Table 2.
Characteristics of included studies.
| Study/ Design |
n | % Drop out or missing data |
Gender F: M |
Mean age yrs ± SD (Range) |
Intervention
vs. Comparator |
PTSD dx required |
Participant characteristics |
Duration of intervention |
PTSD outcomes |
Results | Overall Study Outcome* |
Quality Assessment Score |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ENERGY MEDICINE | ||||||||||||
| Boggio, 2010 RCT | 30 | 13% | 21:9 | 44.5 ± 4.4 | rTMS 20Hz to right or left dlPFC vs.Sham rTMS | Yes, SCID criteria | Mixed trauma types | 5 sessions (1600 pulses per session)/ wk for 2 wks | PCL, TOPS | Right and left rTMS sig dec PTSD outcomes vs sham (PCL p<.001; TOPS p<.001). | Positivea | 92 |
| Cohen, 2004 RCT | 29 | 17% | 7:17* | 41.7 ± 11.4 (22–68) | rTMS 10Hz or rTMS 1Hz to right dlPFC vs.Sham rTMS | Yes, SCID criteria | Mixed trauma types | Five 20-min sessions/wk for 2 wks | PCL, TOPS, CAPS-Hebrew version | For PCL and TOPS: 10Hz rTMS sig better than sham and 1Hz (p<.002). No diff 1Hz rTMS vs. sham. | Positivea | 85 |
| Grisaru, 1998 Pre-post | 10 | 0% | 3:7 | 47 (21–53) | rTMS 0.3Hz | Yes, DSM-IV criteria | Mixed trauma types | Single session of 30 pulses at 1 min intervals | IES | No sig change in total IES or IES-I; Sig dec IES-A at 7 day follow up (p=0.033); no sig diff 28 day follow up. | Mixedc | 71 |
| Osuch, 2009 Cross-over | 9 | 0% | 8:1 | 41.4 ± 12.3 (24–56) | Imaginal exposure therapy plus rTMS 1Hz to right dlPFC vs. Imaginal exposure therapy plus sham rTMS | Yes, no criteria specified | Mixed trauma types | Three to five 30-min sessions/wk for a total of 20 sessions | CAPS, IES | No sig diff between exposure + active rTMS vs. exposure + sham rTMS except for moderate dec CAPS hyperarousal subscale (p=0.08). | Mixeda | 70 |
| Watts, 2012 RCT | 20 | 0% | 2:18 | Tx: 54 ± 12.3; Ctrl: 57.8 ± 11.8 | rTMS 1Hz to right dlPFC vs. Sham rTMS | Yes, SCID criteria | Veterans with mostly combat trauma | Five 20-min sessions/wk for 2 wks | CAPS, PCL | rTMS sig reduced CAPS (p=.009) and PCL (p=.0002) vs sham rTMS. | Positivea | 80 |
| CHINESE MEDICINE | ||||||||||||
| Hollifield, 2007 RCT | 84 | 27% | 57:27 | Acu: 42.3 ± 12.1; CBT: 40.9 ± 13.4; Ctrl: 43.4 ± 13.5 | Acupuncture vs. 1) CBT; 2) 12-wk waitlist control | Yes, SCID criteria | Mixed trauma types | Acupuncture: two 1-hr sessions/wk for 12 wks; CBT: one 2-hr session/wk for 12 wks | PSS-SR | Both acupuncture and CBT dec PTSD outcomes vs waitlist controls (p<.01). No diff between acup and CBT as both groups improved (p=0.29). | Neutrala; Positiveb | 88 |
| Zhang, 2011 RCT | 91 | 1% | 55:36 | 35.0 ± 19.3 (4–89) | Acupoint stimulation (50Hz) + CBT vs.CBT | Yes, WHO criteria | Acute PTSD from China's 2008 Zhejiang Province earthquake | Acupoint and CBT: 30 min session every other day over one wk | IES-R Chinese version | Acupoint +CBT more effective reducing IES-R than CBT alone (p<0.01). | Positivea | 77 |
| MIND-BODY: BIOFEEDBACK | ||||||||||||
| Lande, 2010 CT | 49 | 20% | 6:33* | mean/range not reported | HRV Biofeedback vs. TAU | No | Active duty combat soldiers with self-report PTSD | Two 20-mintue sessions/wk for 3 wks | PCL-M | Both biofeedback and control groups experienced sig dec in PTSD symptoms over time, no sig diff between groups. | Negativeb | 62 |
