Fifty-seven RCTs (n=3,947, range 12 to 360) were included in the review. Dropout rates varied between trials and were reported in the review.
Post-traumatic stress disorder: Individual trauma-focused CBT with an emphasis on exposure (25 RCTs) showed greater improvements in PTSD symptoms compared with waiting list (six RCTs), psycho-education (two RCTs) and no treatment monitoring, repeated assessments, minimal attention and treatment as usual (one RCT each). Nine RCTs reported maintenance of treatment gains up to one year of follow-up. One RCT reported maintenance at five-year follow-up.
Individual trauma-focused CBT with cognitive restructuring (four RCTs): Two RCTs showed a reduction in PTSD symptoms. One RCT showed maintenance up to five years.
Trauma-focused CBT with cognitive restructuring plus exposure (25 RCTs) showed significant improvements in PTSD symptoms compared to waiting list (12 RCTs), minimal attention (one RCT) and repeated assessments and a self-help booklet (one RCT). Improvements were generally maintained up to 12 months follow-up (12 RCTs). Reductions in PTSD symptoms were similar for combined trauma-focused CBT and paroxetine (a selective serotonin reuptake inhibitor) in mixed trauma patients (one RCT).
Stress management (six RCTs): Two RCTs showed significantly greater improvements in PTSD symptoms in assault survivors who received stress inoculation training compared to waiting list; this was maintained at 12-month follow-up in one RCT. Relaxation training was significantly less beneficial compared to trauma-focused CBT with exposure (two RCTs), cognitive restructuring of maladaptive trauma-related beliefs (one RCT) or a combination of both (two RCTs) in assault or abuse and mixed trauma patients.
Group CBT (three RCTs): CBT alone or in combination with individual trauma-focused CBT showed significantly greater reductions in PTSD symptoms compared to waiting list (one RCT) or a minimal attention waiting list condition (one RCT) in survivors of childhood abuse. One RCT showed improved outcomes in refugees who received group CBT plus selective serotonin reuptake inhibitor sertraline.
EMDR (13 RCTs): EMDR showed greater reduction in PTSD symptoms compared to waiting list (four RCTs), standard care (two RCTs) and pill placebo (one RCT) in assault survivors, combat veterans and mixed trauma patients. At six months follow-up EMDR showed greater reduction in PTSD symptoms compared to fluoxetine (one RCT). Conflicting findings were reported for EMDR compared to stress management involving relaxation (two RCTs) and mixed findings were reported for EMDR compared to trauma-focused CBT (seven RCTs).
Other psychological treatments: No statistically significant differences in PTSD symptoms were reported for family therapy in patients with combat-related PTSD (one RCT). One RCT showed significant improvements in survivors of assault or abuse who received group interpersonal therapy compared to waiting list; this was no longer significant at four months follow-up. Mixed findings were reported for supportive counselling (eight RCTs).
Acute stress disorder: Trauma-focused CBT alone or in combination with hypnosis was significantly more effective in preventing PTSD in mixed trauma patients with acute stress disorder compared to supportive counselling (one RCT). This remained up to three-year follow-up. Another RCT showed greater benefit with imaginal and in vivo exposure compared to waiting list and cognitive restructuring in a similar population.
The number of patients no longer meeting diagnostic criteria for PTSD was reported in the review.