Table G-13CBT-mixed interventions compared with inactive controls (waitlist, usual care)

Domains Pertaining to Strength of EvidenceMagnitude of EffectStrength of Evidence
Number of Studies; Number of SubjectsRisk of Bias; DesignConsistencyaDirectnessPrecisionSummary Effect Size (95% CI)High, Moderate, Low, Insufficient
PTSD Symptom Reduction: mean change from baseline to end of treatment for CAPS
8; 476Medium; RCTsSome inconsistency (I2=87%)DirectPreciseWMD −31.1 (−42.6 to −19.6); WMD −34.4 (−45.5, −23.2) when compared with WL (7 of the 8 trials)Moderate
PTSD Symptom Reduction: mean change from baseline to end of treatment for various measures (combined to calculate effect size)
14; 825Medium; RCTsSome inconsistency (I2=75.3%)DirectPreciseSMD −1.09 (−1.4 to −0.78); SMD −1.16 (−1.47, −0.84) when only compared with WL (13 trials)Moderate
Remission (no longer having symptoms)
2; 114Medium; RCTsConsistentDirectPreciseData not pooledbModerate
Loss of Diagnosis
6; 290Medium; RCTsSome inconsistency (I2=60.5%)DirectPreciseRD 0.26 (0.11 to 0.41); NNT 3.8; RD 0.29 (−0.01 to 0.60) and NNT 3.4 when only compared with WL (3 trials)Moderate
Prevention/reduction of comorbid depression: mean change from baseline in BDI
10; 662Medium; RCTsSome inconsistency (I2=81.3%)DirectPreciseWMD −10.4 (−14.4 to −6.4); WMD −10.4 when only compared with WL (9 trials)Moderate
Prevention/reduction of comorbid anxiety: mean change from baseline in STAI
4; 172Medium; RCTsSome inconsistency (I2=83.5%)DirectImpreciseWMD −11.2 (−20 to −2.4); WMD −12.1 when only compared with WL (3 trials)Low
Quality of Life
3; 182Medium; RCTsInconsistentDirectImpreciseMixed resultsInsufficient
Disability/functional impairment
5; 268Medium; RCTsConsistentcDirectImpreciseNot calculated, heterogeneous outcome measuresLow
Return to work or return to active duty
0; 0NANANANANAInsufficient
a

Although meta-analyses often had considerable statistical heterogeneity for the trials comparing CBT mixed interventions with inactive controls, the direction of effects was generally the same across trials—differences were in the magnitude of effects.

b

Two trials used different measures for remission found a greater percentages of subjects achieving remission: 61% vs. 21%, p=NR using the PCL;7 82.4% vs. 0%, P<0.001 using the HTQ.8

c

Four of the five trials compared CBT-mixed interventions with WL controls and found similar benefits for CBT-mixed interventions compared with WL; one trial compared with standard care and found similar outcomes for subjects treated with CBT-mixed and those who received standard care.9

Abbreviations: CI = confidence interval; NA = not applicable; RCT = randomized controlled trial

From: Appendix G, Strength of Evidence

Cover of Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder (PTSD)
Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder (PTSD) [Internet].
Comparative Effectiveness Reviews, No. 92.
Jonas DE, Cusack K, Forneris CA, et al.

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