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      Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis Translated title: Terapias psicológicas para el trastorno de estrés postraumático en adultos: revisión sistemática y metaanálisis Translated title: 成人创伤后应激障碍的心理治疗:系统综述和元分析

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          ABSTRACT

          Background: Psychological therapies are the recommended first-line treatment for post-traumatic stress disorder (PTSD). Previous systematic reviews have grouped theoretically similar interventions to determine differences between broadly distinct approaches. Consequently, we know little regarding the relative efficacy of the specific manualized therapies commonly applied to the treatment of PTSD.

          Objective: To determine the effect sizes of manualized therapies for PTSD.

          Methods: We undertook a systematic review following Cochrane Collaboration guidelines. A pre-determined definition of clinical importance was applied to the results and the quality of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.

          Results: 114 randomized-controlled trials (RCTs) of 8171 participants were included. There was robust evidence that the therapies broadly defined as CBT with a trauma focus (CBT-T), as well as Eye Movement Desensitization and Reprocessing (EMDR), had a clinically important effect. The manualized CBT-Ts with the strongest evidence of effect were Cognitive Processing Therapy (CPT); Cognitive Therapy (CT); and Prolonged Exposure (PE). There was also some evidence supporting CBT without a trauma focus; group CBT with a trauma focus; guided internet-based CBT; and Present Centred Therapy (PCT). There was emerging evidence for a number of other therapies.

          Conclusions: A recent increase in RCTs of psychological therapies for PTSD, results in a more confident recommendation of CBT-T and EMDR as the first-line treatments. Among the CBT-Ts considered by the review CPT, CT and PE should be the treatments of choice. The findings should guide evidence informed shared decision-making between patient and clinician.

           

          Objetivo: determinar los tamaños del efecto de las terapias manualizadas para el TEPT.

          Métodos: Realizamos una revisión sistemática siguiendo las guías de la Colaboración Cochrane. Se aplicó una definición predeterminada de importancia clínica a los resultados y se evaluó la calidad de la evidencia utilizando el enfoque de calificación de recomendaciones, evaluación, desarrollo y evaluaciones (GRADE).

          Resultados: se incluyeron 114 ensayos controlados aleatorizados (ECA) de 8.171 participantes. Hubo evidencia robusta de que las terapias ampliamente definidas como TCC con un enfoque de trauma (TCC-T), así como la desensibilización y reprocesamiento POR movimientos oculares (EMDR), tuvieron un efecto clínicamente importante. Las CBT-Ts manualizados con la mayor evidencia de efecto fueron la terapia de procesamiento cognitivo (CPT); Terapia cognitiva (CT); y exposición prolongada (PE). También hubo alguna evidencia que apoya la TCC sin un enfoque traumático; TCC grupal con enfoque en trauma; TCC basada en Internet guiada; y terapia centrada en el presente (PCT). Hubo evidencia emergente para una serie de otras terapias.

          Conclusiones: Un aumento reciente en ECA de terapias psicológicas para el TEPT, da como resultado una recomendación más confiable de CBT-T y EMDR como los tratamientos de primera línea. Entre los CBT-Ts considerados por la revisión CPT, CT y PE deberían ser los tratamientos de elección. Los hallazgos deben guiar la toma de decisiones compartida informada por la evidencia entre el paciente y el médico.

           

          目的: 确定创伤后应激障碍的规范疗法的效应量大小。

          方法: 我们按照Cochrane协作指南进行了系统综述。临床重要性的预定义用于结果中, 并使用‘建议, 评估, 发展和评估等级’ (GRADE) 方法评估证据的质量。

          结果: 纳入了8171名参与者的114项随机对照试验 (RCT) 。有力的证据表明, 广泛定义为创伤中心CBT (CBT-T) 以及眼动脱敏再加工 (EMDR) 疗法具有重要的临床效果。效果最强的CBT-T是认知加工疗法 (CPT), 认知疗法 (CT), 和延长暴露 (PE) 。也有一些证据支持非创伤中心的CBT, 以创伤中心的团体CBT, 有指导的基于互联网的CBT, 现实中心疗法 (PCT) 。越来越多的证据表明存在其他许多疗法。

          结论: 创伤后应激障碍心理治疗的RCT最近增加, 结果更加支持CBT-T和EMDR作为一线治疗方法。在本综述考虑的CBT-T中, CPT, CT和PE应该是首选的治疗方法。研究结果应指导患者和临床医生之间循证知情的共同决策。

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          Most cited references110

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          The development of a Clinician-Administered PTSD Scale.

