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The Efficacy of Psychological Interventions for Complex Trauma: A Systematic Review and Meta-Analysis

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/cog nitive 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 re processing (EMDR), and present-centered therapy (PCT) each showed moderate to large effect sizes on PTSD. For depres sion, 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 or ganization (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

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