A meta-analytic review of prolonged exposure for posttraumatic stress disorder
Section snippets
Study selection
We selected well-controlled randomized trials of PE for PTSD using a comprehensive search strategy. We searched the following databases: PsycINFO (1840 to March 2009), MEDLINE (1966 to March 2009), Scopus (1869 to March 2009), and the Cochrane Central Register of Controlled Trials up to March 2009. The searches included the following terms: “prolonged exposure,” “cognitive behavioral,” “clinical trial,” “random,” “randomly,” “randomize,” “randomise,” “randomized,” or “randomised” alone and in
Results
Hypothesis 1 PE will outperform the control conditions on primary outcome measures at post-treatment.
This analysis included 13 studies with 675 participants. Consistent with prediction, prolonged exposure outperformed control conditions on primary outcome measures at posttreatment showing a large effect size (Hedges's g = 1.08 [SE = 0.20, 95% CI: 0.69 to 1.46, p < 0.001)]). Thus, the average participant receiving prolonged exposure fared better than 86% of the control participants at posttreatment on primary
Heterogeneity
A heterogeneity analysis was conducted to test the assumption that the effect sizes were from a homogeneous sample (Hedges & Olkin, 1985). For this analysis all 13 studies were included with all time points (post-treatment and follow-up) on primary outcome measures. The test was significant, Q(12) = 59.90, p < 0.001, suggesting that the random effects analyses were most appropriate for this study.
Moderators: effect size as a function of publication year, dose, type of trauma, and time since trauma
The following analyses were completed using unrestricted maximum likelihood meta regressions. There was
Major findings
This meta-analysis of 13 (N = 658) randomized controlled PE trials generally supported the hypotheses. As predicted, PE performed significantly better than control conditions on measures of PTSD both at post-treatment (g = 1.08) as well as at follow-up (g = 0.68). Similarly, PE treatment was associated with significantly better outcomes on secondary outcome measures, both at post-treatment (g = 0.77) and at follow-up (g = 0.41). These effect sizes compare quite favorably to those of other empirically
Acknowledgement
The authors thank Jaclyn L. Bolno for her generous assistance with the literature review.
References (55)
- et al.
The relative efficacy of bona fide psychotherapies for treating post-traumatic stress disorder: A meta-analysis of direct comparisons
Clinical Psychology Review
(2008) - et al.
Cognitive behavioral versus exposure only treatment for social phobia: A meta-analysis
Behavior Therapy
(1995) - et al.
Psychological sequelae of combat violence: A review of the impact of PTSD on the veteran's family and possible interventions
Aggression and Violent Behavior
(2004) - et al.
A meta-analysis of the effects of cognitive therapy in depressed patients
Journal of Affective Disorders
(1998) - et al.
Assessing the quality of reports of randomized clinical trials: Is blinding necessary?
Controlled Clinical Trials
(1996) - et al.
Posttraumatic stress disorder: A state-of-the-science review
Journal of Psychiatric Research
(2006) - et al.
Cognitive-behavior therapy vs exposure therapy in the treatment of PTSD in refugees
Behaviour Research and Therapy
(2001) - et al.
Disability and quality of life impact of mental disorders in Europe: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project
Acta Psychiatrica Scandinavica, Supplement
(2004) - Asukai, N. (in press). Comparison of prolonged exposure and treatment as usual for PTSD in...
On method
(1967)
Psychological treatments for chronic post-traumatic stress disorder: Systematic review and meta-analysis
British Journal of Psychiatry
Introduction to meta-analysis
Comprehensive meta-analysis, a computer program for research synthesis
A multidimensional meta-analysis of psychotherapy for PTSD
American Journal of Psychiatry
A randomized controlled trial of exposure therapy and cognitive restructuring for posttraumatic stress disorder
Journal of Consulting and Clinical Psychology
Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder
Journal of Consulting and Clinical Psychology
Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse
Journal of Consulting and Clinical Psychology
Statistical power analysis for the behavioral sciences
A randomized controlled clinical treatment trial for World Trade Center attack-related PTSD in disaster workers
Journal of Nervous and Mental Disease
Posttraumatic stress disorder
A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims
Journal of Consulting and Clinical Psychology
Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: `utcome at academic and community clinics
Journal of Consulting & Clinical Psychology
Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies
Treatment of posttraumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedures and counseling
Journal of Consulting and Clinical Psychology
A test of behavioral family therapy to augment exposure for combat-related posttraumatic stress disorder
Journal of Consulting and Clinical Psychology
Cited by (697)
The promise of compassion-based therapy as a novel intervention for adolescent PTSD
2024, Journal of Affective Disorders ReportsA trial of prolonged exposure therapy for outpatients with comorbid bipolar disorder and posttraumatic stress disorder (PTSD)
2024, Journal of Affective Disorders