Therapy effective in PTSD, even after repeated traumas

Psychological interventions for post-traumatic stress disorder (PTSD) prove to be highly effective even in individuals with a history of multiple traumatic events.

Led by researchers from University of Münster in Münster, Germany, a meta-analysis of 137 randomized controlled trials involving adults with PTSD showed that psychological interventions performed better than passive control conditions in both single-event-related (Hedges' g, 1.04, 95 percent confidence interval [CI], 0.77–1.31; n=11; I²=43 percent) and multiple-event-related PTSD (Hedges’ g, 1.13,95 percent CI, 0.90–1.35; n=55; I²=87 percent). [Lancet Psychiatry 2024;doi:10.1016/S2215-0366(23)00373-5]

The magnitude of effect of psychological interventions did not significantly differ between the two PTSD groups (p=0.48).

While there were big differences between some studies, as represented by substantial heterogeneity, outlier-corrected analysis showed consistent positive effects of psychological therapy for both single- and multiple-event-related PTSD.

The findings held up in various sensitivity analyses (eg, 90-percent cutoff for multiple-trauma trials) and analyses of follow-up data, with the quality of evidence being moderate to high.

Trauma-focused therapy

That several psychological interventions are about as effective in treating PTSD following multiple traumatic events as when the PTSD follows a single trauma is “very encouraging news” for both patients and clinicians, said senior study author Prof Nexhmedin Morina.

“[This] should remove treatment barriers for patients with a history of multiple traumatic events," added first study author Dr Thole Hoppen, who also noted that the reluctance to talk openly about trauma isn’t solely on the patients’ side.

“Some psychotherapists hesitate to directly address traumatic experiences during treatment,” Hoppen added.

Under such circumstances, Hoppen pointed out that trauma-focused cognitive behavioural therapy may help. This psychotherapy helps process the traumatic memories and “is not only very effective according to the accumulated data but more effective than nontrauma-focused interventions.”

Indeed, national and international treatment guidelines recommend trauma-focused cognitive behavioural therapy as the primary approach to treat PTSD. However, Hoppen underscored a need for additional research to establish the long-term efficacy of such therapy.

The trials included in the meta-analysis comprised 10,684 participants with baseline data and 9,477 with post-treatment data. Thirty-four trials exclusively involved women, 15 trials exclusively involved men, and the remainder included mixed samples. The mean age of the participants across the trials was 40.2 years, ranging from 18.0 to 65.4 years. Twenty-three trials involved participants from low- and middle-income countries. Data on ethnicity were not extracted.