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Table G-2Cognitive therapy (not including cognitive processing therapy) compared with inactive controls (waitlist, self-help booklet, usual care)

Domains Pertaining to Strength of EvidenceMagnitude of EffectStrength of Evidence
Number of Studies; Number of SubjectsRisk of Bias; DesignConsistencyDirectnessPrecisionSummary Effect Size (95% CI)High, Moderate, Low, Insufficient
PTSD Symptom Reduction: mean change from baseline to end of treatmentb
3a; 221Medium; RCTsSome inconsistencyc (I2=79.6%)DirectImpreciseSMD: −1.22 (−1.91, −0.53)

SMD: −1.54 (−2.17, −0.92) when only compared with WL (2 trials)
Moderate
Remission (no longer having symptoms)
0; 0NANANANANAInsufficient
Loss of Diagnosis
3a; 221Medium; RCTsSome inconsistencyc (I2=84.7%)DirectImpreciseRD: 0.51 (0.24, 0.78); NNT 2

RD: 0.66 (0.50, 0.82) when only compared with WL (2 trials)
Moderate
Prevention/reduction of comorbid depression: mean change from baseline to end of treatment in BDI
3a; 221Medium; RCTsConsistentDirectImpreciseSMD: −0.91 (−1.20, −0.62); WMD: −8.34 (−10.8, −5.85)

SMD: −1.06 (−1.52, −0.60) when only compared with WL (2 trials)
Moderate
Prevention/reduction of comorbid anxiety: mean change from baseline to end of treatment in BAI
3a; 221Medium; RCTsConsistentDirectImpreciseSMD: −0.93 (−1.36, −0.50); WMD: −9.22 (−11.9, −6.5)

SMD: −1.20 (−1.67, −0.73) when only compared with WL (2 trials)
Moderate
Quality of Life: SF-12
1; 108Medium; RCTUnknown, single studyDirectImpreciseBetter quality-of-life outcomes for CT group than usual care group for the Physical Component (p=0.002), but not for the Mental Component (p=0.13).Insufficient
Disability/functional impairment: change in SDS from baseline
2; 113Medium; RCTsConsistentDirectImpreciseSMD: −1.13 (−1.76, −0.51); WMD −2.66 (−4.0, −1.33)

SMD: −1.41 (−2.41, −0.41) when only compared with WL (2 trials)
Moderate
Return to work or return to active duty
0; 0NANANANANAInsufficient
a

Included trials compared CT with waitlist (Ehlers 2003 and Ehlers 2005), a self-help booklet (Ehlers 2003), and usual care (Muesser 2008).

b

Data were based on meta-analysis of CAPS total for Muesser 2008 and CAPS-intensity for the Ehlers 2003 and 2005 studies.

c

Direction of effects were consistent; magnitude of effects ranged from very large to small

Abbreviations: CI = confidence interval; NA = not applicable; NNT = number needed to treat; RCT = randomized controlled trial; RD = risk difference; WL = waitlist

Included trials compared CT with waitlist (Ehlers 2003 and Ehlers 2005), a self-help booklet (Ehlers 2003), and usual care (Muesser 2008).

Data were based on meta-analysis of CAPS total for Muesser 2008 and CAPS-intensity for the Ehlers 2003 and 2005 studies.

Direction of effects were consistent; magnitude of effects ranged from very large to small

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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