What are the most effective interventions in adults with PTSD?

In the treatment of post-traumatic stress disorder (PTSD), eye movement desensitization and reprocessing (EMDR) and trauma-focused cognitive behavioural therapy (TF-CBT) appear to be most effective at reducing symptoms and increasing remission rates as well as sustaining symptom improvements after therapy has ended, according to the results of a meta-analysis.

Researchers conducted a systematic review of trials evaluating psychological, psychosocial and other nonpharmacological interventions targeted at clinically important post-traumatic stress symptoms in adults >1 month following a traumatic event. Another outcome assessed was remission post-treatment.

The network meta-analysis included 90 trials, involving 6,560 participants and 22 interventions. Evidence was of moderate-to-low quality.

For reducing PTSD symptoms, the following interventions ranked the best relative to waitlist: EMDR (standardised mean difference [SMD], −2.07, 95 percent credible interval [CrI] −2.70 to −1.44), combined somatic/cognitive therapies (SMD, −1.69, 95 percent CrI, −2.66 to −0.73), TF-CBT (SMD, −1.46, 95 percent CrI, −1.87 to −1.05), and self-help with support (SMD, −1.46, 95 percent CrI, −2.33 to −0.59). These were followed by non-TF-CBT, TF-CBT combined with a selective serotonin reuptake inhibitor (SSRI), SSRIs, self-help without support, and counselling.

Notably, the improvements achieved with EMDR and TF-CBT were sustained at 1–4-month follow-up.

In terms of remission, EMDR, TF-CBT, self-help with support, and counselling were associated with higher rates post-treatment. Results for other interventions were either inconclusive or based on limited evidence.

More studies are warranted to explore the long-term comparative effectiveness of psychological therapies for adults with PTSD, as well as to establish the impact of severity and complexity of PTSD on treatment outcomes, according to the researchers.