Karatzias, Thanos and Murphy, Philip and Cloitre, Marylene and Bisson, Jonathan I. and Roberts, Neil P. and Shevlin, Mark and Hyland, Philip and Maercker, Andreas and Ben-Ezra, Menachem and Coventry, Peter A. and Mason-Roberts, Susan and Bradley, Aoife
(2019)
Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis.
Psychological Medicine, 49 (11).
pp. 1761-1775.
ISSN 0033-2917
Abstract
Background. The 11th revision to the WHO International Classification of Diseases (ICD-11)
identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a
pressing need to identify effective CPTSD interventions.
Methods. We conducted a systematic review and meta-analysis of randomised controlled
trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD),
where participants were likely to have clinically significant baseline levels of one or more
CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships).
We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January
2018), and examined study and outcome quality.
Results. Fifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure
alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to
usual care for PTSD symptoms, with effects ranging from g = −0.90 (CBT; k = 27, 95%
CI −1.11 to −0.68; moderate quality) to g = −1.26 (EMDR; k = 4, 95% CI −2.01 to −0.51;
low quality). CBT and EA each had moderate–large or large effects on negative self-concept,
but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or
moderate–large effects on disturbed relationships. Few RCTs reported affect dysregulation
data. The benefits of all interventions were smaller when compared with non-specific interventions
(e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma
was associated with a poorer outcome.
Conclusions. The development of effective interventions for CPTSD can build upon the success
of PTSD interventions. Further research should assess the benefits of flexibility in intervention
selection, sequencing and delivery, based on clinical need and patient preferences.
| Item Type: |
Article
|
| Additional Information: |
Cite as: Karatzias T et al (2019).
Psychological interventions for ICD-11
complex PTSD symptoms: systematic review
and meta-analysis. Psychological Medicine
1–15. https://doi.org/10.1017/
S0033291719000436 |
| Keywords: |
Childhood trauma; CPTSD; meta-analysis;
psychological therapies; randomised
controlled trials; systematic review; |
| Academic Unit: |
Faculty of Science and Engineering > Psychology |
| Item ID: |
13554 |
| Identification Number: |
https://doi.org/10.1017/S0033291719000436 |
| Depositing User: |
Philip Hyland
|
| Date Deposited: |
12 Nov 2020 15:45 |
| Journal or Publication Title: |
Psychological Medicine |
| Publisher: |
Cambridge University Press |
| Refereed: |
Yes |
| URI: |
|
| Use Licence: |
This item is available under a Creative Commons Attribution Non Commercial Share Alike Licence (CC BY-NC-SA). Details of this licence are available
here |
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