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Trauma-focused cognitive–behavioural therapy (CBT) and eye movement desensitisation and reprocessing therapy (EMDR) are efficacious treatments for post-traumatic stress disorder (PTSD), but few studies have directly compared them using well-powered designs and few have investigated response patterns.
To compare the efficacy and response pattern of a trauma-focused CBT modality, brief eclectic psychotherapy for PTSD, with EMDR (trial registration: ISRCTN64872147).
Out-patients with PTSD were randomly assigned to brief eclectic psychotherapy (n = 70) or EMDR (n = 70) and assessed at all sessions on self-reported PTSD (Impact of Event Scale – Revised). Other outcomes were clinician-rated PTSD, anxiety and depression.
Both treatments were equally effective in reducing PTSD symptom severity, but the response pattern indicated that EMDR led to a significantly sharper decline in PTSD symptoms than brief eclectic psychotherapy, with similar drop-out rates (EMDR: n = 20 (29%), brief eclectic psychotherapy: n = 25 (36%)). Other outcome measures confirmed this pattern of results.
Although both treatments are effective, EMDR results in a faster recovery compared with the more gradual improvement with brief eclectic psychotherapy.
Post-traumatic stress disorder (PTSD) has inconsistently been associated with lower levels of cortisol.
To compare basal cortisol levels in adults with current PTSD and in people without psychiatric disorder.
Systematic review and meta-analysis. Standardised mean differences (SMD) in basal cortisol levels were calculated and random-effects models using inverse variance weighting were applied.
Across 37 studies, 828 people with PTSD and 800 controls did not differ in cortisol levels (pooled SMD = −0.12, 95% C1= −0.32 to 0.080). Subgroup analyses revealed that studies assessing plasma or serum showed significantly lower levels in people with PTSD than in controls not exposed to trauma. Lower levels were also found in people with PTSD when females were included, in studies on physical or sexual abuse, and in afternoon samples.
Low cortisol levels in PTSD are only found under certain conditions. Future research should elucidate whether low cortisol is related to gender or abuse and depends on the measurement methods used.
Recent studies show that individual single-session psychological
debriefing does not prevent and can even aggravate symptoms of
post-traumatic stress disorder (PTSD).
We studied the effect of emotional ventilation debriefing and educational
debriefing v. no debriefing on symptoms of PTSD, anxiety
We randomised 236 adult survivors of a recent traumatic event to either
emotional ventilation debriefing, educational debriefing or no debriefing
(control) and followed up at 2 weeks, 6 weeks and 6 months.
Psychiatric symptoms decreased in all three groups over time, without
significant differences between the groups in symptoms of PTSD
(P=0.33). Participants in the emotional debriefing
group with high baseline hyperarousal score had significantly more PTSD
symptoms at 6 weeks than control participants
Our study did not provide evidence for the usefulness of individual
psychological debriefing in reducing symptoms of PTSD, anxiety and
depression after psychological trauma.
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