Flowchart of the process of identifying and selecting studies.

<p>Flowchart of the process of identifying and selecting studies.</p

Methodological Analysis of Randomized Controlled Trials.

<p>Methodological Analysis of Randomized Controlled Trials.</p

Methodological Analysis of Randomized Controlled Trials; + Low Risk of Bias; – High Risk of Bias; ? Unclear Risk of Bias.

<p>Methodological Analysis of Randomized Controlled Trials; + Low Risk of Bias; – High Risk of Bias; ? Unclear Risk of Bias.</p

Systematic Review of the Efficacy of Cognitive-Behavior Therapy Related Treatments for Victims of Natural Disasters: A Worldwide Problem

<div><p>Natural disasters can have devastating consequences. Each year, about 225 million people are victims of natural disasters worldwide, and up to 13,5 million of these people can develop post-traumatic stress disorder (PTSD) in the first or second year following the disaster. Cognitive-behavior therapy (CBT) is the first-choice treatment for this disorder. In order to evaluate the efficacy of psychotherapeutic treatment based on cognitive-behavior therapy for people who developed post traumatic stress disorder after natural disasters we conducted a systematic search of published studies. We used the terms reported below in the electronic databases ISI Web of Science, PsycINFO, PubMed, PILOTS and Scopus with no restrictions of language or publication date. Articles that described randomized controlled, non-randomized controlled and non controlled studies on the efficacy of cognitive-behavior therapy for individuals diagnosed with post-traumatic stress disorder after exposure to a natural disaster were eligible for inclusion. The studies were required to use a standardized measure of effectiveness before and after the intervention and have a group of patients who had used cognitive-behavior therapy as the only intervention. Our search identified 820 studies, and 11 were selected for this review. These 11 studies involved 742 subjects, 10 related to earthquakes and 1 to a hurricane. The cognitive-behavior therapy techniques used were various: 7 studies used exposure therapy, 2 studies used problem solving, and the only 2 studies with adolescents used techniques including reconstructions and reprocessing of the traumatic experience. As limitations, the search involved only five electronic databases, no experts in the field were consulted, and the heterogeneity of the findings made it impossible to perform a meta-analysis. The results suggest the efficacy of cognitive-behavior therapy, particularly exposure techniques, for the treatment of post-traumatic stress disorder after earthquakes. However, further studies with stronger methodologies, i.e. randomized-control trials and non-randomized controlled trials, are needed.</p></div

Description of variables in evaluation of methodological quality.

<p>Description of variables in evaluation of methodological quality.</p

Methodological Analysis for Study.

<p>Methodological Analysis for Study.</p

Flowchart of the process of identification and selection of studies.

<p>Flowchart of the process of identification and selection of studies.</p

Description of studies.

<p>The studies of Zhang et. al. (2011), Jaycox et. al. (2010) and Oflaz et. al. (2008) are originally randomized studies, but for the purposes of this review and analysis of their results they were used as open trials. Abbreviations: IES-R = Impact of Event Scale – Revised; CPTSD-RI = Child Posttraumatic Stress Disorder Reaction Index; CAPS = Clinician-Administered PTSD Scale; CPTSD-SS = Child PTSD Symptom Scale; CRIES = Children's Revised Impact of Event Scale; TSSC = Traumatic Stress Symptom Checklist; SSBT = Single Session Behavioral Treatment; WL = Waiting List; RA = Repeated Assessments; NET = Narrative Exposure Therapy; CBITS = Cognitive-Behavioral Intervention for Trauma in Schools; TF-CBT = Trauma-Focused Cognitive-Behavioral Therapy; CBT = Cognitive-Behavioral Therapy.</p><p>Description of studies.</p

Methodological Analysis by Criteria.

<p>Methodological Analysis by Criteria.</p

Tonic Immobility Scale items used to compute the total score.

<p>Tonic Immobility Scale items used to compute the total score.</p