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    Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis


    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

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    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:

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