| Muller, 2009 Pre-post | 13 | 15% | 8:3* | 35.7 ± 6.1 | Pain-focused cognitive behavioral biofeedback | Yes, MINI criteria | Refugees with PTSD, chronic pain, and experience of torture or war | One 90-min session/wk for 10 wks | Post-traumatic Diagnostic Scale | No sig changes in PTSD symptoms over time. | Negativec | 76 |
| Tan, 2011 RCT | 20 | 5% | 0:20 | 36.0 ± 13.1 (24–62) | HRV Biofeedback vs. TAU | Yes, no criteria specified | Veterans with combat-related PTSD | One 30-min session/wk for 8 wks | CAPS, PCL | Biofeedback sig dec CAPS (p<.001) and PCL (p=.035) pre-post; Only CAPS-AN better in biofeedback group vs TAU; no other between group diff but moderate effect sizes for change in overall sx (Cohen’s d = 0.52–0.70 for CAPS and PCL respectively). | Mixedb | 80 |
| Zucker, 2009 RCT | 50 | 24% | 17:21* | (18–60) | RSA Biofeedbackvs.Progressive muscle relaxation recording | No | Substance use disorder and elevated PTSD sx; mixed trauma types | Personal instruction for portable biofeedback device or PMR recording: 20-mins/day for 4 wks. | PCL, PTS-T | Both groups decreased PTSD scores over time (both groups p<.01). Biofeedback did not improve PCL scores (p=0.32) or PTS-T scores (p=0.73) over control. | Neutrala | 81 |
| MIND-BODY: THOUGHT FIELD THERAPIES | ||||||||||||
| Folkes, 2002 Pre-post | 61 | 49% | not reported | 27.7 (5–48) | TFT | No | Adult and child refugees from five language groups | One 60 to 90-min session | PCL (adult or child version) | 50% dropout rate, analysis completed on 31 individuals with complete data sets. PCL-C scores dropped 40% from pre- to post-intervention (p=0.05). | Positivec | 62 |
| Karatzias, 2011 RCT | 46 | 43% | 26:20 | EFT: 39.7 ± 10.9; EMDR: 41.5 ± 10.8 | EFT vs.EMDR | Yes, DSM-IV criteria | Mixed trauma types | Up to eight 1-hour sessions. EMDR group received 3.7 ± 2.3 hrs, EFT group received 3.8 ± 2.6 hrs. | CAPS, PCL | 43.5% dropped out from the EMDR group, and 39.1% dropped out from the EFT group. Both EFT and EMDR improved all outcomes (p<.001). Effect size Cohen's d= 0.80 for both modalities. | Neutrala | 85 |
| MIND-BODY: HYPNOSIS | ||||||||||||
| Abramowitz, 2008 RCT | 32 | 0% | 0:32 | 31.7 (21–40) | Hypnosisvs.Zolpidem 10mg | Yes, DSM-IV criteria | Chronic combat-related PTSD with insomnia | Hypnosis: Two 1.5-hour sessions/wk for 2 wks; Zolpidem: 10mg nightly for 2 wks | IES-R, PDS | Hypnosis group had sig reductions in PDS (p<.034) and IES scores (p<.0005) compared to Zolpidem over the course of the study. | Positivea | 77 |
| Abramowitz, 2010 Pre-post | 37 | 3% | 0:37 | 41.2 ± 12.2 (24–64) | Hypnosis paired with olfactory based exposure | Yes, semi-structured interview with DSM-IV criteria | Combat trauma | One 90-min session/wk for 6 wks | IES-R | Hypnosis technique decreased stress reaction after 6 wks (p<.0001). | Positivec | 81 |
| Bryant, 2006 RCT | 87 | 46% | 53:34 | (17–60) | Hypnosis + CBTvs.1) CBT; 2) Supportive counseling | No | Acute stress disorder from motor vehicle accident or sexual assault | CBT and CBT plus hypnosis-Both groups five 90-min sessions | CAPS, IES | No diff in IES scores among groups. CAPS scores for CBT and CBT Hypnosis groups were 43% lower than counseling group at 3 year follow-up (p=0.05). | Neutrala | 77 |
