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