The U.S. Department of Veterans Affairs and the Department of Defense published a clinical practice guideline in 2017 for the management of posttraumatic stress disorder (PTSD) and acute stress disorder.
Knowles KA, Sripada RK, Defever M, and Rauch SAM published 'Comorbid mood and anxiety disorders and severity of posttraumatic stress disorder symptoms in treatment-seeking veterans' in Psychological Trauma: Theory, Research, Practice, and Policy in 2019.
A 2022 randomized clinical trial by Vera et al. was the first study to examine the efficacy of prolonged exposure therapy specifically in a population of Spanish-speaking Latinos with PTSD, aiming to address treatment disparities for racial and ethnic minorities.
Cheng B, Huang X, Li S, Hu X, Luo Y, Wang X, et al. published 'Gray matter alterations in post-traumatic stress disorder, obsessive-compulsive disorder, and social anxiety disorder' in Frontiers in Behavioral Neuroscience in 2015.
Benedek DM, Friedman MJ, Zatzick D, and Ursano RJ authored the 'Guideline watch: practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder', published by the American Psychiatric Association in 2009.
Lewis et al. conducted a systematic review and meta-analysis titled 'Dropout from psychological therapies for posttraumatic stress disorder (PTSD) in adults', published in the European Journal of Psychotraumatology in 2020.
Present-centered therapy (PCT) is a form of non-directive psychotherapy for posttraumatic stress disorder (PTSD) that was originally designed as a placebo treatment.
Randomized controlled trials published in the 5 years prior to the meta-analysis show relatively minimal advantage of Cognitive Behavioral Therapy (CBT) over psychological placebos in the treatment of PTSD.
Exposure-based treatment for PTSD may increase the risk of early patient dropout because the intervention requires patients to revisit traumatic memories.
The HOPE treatment for women residing in shelters with PTSD resulting from intimate partner violence (IPV) utilizes CBT-based skills, including cognitive restructuring, managing triggers, improving relationships, assertiveness, anger management, goal setting, and safety planning.
Present-centered therapy (PCT) has been shown to be effective in improving posttraumatic stress disorder (PTSD) symptoms.
Foa EB, McLean CP, Zang Y, Rosenfield D, Yadin E, Yarvis JS, et al. conducted a randomized clinical trial comparing the effect of prolonged exposure therapy delivered over 2 weeks versus 8 weeks versus present-centered therapy on PTSD symptom severity in military personnel, published in JAMA in 2018.
The effect of Cognitive Behavioral Therapy (CBT) for PTSD studies on depression was not significant (Hedges’ g = 0.09, 95% CI − 0.12 to 0.32, p = n.s.).
Haagen et al. (2015) conducted a metaregression analysis published in Clinical Psychology Review regarding the efficacy of recommended treatments for veterans with PTSD.
The updated analysis found no significant advantage of Cognitive Behavioral Therapy (CBT) over placebo on depression symptoms, either among PTSD studies or across all anxiety-related disorders.
The dropout rate for PTSD across clinical trials exhibits a high degree of variability, potentially caused by sampling error, study characteristics, or patient population characteristics such as comorbidities.
In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), obsessive compulsive disorder (OCD), acute stress disorder (ASD), and posttraumatic disorder (PTSD) are no longer classified as anxiety disorders, though they are highly comorbid with anxiety symptoms like irrational fear, avoidance, and hyperarousal.
Imel et al. (2013) conducted a meta-analysis of dropout rates in treatments for posttraumatic stress disorder, published in the Journal of Consulting and Clinical Psychology.
Haynes PL, Burger SB, Kelly M, Emert S, Perkins S, and Shea MT conducted a randomized controlled pilot trial comparing cognitive behavioral social rhythm group therapy versus present-centered group therapy for veterans with posttraumatic stress disorder and major depressive disorder, published in the Journal of Affective Disorders in 2020.
