Cognitive behavior therapy for adult post-traumatic stress disorder in routine clinical care: A systematic review and meta-analysis

Lars-Göran Öst; Pia Enebrink; Anna Finnes; Ata Ghaderi; Audun Havnen; Gerd Kvale; Sigrid Salomonsson; Gro Janne Wergeland

doi:10.1016/j.brat.2023.104323

Cognitive behavior therapy for adult post-traumatic stress disorder in routine clinical care: A systematic review and meta-analysis

Behav Res Ther. 2023 Jul:166:104323. doi: 10.1016/j.brat.2023.104323. Epub 2023 May 4.

Authors

Lars-Göran Öst¹, Pia Enebrink², Anna Finnes³, Ata Ghaderi², Audun Havnen⁴, Gerd Kvale⁵, Sigrid Salomonsson⁶, Gro Janne Wergeland⁷

Affiliations

¹ Department of Psychology, Stockholm University, Sweden; Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Electronic address: ost@psychology.su.se.
² Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
³ Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Academic Primary Care Center, Region Stockholm, Sweden.
⁴ Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Division of Psychiatry, St. Olavs Hospital, Trondheim, Norway.
⁵ Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Norway.
⁶ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
⁷ Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway.

PMID: 37257304
DOI: 10.1016/j.brat.2023.104323

Abstract

Although different cognitive behavioral therapies (CBT) have strong research support for treatment of adult post-traumatic stress disorder (PTSD) more knowledge is needed about the performance of CBT in routine clinical care. The present study is a systematic review and meta-analysis of CBT for PTSD in adults treated in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for studies published until the end of May 2022. The effectiveness of CBT, methodological quality, and moderators of treatment outcome were examined, and benchmarked by meta-analytically comparing with efficacy studies for PTSD. Thirty-three studies, comprising 6482 participants, were included. The within-group effect sizes (ES) for PTSD-severity at post-treatment (1.75), and follow-up (1.70), on average 6 months post-treatment, were large. The effectiveness studies had very similar ESs as efficacy studies at post-treatment (1.75 vs. 1.72) and follow-up (1.70 vs. 2.02), based on the benchmarking analysis. As the heterogeneity was large, we can only cautiously consider CBT for PTSD an effective treatment when delivered in routine clinical care. The outcomes of effectiveness studies for PTSD seem to be comparable to the results obtained in efficacy studies. PROSPERO REGISTRATION ID: CRD42021228828.

Keywords: Adults; Cognitive behavior therapy; Effectiveness; Meta-analysis; Post-traumatic stress disorder.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adult
Cognitive Behavioral Therapy* / methods
Humans
Psychotherapy / methods
Stress Disorders, Post-Traumatic* / psychology
Stress Disorders, Post-Traumatic* / therapy
Treatment Outcome