Psychological interventions for ICD-11 Complex PTSD symptoms: Systematic review and meta-analysis

Thanos Karatzias, Philip Murphy, Marylene Cloitre, Jonathan I. Bisson, Neil Roberts, M Shevlin, Philip Hyland, Andreas Maercker, Menachem Ben-Ezra, Peter Coventry, Susan Mason-Roberts, Aoife Bradley, Paul Hutton

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Abstract

BackgroundThe 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions.MethodsWe conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality.ResultsFifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = -0.90 (CBT; k = 27, 95% CI -1.11 to -0.68; moderate quality) to g = -1.26 (EMDR; k = 4, 95% CI -2.01 to -0.51; low quality). CBT and EA each had moderate-large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate-large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome.ConclusionsThe development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.

LanguageEnglish
Pages1761-1775
Number of pages15
JournalPsychological Medicine
Volume49
Issue number11
Early online date12 Mar 2019
DOIs
Publication statusPublished - 1 Aug 2019

Fingerprint

Post-Traumatic Stress Disorders
Eye Movement Desensitization Reprocessing
Meta-Analysis
Psychology
Cognitive Therapy
Randomized Controlled Trials
Self Concept
Patient Preference
International Classification of Diseases
MEDLINE
Outcome Assessment (Health Care)
Databases
Wounds and Injuries
Research

Keywords

  • CPTSD,
  • psychological therapies,
  • childhood trauma,
  • systematic review, meta-analysis, randomised controlled trials
  • randomised controlled trials
  • meta-analysis
  • systematic review
  • Childhood trauma
  • CPTSD
  • psychological therapies

Cite this

Karatzias, Thanos ; Murphy, Philip ; Cloitre, Marylene ; Bisson, Jonathan I. ; Roberts, Neil ; Shevlin, M ; Hyland, Philip ; Maercker, Andreas ; Ben-Ezra, Menachem ; Coventry, Peter ; Mason-Roberts, Susan ; Bradley, Aoife ; Hutton, Paul . / Psychological interventions for ICD-11 Complex PTSD symptoms: Systematic review and meta-analysis. In: Psychological Medicine. 2019 ; Vol. 49, No. 11. pp. 1761-1775.
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abstract = "BackgroundThe 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions.MethodsWe conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality.ResultsFifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = -0.90 (CBT; k = 27, 95{\%} CI -1.11 to -0.68; moderate quality) to g = -1.26 (EMDR; k = 4, 95{\%} CI -2.01 to -0.51; low quality). CBT and EA each had moderate-large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate-large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome.ConclusionsThe development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.",
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author = "Thanos Karatzias and Philip Murphy and Marylene Cloitre and Bisson, {Jonathan I.} and Neil Roberts and M Shevlin and Philip Hyland and Andreas Maercker and Menachem Ben-Ezra and Peter Coventry and Susan Mason-Roberts and Aoife Bradley and Paul Hutton",
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Karatzias, T, Murphy, P, Cloitre, M, Bisson, JI, Roberts, N, Shevlin, M, Hyland, P, Maercker, A, Ben-Ezra, M, Coventry, P, Mason-Roberts, S, Bradley, A & Hutton, P 2019, 'Psychological interventions for ICD-11 Complex PTSD symptoms: Systematic review and meta-analysis', Psychological Medicine, vol. 49, no. 11, pp. 1761-1775. https://doi.org/10.1017/S0033291719000436

Psychological interventions for ICD-11 Complex PTSD symptoms: Systematic review and meta-analysis. / Karatzias, Thanos; Murphy, Philip; Cloitre, Marylene; Bisson, Jonathan I.; Roberts, Neil; Shevlin, M; Hyland, Philip; Maercker, Andreas; Ben-Ezra, Menachem; Coventry, Peter ; Mason-Roberts, Susan ; Bradley, Aoife ; Hutton, Paul .

In: Psychological Medicine, Vol. 49, No. 11, 01.08.2019, p. 1761-1775.

Research output: Contribution to journalArticle

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T1 - Psychological interventions for ICD-11 Complex PTSD symptoms: Systematic review and meta-analysis

AU - Karatzias, Thanos

AU - Murphy, Philip

AU - Cloitre, Marylene

AU - Bisson, Jonathan I.

AU - Roberts, Neil

AU - Shevlin, M

AU - Hyland, Philip

AU - Maercker, Andreas

AU - Ben-Ezra, Menachem

AU - Coventry, Peter

AU - Mason-Roberts, Susan

AU - Bradley, Aoife

AU - Hutton, Paul

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Y1 - 2019/8/1

N2 - BackgroundThe 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions.MethodsWe conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality.ResultsFifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = -0.90 (CBT; k = 27, 95% CI -1.11 to -0.68; moderate quality) to g = -1.26 (EMDR; k = 4, 95% CI -2.01 to -0.51; low quality). CBT and EA each had moderate-large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate-large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome.ConclusionsThe development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.

AB - BackgroundThe 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions.MethodsWe conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality.ResultsFifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = -0.90 (CBT; k = 27, 95% CI -1.11 to -0.68; moderate quality) to g = -1.26 (EMDR; k = 4, 95% CI -2.01 to -0.51; low quality). CBT and EA each had moderate-large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate-large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome.ConclusionsThe development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.

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KW - meta-analysis

KW - systematic review

KW - Childhood trauma

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KW - psychological therapies

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