Do all psychological treatments really work the same in posttraumatic stress disorder?
Open accessAbstract
A recent meta-analysis by Benish, Imel, and Wampold (2008, Clinical Psychology Review, 28, 746-758) concluded that all bona fide treatments are equally effective in posttraumatic stress disorder (PTSD). In contrast, seven other meta-analyses or systematic reviews concluded that there is good evidence that trauma-focused psychological treatments (trauma-focused cognitive behavior therapy and eye movement desensitization and reprocessing) are effective in PTSD; but that treatments that do not focus on the patients' trauma memories or their meanings are either less effective or not yet sufficiently studied. International treatment guidelines therefore recommend trauma-focused psychological treatments as first-line treatments for PTSD. We examine possible reasons for the discrepant conclusions and argue that (1) the selection procedure of the available evidence used in Benish et al.'s (2008)meta-analysis introduces bias, and (2) the analysis and conclusions fail to take into account the need to demonstrate that treatments for PTSD are more effective than natural recovery. Furthermore, significant increases in effect sizes of trauma-focused cognitive behavior therapies over the past two decades contradict the conclusion that content of treatment does not matter. To advance understanding of the optimal treatment for PTSD, we recommend further research into the active mechanisms of therapeutic change, including treatment elements commonly considered to be non-specific. We also recommend transparency in reporting exclusions in meta-analyses and suggest that bona fide treatments should be defined on empirical and theoretical grounds rather than by judgments of the investigators' intent.
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Acupuncture may function by downregulating brain systems involved in activating the HPA axis and the sympathetic arm of the autonomic system.
“Studies suggest that acupuncture may function by downregulating brain systems involved in activating the HPA axis and the sympathetic arm of the autonomic system.152–154”
From Fear and the Defense Cascade (2015) · cites this paper as [153]
The ‘Treatment mechanisms’ and ‘Criteria for active treatments’ sections discuss psychological treatments for PTSD, but do not address acupuncture or its effects on the HPA axis or sympathetic nervous system. Searches of our copy for acupuncture and those proposed mechanisms found no supporting passage; page numbers were not available. (LLM, conf=0.76)
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- Authors
- Ehlers, A., Bisson, J., Clark, D. M., Creamer, M., Pilling, S., Richards, D., Schnurr, P. P., Turner, S., & Yule, W.
- Affiliations
- King's College London (GB)
- Cardiff University (GB)
- University College London (GB)
- University of Exeter (GB)
- United States Department of Veterans Affairs (US)
- Corresponding author
- Ehlers, Anke
- ORCID
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2010-03
- Volume
- 30
- Issue
- 2
- Pages
- 269-276
- ISSN
- 0272-7358 (ISSN-L)
- PMC
- PMC2852651
- OpenAlex
- W2101542507
- Cited by
- 199
- References
- 72
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 20 · 2021: 10 · 2020: 9 · 2019: 10 · 2018: 16 · 2017: 13 · 2016: 17 · 2015: 22 · 2014: 22 · 2013: 21 · 2012: 11
- FWCI
- 1.36
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Psychology Review (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Wellcome Trust Principal Research Fellowship (069777)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- post-traumatic stress disorder, trauma-focused cognitive behavioral therapy, EMDR, treatment content, meta-analysis bias, natural recovery, non-specific treatment effects, therapeutic mechanisms, treatment guidelines
- MeSH terms
- Clinical Trials as Topic, Humans, Life Change Events, Psychotherapy, Stress Disorders, Post-Traumatic, Meta-Analysis as Topic, Selection Bias
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