Non-pharmacological and non-psychological approaches to the treatment of PTSD: results of a systematic review and meta-analyses.

Abstract:

Background:Non-pharmacological and non-psychological approaches to the treatment of post-traumatic stress disorder (PTSD) have often been excluded from systematic reviews and meta-analyses. Consequently, we know little regarding their efficacy. Objective:To determine the effect sizes of non-pharmacological and non-psychological treatment approaches for PTSD. Method:We undertook a systematic review and meta-analyses following Cochrane Collaboration guidelines. A pre-determined definition of clinical importance was applied to the results and the quality of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results:30 randomised controlled trials (RCTs) of a range of heterogeneous non-psychological and non-pharmacological interventions (28 in adults, two in children and adolescents) were included. There was emerging evidence for six different approaches (acupuncture, neurofeedback, saikokeishikankyoto (a herbal preparation), somatic experiencing, transcranial magnetic stimulation, and yoga). Conclusions:Given the level of evidence available, it would be premature to offer non-pharmacological and non-psychological interventions routinely, but those with evidence of efficacy provide alternatives for people who do not respond to, do not tolerate or do not want more conventional evidence-based interventions. This review should stimulate further research in this area. :Antecedentes: Los enfoques no farmacológicos y no psicológicos para el tratamiento del trastorno de estrés postraumático (TEPT) han sido frecuentemente excluidos de las revisiones sistemáticas y los metanálisis. Consecuentemente, poco sabemos acerca de su eficacia.Objetivo: Determinar los tamaños de efecto de los enfoques de tratamiento no farmacológicos y no psicológicos para el TEPT.Método: Realizamos una revisión sistemática siguiendo las guías de la Colaboración Cochrane. Se aplicó una definición predeterminada de la importancia clínica a los resultados y se evaluó la calidad de la evidencia usando el enfoque de Calificación del Análisis, Desarrollo y Evaluación de las Recomendaciones (GRADE por sus siglas en ingles de Grading of Recommendations Assessment, Development and Evaluation).Resultados: Se incluyeron 30 estudios controlados aleatorizados (RCTs) de un rango de intervenciones heterogéneas no psicológicas y no farmacológicas (28 en adultos, dos en niños y adolescentes). Hubo evidencia emergente para 6 diferentes enfoques (acupuntura, neurofeedback, saikokeishikankyoto (una preparación a base de hierbas), experiencia somática, estimulación magnética transcraneal y yoga).Conclusiones: Dado el nivel de evidencia disponible, sería prematuro ofrecer intervenciones no farmacológicas y no psicológicas de forma rutinaria, pero aquellas con evidencia de eficacia brindan alternativas para las personas que no responden, no toleran o no quieren intervenciones convencionales basadas en la evidencia. Esta revisión debería estimular mayor investigación en esta área. :背景:治疗创伤后应激障碍 (PTSD) 的非药物学和非心理学方法常常被系统综述和元分析排除。因此, 我们对其疗效知之甚少。目的:确定PTSD的非药物和非心理治疗方法的效应量。方法:我们根据Cochrane协作指南进行了系统综述。将临床重要性的预定义应用于结果, 并使用‘建议, 评估, 发展和评估’ (GRADE) 方法评估证据的质量。结果:纳入了30项各种异质的非心理和非药物干预措施的随机对照试验 (RCT) (成人28例, 儿童和青少年2例) 。有六种不同方法的新证据 (针灸, 神经反馈, saikokeishikankyoto (一种草药制剂), 躯体体验, 经颅磁刺激和瑜伽) 。结论:鉴于可获得的证据水平, 定期提供非药物和非心理干预为时过早, 但有疗效的证据为那些不响应, 不容忍或不愿接受更多传统循证干预的人提供了替代方案。这项综述应促进这一领域的进一步研究。.

journal_name

Eur J Psychotraumatol

authors

Bisson JI,van Gelderen M,Roberts NP,Lewis C

doi

10.1080/20008198.2020.1795361

subject

Has Abstract

pub_date

2020-08-24 00:00:00

pages

1795361

issue

1

issn

2000-8066

pii

1795361

journal_volume

11

pub_type

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