Do adjuvant interventions improve treatment outcome in adult patients with posttraumatic stress disorder receiving trauma-focused psychotherapy? A systematic review

• Published in: European journal of psychotraumatology Vol. 10; no. 1; p. 1634938
• Main Authors: Michael, Tanja, Schanz, Christian G., Mattheus, Hannah K., Issler, Tobias, Frommberger, Ulrich, Köllner, Volker, Equit, Monika
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 01.01.2019; Taylor & Francis Ltd; Taylor & Francis Group
• Subjects: (5-10): posttraumatic stress disorder; adjunct therapy; adjuvant intervention; Adjuvants; CAM; cognitive enhancers; cortisol; evidence-based treatment; intervención auxiliar; Post traumatic stress disorder; potenciación de tratamiento; potenciadores cognitivos; psicoterapia con foco en el trauma; Psychotherapy; Review; Revisión Sistemática; Systematic review; terapia auxiliar; Trastorno de Estrés Postraumático; tratamiento basado en evidencia; trauma-focused psychotherapy; treatment augmentation; 创伤中心心理治疗; 创伤后应激障碍; 循证治疗; 治疗增强辅助治疗; 皮质醇; 系统综述; 认知增强; 辅助干预; adjunct therapy; cortisol; adjuvant intervention; cognitive enhancers; treatment augmentation; Assessment whether adjuvant interventions improve outcome among adult PTSD patients receiving trauma-focused psychotherapy.• No evidence-based recommendations can currently be given.• Several adjuvant interventions are promising.• Further research is needed; evidence-based treatment; systematic review; trauma-focused psychotherapy; (5-10): posttraumatic stress disorder; CAM
• ISSN: 2000-8066; 2000-8198; 2000-8066
• DOI: 10.1080/20008198.2019.1634938

Background: According to clinical guidelines, trauma-focused psychotherapies (TF-PT) such as trauma-focused cognitive behavioural therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) are recommended as first-line treatments for posttraumatic stress disorder (PTSD). TF-CBT and EMDR are equally effective and have large effect sizes. However, many patients fail to respond or have comorbid symptoms or disorders that only partially decline with TF-PT. Thus, there is growing interest in augmenting TF-PT through adjuvant interventions. Objective: The current systematic review aims to assess whether adjuvant interventions improve outcome among adult PTSD patients receiving TF-PT. Methods: We searched the databases PubMed, PILOTS, Web of Science and the Cochrane Library for controlled clinical trials examining whether adjuvant interventions lead to more symptom reduction in adult PTSD patients receiving TF-PT. Thirteen randomized controlled trials fitted the inclusion criteria. These were evaluated for internal risk of bias using the Cochrane Handbook for Systematic Review of Interventions. Results: Most studies have a substantial risk for internal bias, mainly due to small sample sizes. Thus, no strong conclusion can be drawn from the current empirical evidence. Preliminary evidence suggests that exercise and cortisol administration may have an adjuvant effect on PTSD symptom reduction. Breathing biofeedback showed a trend for an adjuvant effect and an effect for accelerated symptom reduction. Conclusions: Currently, it is not possible to formulate evidence-based clinical recommendations regarding adjuvants interventions. While several adjuvant interventions hold the potential to boost the effectiveness of TF-PT, the realization of sufficiently powered studies is crucial to separate plausible ideas from interventions proven to work in practice. * Assessment whether adjuvant interventions improve outcome among adult PTSD patients receiving trauma-focused psychotherapy.* No evidence-based recommendations can currently be given.* Several adjuvant interventions are promising.* Further research is needed.