Question: In veterans of the armed forces with post-traumatic stress disorder (PTSD), how effective are trauma-focussed CBT (TFCBT), eye movement desensitisation and reprocessing (EMDR) and narrative exposure therapy, compared to any other non-pharmacological interventions, specifically metaphors of movement, neuro-linguistic programming(NLP), hypnotherapy, integral eye movement therapy and emotional freedom technique, in reducing PTSD symptoms?

Answer:

Evidence from two systematic reviews, both with significant methodological weaknesses, indicated that TFCBT and EMDR were similarly effective in treating PTSD, where the type of trauma experienced by study participants was not specified. In both reviews, evidence specific to combat veterans was substantially weaker. The first review included one study in combat veterans which indicated that the effect of EMDR on clinician-rated PTSD symptoms was smaller in this population than in the overall PTSD population and that the effect of TFCBT on clinician-rated PTSD symptoms was non-significant. There was some indication, from studies included in the second review, that EMDR was more effective that ET or biofeedback-assisted relaxation techniques in treating PTSD symptoms in combat veterans and that the addition of behavioural family therapy to ET did not improve its effectiveness. One large (n=360) study, included in this review, indicated that trauma-focused group psychotherapy (TFGP) and present-centred group treatment (PCGT) were similarly effective. One additional small, high quality RCT indicated that EMDR and EFT were similarly effective in improving PTSD symptoms, depression scores and satisfaction with life, where the type of trauma experienced by study participants was not specified and it was not clear whether any combat veterans were included in the study. Overall, there was reasonably reliable evidence that TFCBT and EMDR are similarly effective in treating general PTSD and some evidence, from one RCT, that EFT may also be similarly effective. However, there was very little evidence specific to the comparative effectiveness of different psychological interventions for the treatment of PTSD in combat veterans; the small amount of evidence available indicated that EMDR may be the most effective of the psychological interventions assessed.

Larger, high quality randomised controlled trials are needed to provide reliable assessments of the relative effectiveness of different psychological interventions for the treatment PTSD. Trials conducted in combat veterans are particularly needed, as this population is currently under represented in the evidence base.