Ten trials with 881 participants were included in the review. Sample sizes ranged from 24 to 183. All trials were rated as high quality. All the trials used widely-used measurement scales and appropriate analytic methods and took steps to ensure intervention integrity. However, drop-out rates ranged from 22% to over 70% in seven trials. One trial did not blind outcomes assessment. Tt was unclear whether assessment was blinded in four trials.
Pooled estimates were similar regardless of the criteria used to define the cognitive behavioural therapy intervention; the authors focused on the analyses that used the most inclusive definition of the intervention. When all trials were pooled, the intervention was associated with significant reduction in post-traumatic stress symptoms compared with all control conditions, immediately after treatment (moderate effect size: 0.671, 95% CI 0.527 to 0.815; 10 RCTs) and at 12-month follow-up (modest effect size: 0.389, 95% CI 0.149 to 0.630; three RCTs).
Findings for depression and behaviour problems showed a small positive effect from the intervention immediately after treatment (10 RCTs), but findings were no longer significant at 12 months (three RCTs).
When trauma-focused cognitive behavioural therapy was compared with an active comparison immediately after treatment, there was no significant difference between the groups for any outcome (two RCTs).