Psychological interventions for adult PTSD safe and face-to-face delivery may be the safest format

Post-traumatic stress disorder (PTSD) is a common, severe and potentially chronic mental disorder. Psychotherapy over the time has become a popular treatment of choice. But concern about harmful effects of psychological interventions for PTSD has recently increased and a comprehensive meta-analysis is lacking.

A recent study by Hoppen et al., published in The British Journal of Psychiatry has expansively assessed the safety of psychological interventions for adult PTSD and has concluded that in none of the analyses, were psychological interventions associated with an increased risk of harm compared with control conditions, thereby establishing the safety of these interventions.

Psychological interventions are the first-line treatment recommendation for adult PTSD in international treatment guidelines. Authors argue that research on psychotherapy for PTSD has ignored potential harms for a long time.

For the present analysis, data was collected from 56 RCTs and the main research question was formulated describing the Population, Intervention, Comparison, Outcome and Study design (PICOS) as follows: in patients with PTSD (P), are psychological interventions (I), compared with passive and active control conditions (C), associated with lower rates/risk of deterioration of PTSD symptoms, AEs and SAEs (O) in RCTs (S). Whenever possible, the safety profile among different families of psychological intervention was also compared.

It was found that incidences of harms were generally low. Psychological interventions were associated with decreased risk of deterioration relative to passive and active control conditions.

Decreased risk was even more pronounced in sensitivity analyses on trials exclusively delivering treatments face to face. When compared with other psychological interventions, trauma-focused cognitive–behavioural therapy (TF-CBT) was associated with decreased risk of SAEs and with no differential risk of deterioration and AEs.

It was concluded that the current evidence base suggests that psychological interventions are safe for most adults with PTSD. In none of the analyses were psychological interventions associated with an increased risk of harm compared with control conditions. TF-CBT was found at least as safe as other psychological interventions. Individual face-to-face delivery might be the safest delivery format.

Source: The British Journal of Psychiatry: https://doi.org/10.1192/bjp.2022.111