Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis
2019/03/12 by Thanos Karatzias, Philip Murphy, Philip N. Murphy +16 · 344 citations
Medicine · Psychology · #Affect (linguistics) #Clinical psychology #Cognitive behavioral therapy #Eye movement desensitization and reprocessing #Internal medicine #MEDLINE #Medicine #Meta-analysis #Personality Disorders and Psychopathology #Posttraumatic Stress Disorder Research #Posttraumatic stress #PsycINFO #Psychiatry #Psychological intervention #Psychology #Psychosomatic Disorders and Their Treatments #Randomized controlled trial
paper · open access · doi:10.1017/s0033291719000436
published in Psychological Medicine 49(11), 1761-1775 (Cambridge University Press)
openalex publication_date 2019/03/12 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/04
Abstract
BACKGROUND: The 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions. METHODS: We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality. RESULTS: Fifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = -0.90 (CBT; k = 27, 95% CI -1.11 to -0.68; moderate quality) to g = -1.26 (EMDR; k = 4, 95% CI -2.01 to -0.51; low quality). CBT and EA each had moderate-large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate-large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome. CONCLUSIONS: The development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.
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