          Several interviews are available for assessing PTSD. These interviews vary in merit when compared on stringent psychometric and utility standards. Of all the interviews, the Clinician-Administered PTSD Scale (CAPS-1) appears to satisfy these standards most uniformly. The CAPS-1 is a structured interview for assessing core and associated symptoms of PTSD. It assesses the frequency and intensity of each symptom using standard prompt questions and explicit, behaviorally-anchored rating scales. The CAPS-1 yields both continuous and dichotomous scores for current and lifetime PTSD symptoms. Intended for use by experienced clinicians, it also can be administered by appropriately trained paraprofessionals. Data from a large scale psychometric study of the CAPS-1 have provided impressive evidence of its reliability and validity as a PTSD interview.
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            • Record: found
            • Abstract: found
            • Article: not found

            Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse.

            Fifty-eight women with posttraumatic stress disorder (PTSD) related to childhood abuse were randomly assigned to a 2-phase cognitive-behavioral treatment or a minimal attention wait list. Phase 1 of treatment included 8 weekly sessions of skills training in affect and interpersonal regulation; Phase 2 included 8 sessions of modified prolonged exposure. Compared with those on wait list, participants in active treatment showed significant improvement in affect regulation problems, interpersonal skills deficits, and PTSD symptoms. Gains were maintained at 3- and 9-month follow-up. Phase 1 therapeutic alliance and negative mood regulation skills predicted Phase 2 exposure success in reducing PTSD, suggesting the value of establishing a strong therapeutic relationship and emotion regulation skills before exposure work among chronic PTSD populations.
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              • Record: found
              • Abstract: found
              • Article: not found

              Cognitive therapy for post-traumatic stress disorder: development and evaluation.

              The paper describes the development of a cognitive therapy (CT) program for post-traumatic stress disorder (PTSD) that is based on a recent cognitive model (Behav. Res. Therapy 38 (2000) 319). In a consecutive case series, 20 PTSD patients treated with CT showed highly significant improvement in symptoms of PTSD, depression and anxiety. A subsequent randomized controlled trial compared CT (N = 14) and a 3-month waitlist condition (WL, N = 14). CT led to large reductions in PTSD symptoms, disability, depression and anxiety, whereas the waitlist group did not improve. In both studies, treatment gains were well maintained at 6-month follow-up. CT was highly acceptable, with an overall dropout rate of only 3%. The intent-to-treat effect sizes for the degree of change in PTSD symptoms from pre to post-treatment were 2.70-2.82 (self-report), and 2.07 (assessor-rated). The controlled effect sizes for CT versus WL post-treatment scores were 2.25 (self-report) and 2.18 (assessor-rated). As predicted by the cognitive model, good treatment outcome was related to greater changes in dysfunctional post-traumatic cognitions. Patient characteristics such as comorbidity, type of trauma, history of previous trauma, or time since the traumatic event did not predict treatment response, however, low educational attainment and low socioeconomic status were related to better outcome.
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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                ZEPT
                zept20
                European Journal of Psychotraumatology
                Taylor & Francis
                2000-8198
                2000-8066
                2020
                10 March 2020
                : 11
                : 1
                : 1729633
                Affiliations
                [a ]National Centre for Mental Health (NCMH), Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine , Cardiff, UK
                [b ]Directorate of Psychology and Psychological Therapies, Cardiff & Vale University Health Board , Cardiff, UK
                [c ]Cardiff Traumatic Stress Service, Cardiff & Vale University Health Board , Cardiff, UK
                Author notes
                CONTACT Catrin Lewis LewisCE7@ 123456Cardiff.ac.uk Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine , Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK

                Work conducted at the Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK

                Author information
                http://orcid.org/0000-0002-3818-9377
                http://orcid.org/0000-0002-6277-0102
                http://orcid.org/0000-0001-5170-1243
                Article
                1729633
                10.1080/20008198.2020.1729633
                7144187
                32284821
                807cf9eb-d5be-4aa8-8706-4c45c34637c2
                © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 October 2019
                : 23 December 2019
                : 24 January 2020
                Page count
                Figures: 1, Tables: 4, References: 140, Pages: 22
                Funding
                Funded by: unfunded
                This work was unfunded.
                Categories
                Reviews that informed the ISTSS guidelines update

                Clinical Psychology & Psychiatry
                ptsd,systematic review,psychological therapy,tept,revisión sistemática,terapia psicológica,系统评价,心理治疗,• this review informed the latest istss treatment guidelines. it summarises the current evidence-base in relation to the effect of specific therapies for ptsd.

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