COMPARATIVE EFFICACY OF TREATMENTS FOR POSTTRAUMATIC-STRESS-DISORDER - A METAANALYSIS

A meta-analysis was conducted on 61 treatment outcome trials for postt raumatic stress disorder (PTSD). Conditions included drug therapies (T CAs, carbamazepine, MAOIs, SSRIs, and BDZs), psychological therapies ( behaviour therapy, Eye-Movement Desensitization and Reprocessing (EMDR ), relaxation training, hypnotherapy, and dynamic therapy), and contro l conditions (pill placebo, wait-list controls, supportive psychothera pies, and non-saccade EMDR control). Psychological therapies had signi ficantly lower drop-out rates than pharmacotherapies (14% versus 32%), with attrition being uniformly low across all psychological therapies . In terms of symptom reduction, psychological therapies were more eff ective than drug therapies, and both were more effective than controls . Among the drug therapies, the SSRIs and carbamazepine had the greate st effect sizes, although the latter was based upon a single trial. Am ong the psychological therapies, behaviour therapy and EMDR were most effective, and generally equally so. The most effective psychological therapies and drug therapies were generally equally effective. Differe nces across treatment conditions were generally evident across symptom domains, with little matching of symptom domain to treatment type. Ho wever, SSRIs had some advantage over psychological therapies in treati ng depression. Follow-up results were not available for most treatment s, but available data indicates that treatment effects for behaviour t herapy and EMDR are maintained at 15-week follow-up. (C) 1998 John Wil ey & Sons, Ltd.