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

Brooke Jericho, Aileen Luo, David Berle*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

27 Citations (Scopus)
174 Downloads (Pure)


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.

Original languageEnglish
Pages (from-to)132–155
Number of pages24
JournalActa Psychiatrica Scandinavica
Issue number2
Early online date2 Sept 2021
Publication statusPublished - Feb 2022
Externally publishedYes

Bibliographical note

Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • acceptability
  • efficacy
  • network meta- analysis
  • psychotherapy
  • PTSD
  • review


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