Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively we will endeavour to conduct our own review to fill this gap in the Library.

October 2021

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Treatment guidelines typically recommend psychological treatments as first-line treatment for PTSD. Cognitive behavioural therapy (CBT) is one of the most common psychological treatments. CBT challenges distorted, negative thinking patterns associated with the trauma to help people develop more adaptive cognitions and behaviours. It also assists people to rethink assumptions and reactions to the event. Exposure therapies aim to desensitise people to trauma-related memories. This helps overcome symptoms by exposure to specific or non-specific cues or memories related to the trauma. Eye movement desensitisation and reprocessing (EMDR) involves the patient focussing on a disturbing image, memory, emotion, or cognition associated with the trauma while the therapist initiates rapid voluntary eye movements. This is based on the observation that the intensity of traumatic memories can be reduced through eye movements, although how this occurs remain unclear. Other common therapies include narrative therapy, which can help people reconstruct a consistent narrative about the trauma, and supportive therapy, which involves giving support, listening, and helping.

What is the evidence for psychotherapy for PTSD?

Moderate to low quality evidence found large improvements in PTSD symptoms for up to 20 months after treatment with any psychological and combined psychological plus medication treatments compared to medications alone. These improvements were largest in military samples and in people exposed to childhood abuse.

There were large improvements in PTSD symptoms, depression, and anxiety for up to four weeks post-treatment with psychological therapies in adults exposed to humanitarian crises in low and middle-income countries. Smaller, but significant improvements were found for up to 6 months. There were improvements in children in these settings, particularly in children aged 15-18 years, in non-displaced children, and in children living in smaller households (<6 members). Functioning, hope, coping, and social support also improved. There were no improvements in depression and anxiety post-treatment and at follow up (≥6 weeks) in children in these settings.

Moderate quality evidence found CBT with or without a trauma focus, EMDR, prolonged exposure, cognitive processing therapy, narrative exposure therapy, cognitive therapy, present-centred therapy, and virtual reality therapy all showed greater improvements in PTSD symptoms than waitlist or treatment as usual. Moderate to low quality evidence found CBT with a trauma focus was more effective for PTSD symptoms than present-centred therapy, supportive counselling, relaxation training, dialogical exposure therapy, and interpersonal therapy.

August 2021

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Animal-assisted psychotherapy is a goal-directed intervention involving an animal as part of the treatment process. It is usually delivered by a health service professional with specialised expertise and is designed to improve mental and physical health. Studies have shown that being around animals can decrease blood pressure, physiological arousal, and cardiopulmonary pressure. It may also improve trauma symptoms.

What is the evidence for animal-assisted psychotherapy?

Moderate to low quality evidence found a large improvement in PTSD, depression, and anxiety symptoms with animal-assisted therapy (pre-post analysis, mostly utilising group sessions with horses). The effect was medium-sized when compared to control conditions. The following factors were associated with largest effects; studies conducted in Australia (rather than the US or Spain), the intervention provider was someone other than a psychologist, psychiatrist, or therapist, interventions with additional in-clinic individual therapy, studies with more women, group interventions, and interventions delivered outside.

August 2021

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Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively we will endeavour to conduct our own review to fill this gap in the Library.

August 2021

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CBT is one of the most common psychological treatments for mental disorders. CBT covers a range of therapies including the core components of cognitive restructuring and/or a behavioural therapy. It can also include exposure therapy, and newer therapies such as acceptance and commitment therapy and metacognitive therapy. For PTSD, CBT challenges distorted, negative thinking patterns associated with the trauma. This helps people develop more adaptive cognitions and behaviours, and to rethink assumptions and reactions to the event.

What is the evidence for CBT for PTSD?

Moderate quality evidence found between 53% and 63% of adults remitted after treatment with CBT. Individual, trauma-focussed CBT was the most effective for PTSD symptoms (large effects), as well as for altered cognition, sleep, depression and anxiety, compared to no treatment or nonspecific therapies. These improvements in PTSD symptoms lasted for over 12 months. Females showed greater improvement than males, and internet-delivered CBT also improved symptoms, particularly when guided by a therapist.

In children and adolescents with PTSD, there were large improvements in symptoms with individual trauma-focussed CBT, combined trauma-focussed CBT plus parent training, Cohen trauma-focussed CBT/cognitive processing therapy, and group CBT.

In people with complex PTSD, there was a large improvement in PTSD symptoms with CBT with or without exposure therapy compared to standard care/waitlist, and a small to medium-sized improvement when compared to nonspecific therapies. CBT also improved symptoms particularly pertaining to complex PTSD; disturbances in relationships, affect dysregulation, and negative self-concept when compared to standard care/waitlist (medium to large effects). CBT also improved disturbances in relationships when compared to nonspecific therapies (small effect).

Moderate quality evidence found factors associated with uptake of trauma-focussed CBT were (in descending order of effect); adaptability of staff workflow to CBT, veteran affairs service connection, staff familiarity with trauma-focussed CBT, mental health referral source, patient interest in trauma-centred treatment, Vietnam veterans, older age, increased PTSD severity, comorbid depression, female gender, black or racial-ethnic minority, and previous psychotherapy.

