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Internal Consistency ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Risk Of Bias ◽  
Post Traumatic Stress ◽  
Psychological Therapies ◽  
Post Traumatic

Objective To evaluate the factorial validity and internal consistency of a measurement model underlying risk of bias as endorsed by Cochrane for use in systematic reviews; more specifically, how the risk of bias tool behaves in the context of studies on psychological therapies used for treatment of post-traumatic stress disorder in adults. Methods We applied confirmatory factor analysis to a systematic review containing 70 clinical trials entitled “Psychological Therapies for Chronic Post-Traumatic Stress Disorder in Adults” under a Bayesian estimator. Seven observed categorical risk of bias items (answered categorically as low, unclear, or high risk of bias) were collected from the systematic review. Results A unidimensional model for the Cochrane risk of bias tool items returned poor fit indices and low factor loadings, indicating questionable validity and internal consistency. Conclusion Although the present evidence is restricted to psychological interventions for post-traumatic stress disorder, it demonstrates that the way risk of bias has been measured in this context may not be adequate. More broadly, the results suggest the importance of testing the risk of bias tool, and the possibility of rethinking the methods used to assess risk of bias in systematic reviews and meta-analyses.

scholarly journals Verbal memory and treatment response in post-traumatic stress disorder

2008 ◽  
Vol 193 (3) ◽  
pp. 254-255 ◽  
Author(s):  
Jennifer Wild ◽  
Ruben C. Gur
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Verbal Memory ◽  
Stress Disorder ◽  
Neuropsychological Functioning ◽  
Memory Deficits ◽  
Behavioural Therapy ◽  
Post Traumatic Stress ◽  
Cognitive Behavioural ◽  
Post Traumatic

SummaryPost-traumatic stress disorder (PTSD) is often associated with verbal memory deficits, which could influence treatment outcome. We assessed neuropsychological functioning in individuals with PTSD and their response to cognitive– behavioural therapy (CBT). Treatment non-responders had significantly poorer performance on measures of verbal memory compared with responders and demonstrated narrative encoding deficits. Differences were not explained by IQ, performance on tasks of attention, initial PTSD severity, depression, time since trauma, or alcohol/substance misuse. Verbal memory deficits seem to diminish the effectiveness of CBT and should be considered in its implementation.

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