| MIND-BODY: MEDITATION | ||||||||||||
| Bormann, 2005 Pre-post | 101 | 39% | 6:56* | 61.8 ± 13.2 (33–84) | Mantram Meditation | No | Veterans with combat-related trauma | One 90-min instructional session/wk for 5 wks plus home practice | PCL | PTSD scores (only available for n=30) decreased 13.7% from pre- to post-intervention (p=0.02). | Positivec | 90 |
| Bormann, 2008 RCT | 33 | 14% | 0:33 | 56 ± 6.6 (40–76) | Mantram Meditationvs. Waitlist control | Yes, no criteria specified | Veterans with combat-related PTSD | One 90-min session/wk for 6 wks | PCL, CAPS | Intervention improved CAPS score (effect size −0.33) and PCL score (effect size −0.72), no p values provided. | Positiveb | 85 |
| Brooks, 1985 CT | 25 | 28% | 0:18* | 33.3 | Transcendental Meditation vs.Psychotherapy | No | Vietnam veterans with chronic PTSD | Meditation: One 60-min session/wk for 12 wks; Therapy: One 60-min session/wk for 12 wks | Non-standard PTSD Scale (no reference provided in paper) | Meditation showed positive effect compared to psychotherapy for PTSD and related subscales of emotional numbness, anxiety, depression, alcohol use, insomnia, and family problems (all p<.05). | Positivea | 54 |
| Harris, 2011 RCT | 54 | 6% | 6:48 | 45.5 ± 13.5 | Spiritual prayer and/or meditation vs.Waitlist control | No | Veterans with trauma exposure, mixed trauma types | One 2-hour session/wk for 8 wks | PCL | Spiritual prayer/mediation group dec PCL vs waitlist control (p<.02) | Positiveb | 73 |
| Kearney, 2012 Pre-post | 92 | 20% | 22:70 | 51.0 ± 10.6 | Mindfulness Based Stress Reduction (MBSR) | No | Veterans, 74% screened positive for PTSD at baseline | One 2.5-hour session/wk for 8 wks | PCL | MBSR decreased PCL total and all subscores (p<.001). | Positivec | 86 |
| Kimbrough, 2010 Pre-post | 27 | 22% | 24:3 | 45 (23–68) | Mindfulness Based Stress Reduction | No | Adults with history of childhood sexual abuse | One 3-hour session/wk for 8 wks, followed by 3 refresher courses | PCL | MBSR decreased PCL total and all subscores at 8 and 24-wks post-enrollment (p<.0001). | Positivec | 95 |
| Price, 2005 RCT | 25 | 4% | 25:0 | 41 (median) (26–56) | Mindful Awareness in Body Oriented Therapyvs.Massage | No | Adult women currently in therapy for childhood sexual abuse | Two 60-min sessions/wk for 4 wks | Crime-related PTSD Scale | Both body-oriented therapy and regular massage improved PTSD symptoms, no sig diff between the groups (p>.05). | Neutrala | 81 |
| Price, 2006 RCT | 8 | 0% | 8:0 | (28–52) | Mindful Awareness in Body Oriented Therapyvs.Waitlist control | No | Adult women currently in therapy for childhood sexual abuse | One 60-min session/wk for 8 wks | Crime-related PTSD Scale | Body-oriented therapy group had sig pre-post improvement in PTSD scale (p<0.01), control group did not experience sig improvements. | Positiveb | 72 |
