Trauma-focused psychotherapies for post-traumatic stress disorder: A systematic review and network meta-analysis

Acta Psychiatr Scand. 2022 Feb;145(2):132-155. doi: 10.1111/acps.13366. Epub 2021 Sep 17.


Introduction: Meta-analytic reviews suggest similar outcomes across trauma-focused psychotherapies for adults with post-traumatic stress disorder (PTSD). However, this conclusion may be premature due to suboptimal statistical-review methodologies. Network meta-analysis (NMA) allows a detailed rank-ordering of the efficacy of established psychotherapy interventions derived from indirect evidence as well as results from direct head-to-head comparisons.

Objective: We sought to determine the efficacy and attrition rates of psychotherapy interventions for PTSD by applying NMA.

Methods: We searched EMBASE, PsychINFO, PTSDPubs and PubMed for randomised controlled trials that compared psychotherapies either head-to-head or against controls for adults with PTSD. A frequentist NMA was used to compare direct and indirect effects to determine the efficacy and attrition rates of psychotherapy interventions.

Results: Of the 5649 papers identified, 82 trials comprising of 5838 patients were included. The network comprised 17 psychotherapies and four control conditions. Network estimates indicated superior efficacy of meta-cognitive therapy and cognitive processing therapy over other psychotherapies (ESs between = 0.26 and 2.32). Written exposure therapy and narrative exposure therapy were associated with lower risk of drop out when considered alongside other psychotherapies. Confidence in the network meta-analytic estimates was considered moderate for both outcomes.

Conclusions: In broad terms, therapeutic commensurability was evident. Nevertheless, with additional studies and larger sample sizes, meta-cognitive and written exposure therapies could indeed differentiate themselves from other approaches as having favourable efficacy and acceptability respectively. These findings may inform clinical decision-making, as well as guide future research for PTSD.

Keywords: PTSD; acceptability; efficacy; network meta-analysis; psychotherapy; review.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Cognitive Behavioral Therapy*
  • Humans
  • Network Meta-Analysis
  • Psychotherapy
  • Stress Disorders, Post-Traumatic* / therapy