Abstract

Purpose: The long-term comparative effectiveness of psychotherapies for adults with posttraumatic stress disorder (PTSD) remains unclear. We conducted a network meta-analysis (NMA) to evaluate the effectiveness of various psychotherapies for adults with PTSD using randomized controlled trials (RCTs) and long-term follow-up measurements to extend existing evidence.

Methods: A comprehensive search was performed in the Cochrane Library, Embase, Medline-OVID, PubMed, Scopus, and PsycInfo databases, including studies on the effectiveness of psychotherapies—cognitive processing therapy (CPT), cognitive therapy (CT), eye movement desensitization and reprocessing (EMDR), narrative exposure therapy (NET), prolonged exposure (PE), cognitive behavioral therapy (CBT), present-centered therapy (PCT), brief eclectic psychotherapies (BEP), psychodynamic therapy (PDT), or combination therapies—compared to no treatment (NT) or treatment as usual (TAU) in adults with PTSD. A frequentist NMA model estimated therapy effect sizes as standardized mean differences (SMD) with 95% confidence intervals (CI) for comparisons, while the netrank function in R software ranked the therapies. Meta-regression models were analyzed using a Bayesian NMA model.

Results: Ninety-eight RCTs involving 5,567 participants were included. At immediate post-treatment, CPT, EMDR, CT, NET, PE, and CBT significantly reduced PTSD symptoms (SMD range: -1.53 to -0.83). Long-term follow-up analysis identified CPT (-0.85) and EMDR (-0.64) as the most effective therapies. NET and CPT had a higher proportion of loss of PTSD diagnosis (RR range: 5.51 to 3.45), while no psychotherapies showed a significant difference in retention rates compared to NT (RR range: 1.00 to 0.79).

Conclusions: CPT, EMDR, CT, NET, PE, CBT, and PCT were the most effective therapies for reducing PTSD symptoms, with large to moderate effects at post-treatment. Therapists' insights, developed through mutual understanding and long-term rapport with clients, should also be considered when delivering PTSD treatments. These findings support refining current guidelines and improving clinical decision-making, emphasizing that the best PTSD treatment plan should be tailored to the patient's needs, characteristics, and clinician expertise.

Notes

References:

Cohen, J. (2013). Statistical power analysis for the behavioral sciences. New York, NY: Routledge.

Faraone, S. V. (2008). Interpreting estimates of treatment effects: implications for managed care. Pharmacy and Therapeutics, 33(12), 700.

Lakens, D. (2013). Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Frontiers in Psychology, 4, 863.

Mavranezouli, I., Megnin-Viggars, O., Daly, C., Dias, S., Stockton, S., Meiser-Stedman, R., ... & Pilling, S. (2020). Research Review: Psychological and psychosocial treatments for children and young people with post-traumatic stress disorder: a network meta-analysis. Journal of Child Psychology and Psychiatry, 61(1), 18-29.

Merz, J., Schwarzer, G., & Gerger, H. (2019). Comparative efficacy and acceptability of pharmacological, psychotherapeutic, and combination treatments in adults with posttraumatic stress disorder: a network meta-analysis. JAMA Psychiatry, 76(9), 904-913.

R (Version 4.4.2) [Computer software]. (2020). Vienna, Austria: R Core Team. Available from https://www.R-project.org/.

Description

Our research findings offer insights from a network meta-analysis of 98 RCTs assessing the effectiveness of psychotherapies like CPT, EMDR, and CBT for treating PTSD, highlighting which therapies had the most significant impact on reducing symptoms and improving long-term patient outcomes

Author Details

Kuei-Ru Chou, PhD, FAAN, FFNMRCSI; Ninik Yunitri, PhD

Sigma Membership

Lambda Beta at-Large

Type

Poster

Format Type

Text-based Document

Study Design/Type

Meta-Analysis/Synthesis

Research Approach

Quantitative Research

Keywords:

Posttraumatic Stress Disorder, PTSD, Psychotherapies, Stress, Coping

Conference Name

36th International Nursing Research Congress

Conference Host

Sigma Theta Tau International

Conference Location

Seattle, Washington, USA

Conference Year

2025

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

Review Type

Abstract Review Only: Reviewed by Event Host

Acquisition

Proxy-submission

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Comparative Effectiveness of Psychotherapies for PTSD in Adults: A Network Meta-Analysis

Seattle, Washington, USA

Purpose: The long-term comparative effectiveness of psychotherapies for adults with posttraumatic stress disorder (PTSD) remains unclear. We conducted a network meta-analysis (NMA) to evaluate the effectiveness of various psychotherapies for adults with PTSD using randomized controlled trials (RCTs) and long-term follow-up measurements to extend existing evidence.

Methods: A comprehensive search was performed in the Cochrane Library, Embase, Medline-OVID, PubMed, Scopus, and PsycInfo databases, including studies on the effectiveness of psychotherapies—cognitive processing therapy (CPT), cognitive therapy (CT), eye movement desensitization and reprocessing (EMDR), narrative exposure therapy (NET), prolonged exposure (PE), cognitive behavioral therapy (CBT), present-centered therapy (PCT), brief eclectic psychotherapies (BEP), psychodynamic therapy (PDT), or combination therapies—compared to no treatment (NT) or treatment as usual (TAU) in adults with PTSD. A frequentist NMA model estimated therapy effect sizes as standardized mean differences (SMD) with 95% confidence intervals (CI) for comparisons, while the netrank function in R software ranked the therapies. Meta-regression models were analyzed using a Bayesian NMA model.

Results: Ninety-eight RCTs involving 5,567 participants were included. At immediate post-treatment, CPT, EMDR, CT, NET, PE, and CBT significantly reduced PTSD symptoms (SMD range: -1.53 to -0.83). Long-term follow-up analysis identified CPT (-0.85) and EMDR (-0.64) as the most effective therapies. NET and CPT had a higher proportion of loss of PTSD diagnosis (RR range: 5.51 to 3.45), while no psychotherapies showed a significant difference in retention rates compared to NT (RR range: 1.00 to 0.79).

Conclusions: CPT, EMDR, CT, NET, PE, CBT, and PCT were the most effective therapies for reducing PTSD symptoms, with large to moderate effects at post-treatment. Therapists' insights, developed through mutual understanding and long-term rapport with clients, should also be considered when delivering PTSD treatments. These findings support refining current guidelines and improving clinical decision-making, emphasizing that the best PTSD treatment plan should be tailored to the patient's needs, characteristics, and clinician expertise.