August 2021

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The post Cognitive behavioural therapy appeared first on NeuRA Library.

Cognitive therapies are based on the theory that an individual’s perception of a situation influences his or her emotional response to it. They aim to help people identify distorted thinking and to modify existing beliefs. Cognitive processing therapy is a type of cognitive therapy that involves psychoeducation, written accounts about the traumatic event, and cognitive restructuring to address beliefs about the event’s meaning and its implications. Cognitive restructuring aims to facilitate relearning thoughts and beliefs generated from a traumatic event. This increases awareness of dysfunctional trauma-related thoughts, and corrects or replaces those thoughts with more adaptive and rational cognitions.

What is the evidence for cognitive therapies for PTSD?

Moderate to low quality evidence found large improvements in PTSD and depression symptoms with cognitive therapy compared to no treatment or usual care. There were no differences in symptoms when comparing cognitive therapy with exposure therapy.

Moderate quality evidence found large improvements in PTSD and depression symptoms with cognitive processing therapy compared to no treatment or usual care. These improvements were maintained for up to 12 months. Females showed greater improvements than males following cognitive processing therapy. When compared to active control conditions (mainly exposure therapies), the effect was small immediately post-treatment. It was not maintained at follow-up. Moderate to high quality evidence found a large improvement in negative, trauma-related cognitions immediately following cognitive processing therapy.

August 2021

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Creative arts therapy allows thoughts and feelings about trauma to be expressed non-verbally. Visual and musical artistic expressions, as well as the body itself, are used to recall the traumatic memory and to symbolise the pain and suffering resulting from trauma. Proposed mechanisms by which creative art therapies may improve PTSD include relaxation, expression of memories and emotions that are difficult to put into words, containment of traumatic material within a creative art product may provide a sense of control, symbolic expression may make progressive exposure more tolerable, and creation may build self-esteem and reduce emotional numbness.

What is the evidence for creative art therapy?

Low quality evidence is unable to determine any benefit of creative arts therapy for PTSD symptoms. Review authors conclude that trials with greater scientific rigor are needed in this area.

August 2021

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Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively we will endeavour to conduct our own review to fill this gap in the Library.

October 2021

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The post Emotion-focussed therapies appeared first on NeuRA Library.

Emotional freedom techniques use established exposure methods and cognitive processing, along with stimulation of acupoints. During treatment, the client remembers a traumatic memory or emotional trigger and pairs it with cognitive reframing while tapping, holding, or massaging a set of acupoints. The tapping may help access the body’s energy and send signals to the part of the brain that controls stress. Rounds of mental exposure, cognitive processing, and acupoint stimulation are repeated until the client can bring the memory to mind with little or no subjective distress.

What is the evidence for emotional freedom techniques?

Moderate to low quality evidence found a large improvement in PTSD symptoms after treatment with emotional freedom techniques. However, individual studies found no advantage for these techniques over other psychosocial interventions such as cognitive behavioural therapy.

August 2021

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Exposure therapies help people confront their fear in a safe environment. In vivo exposure involves directly facing a feared object, situation, or activity. Imaginal exposure involves vividly imagining the feared factors, while virtual reality exposure uses technology to imitate the feared factors. Graded exposure involves ranking the feared factors according to difficulty, with the mild factors exposed first. Flooding also uses this hierarchy but begins with the most difficult tasks. Systematic desensitisation combines exposure with relaxation to associate the feared factors with being relaxed.

Exposure therapy can help weaken previously learned associations between feared factors and bad outcomes. It can help show people that they can confront their fears and manage feelings of anxiety. People can learn to attach more realistic beliefs about the feared factors, and they can become more comfortable with the experience of fear.

What is the evidence for exposure therapies for PTSD?

Moderate quality evidence found large effects of reduced PTSD and depressive symptoms, and more loss of PTSD diagnosis with exposure therapies than with waitlist or usual care. There was a medium-sized effect of greater improvements in PTSD and depressive symptoms with prolonged exposure therapy than with relaxation.

Moderate quality evidence found large effects of reduced PTSD symptoms and general subjective stress with prolonged exposure therapy compared to control conditions. These effects were reduced at the 12-months follow-up. Larger effects were found when the comparison was with waitlist/no treatment than when the comparison was with a psychological placebo (e.g., treatment as usual). There were no differences in symptoms between prolonged exposure therapy and active treatments (e.g., cognitive therapies).

Moderate quality evidence found medium-sized effects of improved PTSD and depression symptoms with virtual reality exposure therapy compared to inactive controls (no treatment, treatment as usual, waitlist, or attention placebo). More treatment sessions were associated with larger effect sizes, and effects remained for up to 12 months. There were no differences in symptom improvements between virtual reality exposure therapy and active controls (CBT, prolonged exposure, or present-centred group therapy).

Moderate to low quality evidence found large effects of reduced PTSD symptom severity with narrative and prolonged exposure therapies compared to waitlist/no treatment in children and adolescents. At 1-4 months post-treatment narrative exposure therapy continued to show a large effect in children and adolescents.

August 2021

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