The efficacy of recommended treatments for veterans with PTSD: A metaregression analysis
Open accessAbstract
Soldiers and veterans diagnosed with PTSD benefit less from psychotherapy than non-military populations. The current meta-analysis identified treatment predictors for traumatised soldiers and veterans, using data from studies examining guideline recommended interventions, namely: EMDR, exposure, cognitive, cognitive restructuring, cognitive processing, trauma-focused cognitive behavioural, and stress management therapies. A systematic search identified 57 eligible studies reporting on 69 treated samples. Exposure therapy and cognitive processing therapy were more effective than EMDR and stress management therapy. Group-only therapy formats performed worse compared with individual-only formats, or a combination of both formats. After controlling for study design variables, EMDR no longer negatively predicted treatment outcome. The number of trauma-focused sessions, unlike the total number of psychotherapy sessions, positively predicted treatment outcome. We found a relationship between PTSD pretreatment severity levels and treatment outcome, indicating lower treatment gains at low and high PTSD severity levels compared with moderate severity levels. Demographic variables did not influence treatment outcome. Consequently, soldiers and veterans are best served using exposure interventions to target PTSD. Our results did not support a group-only therapy format. Recommended interventions appear less effective at relatively low and high patient PTSD severity levels. Future high-quality studies are needed to determine the efficacy of EMDR.
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Findings of two meta-analyses indicated that cognitive processing therapy may be the most effective treatment for post-traumatic stress symptoms compared to other psychotherapies and medications across several traumatized groups.
“The findings of two meta-analyses [21,22] have indicated that CPT may be the most effective treatment for PTS symptoms (compared to other psychotherapies and medications) across several traumatized groups.”
From Psychological Interventions for Survivors of Intimate Partner Violence in Humanitarian Settings: An Overview of the Evidence and Implementation Considerations (2022) · cites this paper as [21]
The Discussion reports that CPT and exposure therapy predicted better PTSD treatment outcomes for veterans and soldiers, and the Clinical implications section prefers both over stress management therapy. It does not establish CPT as more effective than other psychotherapies or medications, or extend that comparison across several traumatized groups. Page numbers were not available in our copy. (LLM, conf=0.88)
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“Third, the number of trauma-focused sessions has been shown to positively predict treatment response (Haagen et al., 2015), and IFS by design encourages exploring and addressing traumatic content early and consistently in the treatment process.”
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- Authors
- Haagen, J. F. G., Smid, G. E., Knipscheer, J. W., & Kleber, R. J.
- Affiliations
- Utrecht University (NL)
- Foundation Centrum '45 (NL)
- Corresponding author
- Haagen, Joris F.G.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2015-08
- Volume
- 40
- Pages
- 184-194
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W776481976
- Semantic Scholar
- e6f4595afb5d82f4d4e2764d2127438b6966c2e8
- Cited by
- 246
- References
- 81
- Citations by year
- 2026: 8 · 2025: 28 · 2024: 16 · 2023: 21 · 2022: 19 · 2021: 30 · 2020: 33 · 2019: 26 · 2018: 29 · 2017: 20 · 2016: 11 · 2015: 3
- FWCI
- 3.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (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, veterans, military personnel, psychotherapy efficacy, EMDR, exposure therapy, cognitive processing therapy, trauma-focused cognitive behavioral therapy, group versus individual therapy, treatment outcome predictors, PTSD symptom severity, treatment response
- MeSH terms
- Humans, Psychotherapy, Regression Analysis, Stress Disorders, Post-Traumatic, Veterans, Outcome Assessment, Health Care
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