Korean Clinical Psychology Association

Current Issue

Korean Journal of Clinical Psychology - Vol. 39 , No. 2

[ Review Article ]
Korean Journal of Clinical Psychology - Vol. 39 , No. 2 , pp.164-185
ISSN: 2733-4538 (Online)
publication date 30 May 2020
Received 03 Jan 2020 Revised 09 Feb 2020 Accepted 27 Feb 2020
DOI: https://doi.org/10.15842/kjcp.2020.39.2.007

The Efficacy of Psychological Interventions for Complex Trauma: A Systematic Review and Meta-Analysis
Hyunjung Choi1, ; Wooyeol Lee1 ; Simyang Heo2 ; Jahye Kim2
1Department of Psychology, Chungbuk National University, Cheongju, Korea
2Traumahealing Center Human Hearts, Seoul, Korea

Correspondence to : Hyunjung Choi, Department of Psychology, Chungbuk National University, 1 Chung-daero, Suwon-gu, Cheongju, Korea; E-mail: hchoi@chungbuk.ac.kr


© 2020 Korean Clinical Psychology Association
Funding Information ▼

Abstract

This study meta-analyzed interventions for symptom constructs of complex posttraumatic stress disorder related to complex trauma, such as child abuse, multiple interpersonal trauma, and organized violence. From 42 randomized controlled studies, 164 effect sizes were calculated comprising various treatment comparisons and outcomes. Cognitive processing therapy/cognitive therapy (CPT/CT), narrative exposure therapy (NET), phase-based trauma-focused cognitive behavior therapy (phased TF-CBT), single-phased TF-CBT (single TF-CBT), prolonged exposure (PE), eye movement desensitization and reprocessing (EMDR), and present-centered therapy (PCT) each showed moderate to large effect sizes on PTSD. For depression, CPT/CT, phased TF-CBT, single TF-CBT, NET, and PE showed moderate to large effect sizes. Meta regression revealed that efficacy on PTSD and depression was greater with trauma-focused than with present-centered interventions. Limited evidence made it impossible to compare phased treatments and single-phase treatments. Outcomes of disturbance in self organization (DSO) were relatively scarce; however, among those, CPT/CT, PE, and PCT showed large to moderate effect sizes on negative self-concept. For emotion regulation and interpersonal problems, phased TF-CBT seemed to be promising. Treatment completion rates were similar between trauma-focused and present-centered. Population and study characteristics did not affect efficacy; however, we discussed related clinical issues.


Keywords: complex trauma, evidence-based interventions, posttraumatic stress disorder, complex posttraumatic stress disorder, meta-analysis

Acknowledgments

This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2017S1A5B5A07062178).