| Rosenthal, 2011 Pre-post | 6 | 17% | 0:6 | (25–40) | Transcendental meditation | PTSD as judged by investigator | OEF/OIF vets with combat-related | 3–5 hrs of instruction followed by home practice: 20 mins twice a day for 12 wks | CAPS, PCL-M | Participants showed sig improved CAPS (p=0.02) and PCL-M (p=0.02) scores. | Positivec | 86 |
| MIND-BODY: RELAXATION | ||||||||||||
| Colosetti, 2000 Cross-over | 5 | 0% | 5:0 | 38.8 (25–50) | Relaxation (control condition)vs.EMDR | Yes, CAPS criteria | Incarcerated women with history of abuse in an intimate relationship | One session relaxation training/wk for 3 to 6 wks followed by one session of EMDR/wk for 3 wks | IES | Neither relaxation training or EMDR exhibited sig changes in PTSD outcomes, no statistics provided due to small sample size. | Negativea | 65 |
| Echeburua, 1997 CT | 20 | 0% | 20:0 | 20 ± 7.1 | PMR (control condition)vs.Gradual self-exposure with cognitive restructuring | Yes, ADIS-R DSM-III criteria | Women with history of sexual abuse | 1x/wk for 6 wks; home practice 2x/day. | Scale of Severity of Posttraumatic Stress Disorder Symptoms | Cognitive restructuring lead to the reversal of DSM-III PTSD diagnosis in 100% of participants while relaxation was only 40% by 12 months. PTSD scale score was 4×lower in the cognitive restructuring group. | Negativea | 60 |
| Mitani, 2006 Pre-post | 22 | 0% | 0:22 | 42.2 ± 9.7 | Relaxation | No | Japanese fire fighters in a select fire station | One 60-min instructional session followed by home practice: 2–3 x/wk for 2 months. | IES-R (Japanese version) | Total IES-R scores dec 60% from pre- to post in PTSD stress-related group (p=0.04). Intrusion subscale dec sig in the PTSD stress-related group (p=.038); hyperarousal and avoidance did not change sig. No sig changes in the non-PTSD stress-related group IES scores noted (p=.76 – 1.0). | Mixedc | 68 |
| Taylor, 2003 RCT | 60 | 25% | 45:15 | 37 ± 10 | Relaxation (control condition)vs. 1) Exposure therapy; 2) EMDR | Yes, DSM-IV criteria | Mixed trauma types | Eight 90-min individualized session of relaxation, exposure, or EMDR therapy. | CAPS, PTSD Symptom Severity Scale, PTSD dx | Exposure superior to relaxation in reducing # who met PTSD dx (p<.02); no sig diff between EMDR and exposure or EMDR and relaxation for this outcome. CAPS and Symptom Severity Scale dec sig in all groups with no difference between groups. | Neutrala | 85 |
| MIND-BODY: GUIDED IMAGERY | ||||||||||||
| Jain, 2012 RCT | 123 | 17% | 11:112 | Tx: 27.1 (20–42); Ctrl: 27.9 (20–48) | Healing touch plus guided imagery vs.TAU | No | Returning combat-exposed active duty military with sig PTSD sx | Two 60-min sessions/wk for 3 wks | PCL-M | Healing touch/guided imagery group had sig dec in PCL score compared to controls (p<0.0005). | Positiveb | 92 |
| MIND-BODY: YOGIC BREATH WORK | ||||||||||||
| Descilo, 2010 CT | 183 | 3% | 160:23 | Tx 1: 30.8; Tx 2: 35.1; Ctrl: 34.7 | Yogic breath workvs. 1) Yoga breath work with exposure therapy; 2) 6-wk waitlist control | No | 2004 South East Asian tsunami survivors living in refugee camps who scored > 50 on the PCL | Breath work: one 2-hr session/day×4 days. Exposure therapy: as above + 3–5 exposure sessions | PCL | Both treatment groups showed improvement in PCL scores over waitlist control (p<.0001), no diff between active treatments. | Neutrala; Positiveb | 83 |
