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Cited by 212Posttraumatic Stress Disorder ResearchPsychotherapy Techniques and ApplicationsSleep and related disorders

Combined pharmacotherapy and psychological therapies for post traumatic stress disorder (PTSD)

Open access
Hetrick, Sarah E, Purcell, Rosemary, Garner, Belinda, Parslow, Ruth·2010·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd007316.pub2PMC PMC12515543
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Abstract

BACKGROUND: PTSD is an anxiety disorder related to exposure to a severe psychological trauma. Symptoms include re-experiencing the event, avoidance and arousal as well as distress and impairment resulting from these symptoms.Guidelines suggest a combination of both psychological therapy and pharmacotherapy may enhance treatment response, especially in those with more severe PTSD or in those who have not responded to either intervention alone. OBJECTIVES: To assess whether the combination of psychological therapy and pharmacotherapy provides a more efficacious treatment for PTSD than either of these interventions delivered separately. SEARCH STRATEGY: Searches were conducted on the trial registers kept by the CCDAN group (CCDANCTR-Studies and CCDANCTR-References) to June 2010. The reference sections of included studies and several conference abstracts were also scanned. SELECTION CRITERIA: Patients of any age or gender, with chronic or recent onset PTSD arising from any type of event relevant to the diagnostic criteria were included. A combination of any psychological therapy and pharmacotherapy was included and compared to wait list, placebo, standard treatment or either intervention alone. The primary outcome was change in total PTSD symptom severity. Other outcomes included changes in functioning, depression and anxiety symptoms, suicide attempts, substance use, withdrawal and cost. DATA COLLECTION AND ANALYSIS: Two or three review authors independently selected trials, assessed their 'risk of bias' and extracted trial and outcome data. We used a fixed-effect model for meta-analysis. The relative risk was used to summarise dichotomous outcomes and the mean difference and standardised mean difference were used to summarise continuous measures. MAIN RESULTS: Four trials were eligible for inclusion, one of these trials (n =24) was on children and adolescents. All used an SSRI and prolonged exposure or a cognitive behavioural intervention. Two trials compared combination treatment with pharmacological treatment and two compared combination treatment with psychological treatment. Only two trials reported a total PTSD symptom score and these data could not be combined. There was no strong evidence to show if there were differences between the group receiving combined interventions compared to the group receiving psychological therapy (mean difference 2.44, 95% CI -2.87, 7.35 one study, n=65) or pharmacotherapy (mean difference -4.70, 95% CI -10.84 to 1.44; one study, n = 25). Trialists reported no significant differences between combination and single intervention groups in the other two studies. There were very little data reported for other outcomes, and in no case were significant differences reported. AUTHORS' CONCLUSIONS: There is not enough evidence available to support or refute the effectiveness of combined psychological therapy and pharmacotherapy compared to either of these interventions alone. Further large randomised controlled trials are urgently required.

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Crossref · 10.1002/14651858.cd007316.pub2

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  • Clinical guidelines for the treatment of PTSD are based on reviews and meta-analyses that mainly include studies on non-refugee PTSD populations.

    “Therefore, clinical guidelines for the treatment of PTSD are based on reviews and meta-analyses, which mainly include studies on non-refugee PTSD populations [4–7].”

    From Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy - a randomised study (2016) · cites this paper as [6]

    The Included studies section (page unavailable) lists four trials: one in Cambodia, identified elsewhere in the review as a study of Cambodian refugees, and three in the USA. The review also discusses PTSD treatment recommendations and systematic reviews in Why it is important to do this review (page unavailable), but it does not establish that clinical guidelines are based on reviews and meta-analyses predominantly involving non-refugee populations. (LLM, conf=0.82)

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  • The single existent Cochrane review on combined pharmacotherapy and psychological treatment methods in patients with PTSD identified only four studies that could be included in the review.

    “The single existent Cochrane review on combined pharmacotherapy and psychological treatment methods in patients with PTSD [6] identified only four studies that could be included in the review.”

    From Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy - a randomised study (2016) · cites this paper as [6]

    The review’s Main results state that four trials were eligible for inclusion, directly supporting the study count. Our copy identifies this as a Cochrane review of combined treatment for PTSD, but it does not establish that it was the only such Cochrane review in existence. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Several previous reviews of interventions for PTSD have included sexual violence and abuse survivors as a subset of the overall trauma population.

    “Several previous reviews of interventions for PTSD have included sexual violence and abuse survivors as a subset of the overall trauma population (Hetrick 2010; Kitchiner 2019; Roberts 2015; Roberts 2016; Steenkamp 2015)”

    From Psychosocial interventions for survivors of rape and sexual assault experienced during adulthood (2023) · cites this paper as Hetrick 2010

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2 of the 73 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. [20]20. Davis M, Barad M, Otto M, Southwick S. Combining Pharmacotherapy With CognitiveBehavioral Therapy: Traditionaland New Approaches. Journal of Traumatic Stress, 2006;19(5):571-581.
  2. [28]28. Foa EB, Steketee G, Rothbaum BO. Behavioural-cognitve conceptualizations of posttraumatic stress disorder. Behavior Therapy 1989;20:155-76.

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Authors
Hetrick, S. E., Purcell, R., Garner, B., & Parslow, R.
Affiliations
The University of Melbourne (AU)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2010-07-07
Volume
2010
Issue
7
Pages
CD007316-CD007316
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd007316.pub2
PMC
PMC12515543
OpenAlex
W1796823137
Cited by
212
References
73
Citations by year
2026: 5 · 2025: 5 · 2024: 8 · 2023: 8 · 2022: 26 · 2021: 11 · 2020: 12 · 2019: 22 · 2018: 11 · 2017: 9 · 2016: 12 · 2015: 19 · 2014: 19 · 2013: 18 · 2012: 14
FWCI
1.96
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed (publishedVersion)
  • QUT ePrints (Queensland University of Technology) (submittedVersion)
  • Swinburne figshare (Swinburne University of Technology) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords
post-traumatic stress disorder, prolonged exposure therapy, cognitive behavioral therapy, selective serotonin reuptake inhibitors, PTSD symptom severity, anxiety and depressive symptoms, suicide attempts, substance use, treatment costs, children and adolescents, treatment response, risk of bias in trials, treatment cost-effectiveness, treatment relapse
MeSH terms
Adolescent, Adult, Child, Child Abuse, Sexual, Clonazepam, Combined Modality Therapy, Female, Humans, Male, Refugees, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Selective Serotonin Reuptake Inhibitors, Paroxetine, Sertraline

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