References
1. American Psychological Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. Washington, DC: Author..
2. Becker, B. J. (1990). Coaching for the scholastic aptitude test: Further synthesis and appraisal. Review of Educational Research, 60, 373-417..
3. Bisson, J. I., Roberts, N. P., Andrew, M., Cooper, R., & Lewis, C. (2013). Psychological therapies for chronic post‐traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews, 2013, CD003388..
4. Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162, 214-227..
5. Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R. A., . . . Reed, G. M. (2017). A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clinical Psychology Review, 58, 1-15..
6. Briere, J. N. (1992). Child abuse trauma: Theory and treatment of the lasting effects. Thousand Oaks, CA: Sage Publications..
7. Cloitre, M., Courtois, C., Ford, J., Green, B., Alexander, P., Briere, J., . . . van der Hart, O. (2012). The ISTSS Expert Consensus Treatment Guidelines for Complex PTSD in Adults. Retrieved from http://www.istss.org/AM/Template.cfm?Section=ISTSS_Complex_PTSD_Treatment_Guidelines&Template=/CM/ContentDisplay.cfm&ContentID=5185.
8. Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A., & Maercker, A. (2013). Evidence for proposed ICD-11 PTSD and complex PTSD: A latent profile analysis. European Journal of Psychotraumatology, 4, 20706..
9. Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014). Distinguishing PTSD, complex PTSD, and borderline personality disorder: A latent class analysis. European Journal of Psychotraumatology, 5, 25097..
10. Cloitre, M., Petkova, E., Wang, J., & Lu Lassell, F. (2012). An examination of the influence of a sequential treatment on the course and impact of dissociation among women with PTSD related to childhood abuse. Depression and Anxiety, 29, 709-717..
11. Cloitre, M., Shevlin, M., Brewin, C., Bisson, J. I., Roberts, N. P., Maercker, A., . . . Hyland, P. (2018). The International Trauma Questionnaire: Development of a self‐report measure of ICD‐11 PTSD and complex PTSD. Acta Psychiatrica Scandinavica, 138, 536-546..
12. Cohen, J. (1988). Statistical power analysis for the behavioral science (2nd ed.). Hillsdale, NJ: Erlbaum..
13. Conn, V. S., Valentine, J. C., Cooper, H. M., & Rantz, M. J. (2003). Grey literature in meta-analysis. Nursing Research, 52, 256-261..
14. Cooper, H. M. (1998). Synthesizing research: A guide for literature reviews (3rd ed.). Thousand Oaks, CA: Sage..
15. Cooper, H. M. (2010). Research synthesis and meta-analysis: A step by step approach. New York, NY: Sage..
16. Courtois, C. A., & Ford, J. D. (2013). Treatment of complex trauma: A sequenced, relationship-based approach. New York, NY : Guilford Press..
17. De Jongh, A., Resick, P. A., Zoellner, L. A., van Minnen, A., Lee, C. W., Monson, C. M., . . . Bicanic, I. A. E. (2016). Critical analysis of the current treatment guidelines for complex PTSD in adults. Depression and Anxiety, 33, 359-369..
18. Dorrepaal, E., Thomaes, K., Hoogendoorn, A. W., Veltman, D. J., Draijer, N., & van Balkom, A. J. L. M. (2014). Evidence-based treatment for adult women with child abuse-related complex PTSD: A quantitative review. European Journal of Psychotraumatology, 5, 23613..
19. Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56, 455-463..
20. Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., & Fennell, M. (2005). Cognitive therapy for post-traumatic stress disorder: Development and evaluation. Behaviour Research and Therapy, 43, 413-431..
21. Ehring, T., Welboren, R., Morina, N., Wicherts, J. M., Freitag, J., & Emmelkamp, P. M. (2014). Meta-analysis of psychological treatments for posttraumatic stress disorder in adult survivors of childhood abuse. Clinical Psychology Review, 34, 645-657..
22. Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. New York, NY: Guilford Press..
23. Haagen, J. F., Smid, G. E., Knipscheer, J. W., & Kleber, R. J. (2015). The efficacy of recommended treatments for veterans with PTSD: A metaregression analysis. Clinical Psychology Review, 40, 184-194..
24. Hall, B. J., Murray, S. M., Galea, S., Canetti, D., & Hobfoll, S. E. (2015). Loss of social resources predicts incident posttraumatic stress disorder during ongoing political violence within the Palestinian Authority. Social Psychiatry and Psychiatric Epidemiology, 50, 561-568..
25. Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. In M. J. Horowitz (Ed.), Essential papers on post traumatic stress disorder. New York, NY: New York University Press..
26. Herman, J. L. (1997). Trauma and recovery: The aftermath of violence-from domestic abuse to political terror. New York, NY: Basic Books..
