Skip to main content
. 2013 Dec 13;2013(12):CD003388. doi: 10.1002/14651858.CD003388.pub4

Marks 1998.

Methods Randomised controlled trial
Participants 87 DSM‐IIIR PTSD, various traumas, in the UK
Interventions 10 x 90‐minute sessions of exposure (n = 23) vs cognitive restructuring (n = 19) vs exposure and cognitive restructuring (n = 24) vs relaxation therapy (n = 21) (the three exposure/cognitive‐restructuring groups were combined).
Outcomes CAPS, IES, BDI, STAI
Notes Experienced therapists delivered therapy. Treatment adherence was assessed, as was homework compliance.
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Comment: The method of sequence generation was not reported.
Allocation concealment (selection bias) Unclear risk Comment: There is no mention of any measures taken to conceal allocation.
Incomplete outcome data (attrition bias) 
 All outcomes Low risk Quote: "analyses were also done on end‐point imputed‐scores carrying forward non‐completers last available ratings".
Comment: There were drop‐outs from each group: exposure (3) cognitive restructuring (1) exposure and cognitive restructuring (5) and relaxation therapy (1). Reasons for drop‐out were not fully reported.
Selective reporting (reporting bias) Low risk Comment: All specified outcomes were reported.
Other bias Low risk Comment: no other sources of bias detected.
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Comment: Participants were aware of their allocation.
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk Quote: "assessors were kept unaware of the treatment condition".