First-line therapy for post-traumatic stress disorder : a systematic review of cognitive behavioural therapy and psychodynamic approaches

Background: Despite evidence supporting cognitive behavioural therapy (CBT) based interventions as the most effective approach for treating posttraumatic stress disorder (PTSD) in randomised control trials, alternative treatment interventions are often used in clinical practice. Psychodynamic (PDT) based interventions are one example of such preferred approaches, this is despite comparatively limited available evidence supporting their effectiveness for treating PTSD. Aims: Existing research exploring effective therapeutic interventions for PTSD includes trauma-focused CBT involving exposure techniques. The present review sought to establish the treatment efficacy of CBT and PDT approaches, and considers the potential impact of selecting PDT-based techniques over CBT-based techniques for the treatment of PTSD.Results: The evidence reviewed provided examples supporting PDT-based therapy as an effective treatment for PTSD, but confirmed CBT as more effective in the treatment of this particular disorder. Comparable dropout rates were reported for both treatment approaches, suggesting that relative dropout rate should not be a pivotal factor in the selection of a PDT approach over CBT for treatment of PTSD.Conclusion/Implications: The need to routinely observe evidence-based recommendations for effective treatment of PTSD is highlighted and factors undermining practitioner engagement with CBT-based interventions for the treatment of PTSD are identified

Women health: Psychological and most prominent somatic problems in 3-year follow-up in Bosnian refugees.

BACKGROUND: Little is known about gender differences among people exposed to war related trauma. Aim of this study is to explore gender differences in health status and comorbidity of mental and physical disorders in a cohort of Bosnian refugees followed up for 3 years (1996-1999). METHODS: This longitudinal study included 534 subjects followed up for 3 years. The interviews were conducted in refugee camps in Varaždin, Croatia in Bosnian language. Data were collected using Harvard Trauma Questionnaire (Bosnian version) and Hopkins Checklist-25, respectively. Physical health disorders were self-reported. RESULTS: In both assessments there was a statistically significant difference between men and women in the number of physical health disorders, even when results were controlled for educational status. Although there was no difference in total number of symptoms in both assessments (F = 0.32; df = 1; p > 0.05 and F = 1.15; df = 1; p > 0.05), important physical health disorders were significantly more frequent among women than in men in different educational groups, namely high blood pressure and cardiovascular diseases, arthritis, and anaemia. Asthma, tuberculosis, cirrhosis of the liver, ulcer and epilepsy were more frequent in men than in women. There were no differences in frequencies of psychiatric disorders at baseline, but frequency of psychiatric disorders in women was higher at endpoint for uneducated respondents. There was significant difference compared to men in group of respondents without formal education, but only in comorbidity of PTSD and depression which was more often present in females (22.1%) than in males (3.6%). CONCLUSION: Our findings indicate the importance of gender and education on mental and physical health of people exposed to warrelated trauma. Long term health monitoring and programs, especially related to women's health are needed in order to avoid lasting consequences. This is the accepted manuscript of an article published online: Sarajlić Vuković I, Jovanović N, Džubur Kulenović A, Britvić D, Mollica RF. Women health: Psychological and most prominent somatic problems in 3-year follow-up in Bosnian refugees. International Journal of Social Psychiatry. November 2020. doi:10.1177/0020764020972433