The meta-analysis included Obsessive-Compulsive Disorder (OCD), Acute Stress Disorder (ASD), and Post-Traumatic Stress Disorder (PTSD) in its scope, despite their reclassification as non-anxiety disorders, to maintain consistency with prior analyses by Hofmann and Smits and Carpenter et al.
In 2008, Hofmann and Smits compiled data from 27 studies examining anxiety disorders, obsessive-compulsive disorder, and PTSD, reporting a large effect size (Hedges’ g = 0.73) for Cognitive Behavioral Therapy compared to placebo.
Nidich S, Mills PJ, Rainforth M, Heppner P, Schneider RH, Rosenthal NE, et al. conducted a randomized controlled trial comparing nontrauma-focused meditation versus exposure therapy in veterans with posttraumatic stress disorder.
When examining only posttraumatic stress disorder (PTSD) studies within the 2022 meta-analysis, the effects of cognitive behavioral therapy (CBT) were reduced (Hedges’ g = 0.14, p < 0.05).
Price M, Legrand AC, Brier ZMF, and Hébert-Dufresne L published 'The symptoms at the center: examining the comorbidity of posttraumatic stress disorder, generalized anxiety disorder, and depression with network analysis' in the Journal of Psychiatric Research in 2019.
The National Institute for Health and Care Excellence (NICE) published clinical guideline NG116 regarding the management of posttraumatic stress disorder in 2018.
The majority of the 10 studies included in the meta-analysis 'Efficacy of Cognitive Behavioral Therapy for Anxiety-Related Disorders' examined the treatment of PTSD (n = 7 studies), while one study each covered ASD, GAD, and SAD, with no studies covering panic disorder, OCD, or specific phobia.
In a meta-analysis of seven studies examining Cognitive Behavioral Therapy (CBT) for Post-Traumatic Stress Disorder (PTSD), the post-treatment effect size was significant but small (Hedges’ g = 0.14, 95% CI 0.02 to 0.24) with low and significant heterogeneity (I2 = 0%, 95% CI 0.0 to 71%, p < 0.05).
Non-PTSD anxiety-related studies analyzed in the updated analysis demonstrated individual effect sizes (Hedges’ g = 0.48–0.67) similar to those found in prior meta-analyses.
Present-centred therapy (PCT) has been effective in reducing PTSD severity compared to waitlist (WL) conditions.
In PTSD-specific studies, the difference in dropout rates between Cognitive Behavioral Therapy (CBT) (21%) and placebo (15%) was significant (OR = 1.50, 95% CI = 1.08 to 2.06, p < 0.05).
Social rhythm-based cognitive behavioral therapy (CBSRT) is a therapeutic intervention designed to improve sleep disturbances in combat veterans with PTSD by addressing the social rhythm hypothesis, which posits that dysregulated mood results from poor circadian rhythms.
In a randomized controlled pilot trial, combat veterans with PTSD assigned to the social rhythm-based cognitive behavioral therapy (CBSRT) group experienced significant reductions in the frequency of nightmares compared to those assigned to present-centered therapy (PCT), though there was no significant difference in overall PTSD symptoms.
The pooled placebo-controlled effect size for Post-Traumatic Stress Disorder (PTSD) studies published since 2017 was statistically significant but small (Hedges’ g = 0.14), which is notably smaller than the effect size of 0.41 reported in the Carpenter et al. meta-analysis.
Speckens et al. (2006) studied changes in intrusive memories associated with imaginal reliving in patients with posttraumatic stress disorder, published in the Journal of Anxiety Disorders.
A 2019 meta-analysis by Belsher et al. compared present-centered therapy (PCT) with trauma-focused cognitive-behavioral therapy (TCBT) and other control conditions for treating posttraumatic stress disorder (PTSD) in adults.
Participants receiving Cognitive Behavioral Therapy (CBT) for anxiety and PTSD showed a significantly higher chance of dropping out from the study than those receiving the psychological placebo.
In studies of Cognitive Behavioral Therapy (CBT) for PTSD, there were no significant group differences found between Present-Centered Therapy (PCT) and other psychological placebos, nor between military and non-military participants.