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Efficacy of Complementary and Alternative Medicine Therapies for Posttraumatic Stress Disorder [Internet]

Efficacy of Complementary and Alternative Medicine Therapies for Posttraumatic Stress Disorder [Internet]

Evidence-based Synthesis Program - Department of Veterans Affairs (US)

Version: August 2011

INTRODUCTION

Posttraumatic stress disorder (PTSD) is among the most common Axis I disorders, with an estimated lifetime prevalence in the U.S. of approximately 7 percent. PTSD is often chronic and is associated with significant adverse consequences, including high rates of depression and other psychiatric comorbidities; substance abuse; suicidality; impaired social, occupational, and family functioning; decreased quality of life; and increased rates of medical morbidity, health risk behaviors, and health service use. PTSD is the emotional disorder most frequently associated with combat and other potentially traumatic experiences that may occur during the course of military service (e.g., sexual assault, motor vehicle injury). Over 2.2 million U.S. troops have deployed in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). One anticipated consequence of this sustained period of military operations is the increased incidence of PTSD among Veterans. Among OEF/OIF Veterans who received Department of Veterans Affairs (VA) care between 2002 and 2008, 22 percent were diagnosed with PTSD. In addition to increased mental health service use among this newest generation of Veterans, the VA has witnessed the sharpest increase in mental health service use among Vietnam-era Veterans. As the VA strives to anticipate and serve the treatment needs of the Veteran population, including those returning from current Middle East conflicts as well as Veterans of previous service eras, identifying and implementing effective PTSD treatment approaches remains a critical priority.

SUMMARY AND DISCUSSION

This evidence synthesis was requested by VA Research and Development to review and summarize the empirical evidence for applications of common CAM therapies to the treatment of PTSD. Four KQs were identified to examine the efficacy of mind-body therapies (KQ 1), manipulative and body-based therapies (KQ 2), movement-based therapies (KQ 3), and relevant evidence derived from nonrandomized trials of CAM interventions for PTSD (KQ 4).

RESULTS

We identified 1776 unique citations from a combined search of MEDLINE® (via PubMed®, n = 353), Embase® (n = 451), CINAHL® (n = 429), PsychINFO® (n = 390), Cochrane Database of Systematic Reviews (n = 32), and the PILOTS database (n = 121). By manual examination of the bibliographies of included studies and review articles, we identified four additional citations. Of these, 1738 were excluded at the title-and-abstract level. Of the 1738 studies excluded at the title-and-abstract level, we reevaluated and categorized the reason for exclusion in a subsample of 600 citations. The most common reasons for exclusion were review article (23%); a drug or a non-CAM intervention (22%); a “standard treatment” (e.g., EMDR or CBT) without a CAM comparator (14%); a sample under 19 years of age (13%); a sample that did not have PTSD (10%); and evaluation of therapies that were neither standard for PTSD nor for CAM (10%).

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