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Child Psychiatrist /Adult Psychiatrist

Psychotherapy for PTSD Effective Even After Multiple Traumas

Psychotherapy for posttraumatic stress disorder (PTSD) is as effective in cases involving multiple traumatic events as it is in those with a single trauma, a new meta-analysis of randomized clinical trials (RCTs) showed.

Psychotherapy for PTSD

Investigators said this is the first study of its kind to compare the efficacy of psychological interventions in single-event PTSD vs multiple-event PTSD.

When compared with control conditions at the treatment endpoint, moderate benefits were reported in both groups of patients, with little difference between the two. Researchers also found that trauma-focused cognitive behavioral therapy (CBT) was more effective than non-trauma–based psychotherapy for PTSD with multiple traumatic events.

"Some therapists believe that trauma-focused interventions are not appropriate for individuals who have been through multiple traumas," investigators, led by Thole Hoppen, PhD, of the University of Münster in Münster, Germany, said. "The finding of this meta-analysis could be used in therapist training to highlight the large body of evidence that contradicts such misconceptions."

A Vulnerable Population

Hoppen and his team analyzed the results of 137 RCTs with 10,600 individuals (54% female, mean age, 40).

The trials compared the efficacy by time — short-term or treatment endpoint, mid-term or ≤ 5 months, or long-term or > 5 months — of different types of psychotherapy vs one another or vs control treatment on PTSD symptoms stemming from single or multiple events.

Trials involving individuals with comorbid PTSD and substance abuse orders or comorbid traumatic brain injury were excluded from the analysis, and clinician-administered PTSD outcome assessments were prioritized over self-report-based ones when both were reported.

At treatment endpoint, psychotherapy was highly efficacious for PTSD when compared with passive control conditions in both samples with single-trauma events and multiple trauma events, with no statistically significant difference in efficacy.

When analyzing benefits of specific psychotherapies in multiple trauma trials, trauma-focused CBT and eye movement desensitization and reprocessing therapy offered similar short-term results, while trauma-focused CBT yielded larger efficacy than non-trauma–focused interventions.

Investigators noted that because multiple traumas can be associated with worse PTSD presentation, "the finding that this vulnerable population nevertheless responds well to intervention is encouraging."

Dispelling Misconceptions

In an accompanying editorial, Maria Bragesjö, PhD, Karolinska Institutet, Stockholm, Sweden, noted that the study advances clinicians' understanding of PTSD treatment and "serves as a powerful catalyst, challenging prevailing stigmas and misconceptions."

She added that by "dispelling misconceptions about the efficacy of trauma-focused interventions for individuals with multiple trauma histories, this meta-analysis contributes substantially to reshaping the landscape of PTSD treatment strategies, fostering a more comprehensive and inclusive treatment approach."

Limitations of the meta-analysis included a shortage of studies that reported the number of total traumatic events and more detailed information about treatment effects.

This article originally appeared on Medscape

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