Study designs of evaluations included in the review
Clinical trials were eligible for inclusion if they used a comparison group and provided inferential statistics for the calculation of effect sizes. The follow-up periods ranged from 3 months to 2 years after the treatment had finished.
Specific interventions included in the review
The inclusion criteria were not defined in terms of interventions. The predominant psychotherapeutic modalities were behavioural and cognitive behavioural interventions. The following interventions were included: direct therapeutic exposure; eye movement desensitisation or reprocessing; biofeedback-assisted desensitisation; a brief prevention programme; applied muscle relaxation; anger treatment; the Coatsville Tx programme; cognitive processing therapy; combat stress reaction; exposure without eye movement; image habituation training; prolonged exposure; the Salem Tx programme; and the Koach programme. In-patient and residential programmes were also included.
The control interventions included: standard treatment, i.e. supportive counselling or no exposure; a waiting-list; and assessment.
Participants included in the review
Only studies that were performed predominately on participants who met the American Psychiatric Association's threshold DSM-III, III-R, or IV criteria for PTSD were eligible for inclusion. Victimised or traumatised people were excluded unless the participants met the criteria for PTSD. The participants included were: Vietnam veterans; Israeli combat veterans; female rape or assault victims; and men and women who were victims of violent crimes, motor vehicle accidents, or who suffered PTSD from the traumatic loss of a loved one.
Outcomes assessed in the review
Five categories of objective measures of outcome were assessed: intrusion, hyperarousal, avoidance, depression and anxiety.
Intrusion included measures from the PTSD Structured Interview, the intrusion scale of the Impact of Event Scale, clinical interview ratings or intrusive experiences, the sleep disturbance subscale of the Modified Vietnam Experiences Questionnaire, and other self-reports of nightmares or flashbacks.
Hyperarousal included self-reports, interviewer ratings, and/or psychological test results of arousal, anxiety, electromyographic activity, heart rate, and skin conductance in response to stressful images; and scores on the arousal subscale of the PTSD Symptom Scale.
Avoidance included interviewer ratings of avoidance, and scores on the avoidance subscales of the PTSD Symptom Scale and Impact of Event Scale.
Depression included scores from the Hamilton Rating Scale for Depression, the Beck Depression Inventory, and the depression subscale of the Symptom Checklist 90-Revised.
Anxiety included scores from the state version of the State-Trait Anxiety Inventory and the anxiety subscale of the Symptom Checklist 90-Revised.
Global personality and trait measures were not assessed.
How were decisions on the relevance of primary studies made?
The author does not state how the papers were selected for the review, or how many of the reviewers performed the selection.