Effectiveness and moderators of PE and CPT in adult PTSD treatment: a systematic review and meta-analysis.

چکیده اصلی

Background: Posttraumatic Stress Disorder (PTSD) is a prevalent and debilitating condition that challenges mental health services worldwide. Effective psychological interventions are crucial for treatment, among which Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) are prominent. Comparative analyses of these treatments, considering moderators such as patient demographics and treatment specifics, are necessary to tailor interventions effectively.Objective: This meta-analysis synthesised findings from 175 treatment arms across 163 studies to evaluate the comparative effectiveness of PE and CPT for PTSD. Effect sizes were calculated as Hedges' g for between-group (treatment vs. control) and within-group (pre-post) comparisons.Results: Using a random-effects model, the overall pooled effect size was large (Hedges' g = 1.67, 95% CI [1.56, 1.79]), suggesting substantial treatment-related symptom improvement. Multivariate meta-regression revealed, across the full sample, none of the main effects or interactions was significant. A sensitivity analysis excluding 10 influential outliers reduced the overall effect size (g = 1.55), indicating that PE was associated with larger effects than CPT among non-military samples, and larger effects were observed in studies with a higher proportion of female participants, military samples, and samples with lower proportions of sexual trauma. Treatment-by-sample-characteristic interactions were not significant in the trimmed model.Conclusions: Findings suggest that PE and CPT produce large effects in reducing PTSD symptoms, with some variation across treatment type and sample characteristics. Results underscore the importance of examining contextual moderators such as treatment setting and population type and highlight the need for transparent reporting of key sample features to improve future meta-analytic precision.

ترجمه فارسی چکیده

پس از سانحه (PTSD) یک وضعیت شایع و ناتوان‌کننده است که خدمات سلامت روان را در سراسر جهان به چالش می‌کشد. درمان‌های روان‌شناختی مؤثر برای درمان ضروری هستند، از جمله درمان مواجهه طولانی‌مدت (PE) و درمان پردازش شناختی (CPT). این متاآنالیز یافته‌های ۱۷۵ شاخص درمانی در ۱۶۳ مطالعه را برای ارزیابی کارایی مقایسه‌ای PE و CPT برای PTSD جمع‌آوری کرد. اندازه اثر به صورت Hedges' g محاسبه شد. با استفاده از مدل اثر تصادفی، اندازه اثر کل بزرگ (Hedges' g = ۱.۶۷، ۹۵٪ CI [۱.۵۶، ۱.۷۹]) بود. تحلیل حساسیت نشان داد که PE اثرات بزرگتری نسبت به CPT در نمونه‌های غیرنظامی داشت و اثرات بزرگتری در مطالعات با نسبت بالاتر شرکت‌کنندگان زن، نمونه‌های نظامی و نمونه‌هایی با نسبت پایین‌تر آسیب‌های جنسی مشاهده شد.

متن کامل اصلی