| NUTRACEUTICAL | ||||||||||||
| Kaplan, 1996 Cross-over | 17 | 24% | 5:8* | 39.7 (25–56) | Inositol powder 12g/day vs. Placebo (glucose powder) 12g/day | Yes, DSM-III-R criteria | Trauma type not reported | Inositol or placebo daily for 4 wks, 2 wk washout between cross-over | IES-Hebrew version | No sig diff between inositol and placebo for total IES scores or avoidance and intrusion subscales, no p values reported. | Negativea | 73 |
| Shams,2007 RCT | 40 | 0% | 34:6 | Tx: 38.2 ± 11.2; Ctrl: 38.5 ± 13.7 | Gingko Biloba 200mg vs. Placebo | Yes, DSM-IV | Earthquake survivors | 12 wks | Watson’s PTSD Scale | Sig improvement in gingko group over control (p<.01) | Positivea | 73 |
Acu: acupuncture; ADIS-R: Anxiety Disorders Interview schedule Revised; CAPS: Clinician-Administered PTSD Scale; CAPS-AN: Clinician-Administered PTSD Scale Avoidance/Numbing Subscale; CBT: cognitive behavioral therapy; CGI-I: Clinical Global Impression-Improvement; CGI-S: Clinical Global Impression-Severity; Ctrl: Control group; Dec: decreased; Diff: difference; dlPFC: dorsolateral prefrontal cortex; DSM: Diagnostic and Statistical Manual of Mental Disorders; EFT: Emotional Freedom Technique; EMDR: Eye Movement Desensitization and Reprocessing; Hr: Hour; IES: Impact of Event Scale; IES-R: Impact of Event Scale-Revised; IES-I: Impact of Event Scale Intrusion Subscale; IES-A: Impact of Event Scale Avoidance Subscale; MBSR: Mindfulness Based Stress Reduction; Min: Minute; MINI: Mini International Neuropsychiatric Interview with DSM-IV criteria; OEF: Operation Enduring Freedom; OIF: Operation Iraqi Freedom; PCL: PTSD Checklist Civilian Version; PCLM: PTSD Checklist Military Version; PDS: Posttraumatic Diagnostic Scale; PMR: Progressive muscle relaxation; PSS-SR: Posttraumatic Stress Disorder Symptom Scale Self Report; PTS-T: Posttraumatic Stress-Total scale of the Detailed Assessment of Posttraumatic States; RSA: Respiratory sinus arrhythmia; rTMS: repetitive transcranial stimulation; SCID: Structured Clinical Interview DSM-IV; Sig: Significant; Sx: Symptom; TAU: Treatment as usual; TFT: Thought field therapy; TOPS: Treatment Outcomes for PTSD Scale; Tx: Treatment; WHO: World Health Organization; Wk: Week
*
These studies only provided gender characteristics for those who completed the trial.
**
Criteria for determining overall study outcome: Positive = most PTSD outcomes showed statistically significant improvements, Mixed = only 1–2 PTSD subscales are significantly improved, Negative = no PTSD outcomes significantly improved, Neutral = both intervention and active control showed significant improvements, no difference between the groups, Two studies have two grades to account for comparisons between the active control and non-active control groups. For example, Hollifield had a positive results compared to the waitlist (Positiveb) but a Neutral results compared to the active control because both active control groups had improvements from before to after the intervention.
a
= active control comparison
b
= non-active control comparison
c
= no control