Systematic Review and Meta-Analysis: Imputing Response Rates for First-Line Psychological Treatments for...

Meta-analyses assessing psychological therapies for posttraumatic stress disorder (PTSD) in youth have demonstrated their effectiveness using standardized mean differences. Imputation of response rates (ie, 50% or greater reduction in symptoms) may facilitate easier interpretation for clinicians.

We searched 4 databases (MEDLINE, PsycINFO, PTSDPubs, and Web of Science) and screened 1,654 records to include 60 randomized controlled trials (52 trauma-focused cognitive behavioral therapy [TF-CBT], 8 eye movement desensitization [EMDR]) with a total of 5,113 participants, comparing psychological therapies for PTSD against control conditions in youth. Data from randomized controlled trials of EMDR and TF-CBT for PTSD were used to impute response rates, establishing how many patients display 50% reduction, 20% reduction, and reliable improvement and deterioration (using reliable change indices) in PTSD and depression.

The proportion of youth exhibiting a 50% reduction in PTSD symptoms was 0.48 (95% CI = 0.41-0.55) for TF-CBT, 0.30 (0.24-0.37) for EMDR, and 0.46 (0.39-0.52) for all psychological therapies, compared to 0.20 (0.16-0.24) for youth in control conditions. Reliable improvement was displayed by 0.53 (0.45-0.61; TF-CBT 0.55 [0.46-0.64], EMDR 0.42[0.30-0.55]) of youth receiving psychological therapies, compared to 0.25 (0.20-0.30) of youth in control conditions. Reliable deterioration was seen in 0.01 (0.01-0.02) of youth receiving psychological therapies, compared to 0.13 (0.08-0.20) of youth in control conditions. There was a high degree of heterogeneity in the included studies.

Psychological therapies, in particular TF-CBT, for young people with PTSD are effective and unlikely to cause deterioration, with around half of youth receiving TF-CBT exhibiting 50% symptom reduction.

In this study, the authors analyzed data from 57 randomized controlled trials involving over 5,000 youth assessing psychological therapies for posttraumatic stress disorder (PTSD). Forty-eight percent of youth with PTSD who received trauma-focused cognitive behavioral therapy (TF-CBT) and 30% of youth who received eye movement desensitization and reprocessing (EMDR) exhibited 50% symptom reduction after treatment, compared to 20% of youth in control conditions. Deterioration was seen in 1% of youth receiving TF-CBT or EMDR, compared to 13% of youth in control conditions.

• Psychological therapies for posttraumatic stress disorder (PTSD) in youth, like trauma-focused cognitive behavioral therapy and eye movement desensitization and reprocessing, can be helpful in symptom reduction and have low likelihood of causing deterioration of symptoms.

Imputing response rates from randomised controlled trials of first-line psychological treatments for PTSD in children and adolescents; a systematic review and meta-analysis; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022304592.