27. Hien, D. A., Lopez-Castro, T., Papini, S., Gorman, B., & Ruglass, L. M. (2017). Emotion dysregulation moderates the effect of cognitive behavior therapy with prolonged exposure for co-occuring PTSD and substance use disorders. Joural of Anxiety Disorders, 52, 53-61..
28. Hobfoll, S. E., Mancini, A. D., Hall, B. J., Canetti, D., & Bonanno, G. A. (2011). The limits of resilience: Distress following chronic political violence among Palestinians. Social Science & Medicine, 72, 1400-1408..
29. Imel, Z. E., Laska, K., Jakupcak, M., & Simpson, T. L. (2013). Meta-analysis of dropout in treatments for posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 81, 394-404..
30. Institute of Medicine. (2011). Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press..
31. ISTSS Guidelines Committee. (2018). ISTSS Guidelines Position Paper on Complex PTSD in Adults. Oakbrook Terrace, IL: Author..
32. Jang, D., & Shin, I. (2011). Historical development of meta-analysis as an educational research methodology. Journal of Curriculum and Evaluation, 14, 309-332..
33. Karatzias, T., Murphy, P., Cloitre, M., Bisson, J., Roberts, N., Shevlin, M., . . . Hutton, P. (2019). Psychological interventions for ICD-11 complex PTSD symptoms: Systematic review and meta-analysis. Psychological Medicine, 49, 1-15..
34. Kleindienst, N., Priebe, K., Görg, N., Dyer, A., Steil, R., Lyssenko, L., . . . Bohus, M. (2016). State dissociation moderates response to dialectical behavior therapy for posttraumatic stress disorder in women with and without borderline personality disorder. European Journal of Psychotraumatology, 7, 30375..
35. Knefel, M., Garvert, D. W., Cloitre, M., & Lueger-Schuster, B. (2015). Update to an evaluation of ICD-11 PTSD and complex PTSD criteria in a sample of adult survivors of childhood institutional abuse by Knefel & Lueger-Schuster (2013): A latent profile analysis. European Journal of Psychotraumatology, 6, 25290..
36. Leeman, R. F., Hefner, K., Frohe, T., Murray, A., Rosenheck, R. A., Watts, B. V., & Sofuoglu, M. (2017). Exclusion of participants based on substance use status: Findings from randomized controlled trials of treatments for PTSD. Behaviour Research and Therapy, 89, 33-40..
37. Levine, P. A. (2010). In an unspoken voice: How the body releases trauma and restores goodness. Berkeley, CA: North Atlantic Books..
38. Linehan, M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York, NY: Guilford Press..
39. Martin, J. L. R., Pérez, V., Sacristán, M., & álvarez, E. (2005). Is grey literature essential for a better control of publication bias in psychiatry? An example from three meta-analyses of schizophrenia. European Psychiatry, 20, 550-553..
40. Miller, K. E., & Rasmussen, A. (2010). War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks. Social Science & Medicine, 70, 7-16..
41. Morris, S. B. (2008). Estimating effect sizes from pretest-posttest-control group designs. Organizational Research Methods, 11, 364-386..
42. National Institute for Health and Care Excellence (NICE). (2012). The guidelines manual. London: National Institute for Health and Care Excellence..
43. Ogden, P., & Fisher, J. (2015). Sensorimotor psychotherapy: Interventions for trauma and attachment (Norton series on interpersonal neurobiology). New York, NY: WW Norton & Company..
44. Pelcovitz, D., van der Kolk, B. A., Roth, S., Mandel, E. S., Kaplan, S., & Resick, P. (1997). Development of a criteria set and a structured interview for disorders of extreme stress (SIDES). Journal of Traumatic Stress, 10, 3-16..
45. Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60, 748..
46. Seidler, G. H., & Wagner, F. E. (2006). Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: A meta-analytic study. Psychological Medicine, 36, 1515-1522..
47. Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures. New York, NY: Guilford Press..
48. ter Heide, F. J. J., Mooren, T. M., & Kleber, R. J. (2016). Complex PTSD and phased treatment in refugees: A debate piece. European Journal of Psychotraumatology, 7, 28687..
49. Terr, L. (1990). Too scared to cry. New York, NY: Basic Books..
50. van der Kolk, B. A. (1996). The complexity of adaptation to trauma: Self-regulation, stimulus discrimination, and characterological development. In B. A. van der Kolk, A. C. McFarlane, & L. Weisæth (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body, and society (pp.182-213). New York, NY: Guilford Press..
51. World Health Organization. (2018). International Classification of Disorders, 11th edition. Geneva: World Health Organization..