For studies that meet our inclusion criteria, we will abstract important information into evidence tables.
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- Post-traumatic stress disorder: Basic science and clinical practice;
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We will design data abstraction forms to gather pertinent information from each article, including characteristics of study populations, settings, interventions, comparators, study designs, methods, and results. Trained reviewers will extract the relevant data from each included article into the evidence tables. A second member of the team will review all data abstractions for completeness and accuracy. To assess the risk of bias internal validity of studies, we will use predefined criteria based on guidance provided by AHRQ44 and the University of York Centre for Reviews and Dissemination.
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A study with medium risk of bias is susceptible to some bias but probably not sufficient enough to invalidate its results. A study with high risk of bias has significant methodological flaws e. We will consider the risk of bias for each relevant outcome of a study. Two independent reviewers will assess the risk of bias for each study.
Disagreements between the two reviewers will be resolved by discussion and consensus or by consulting a third member of the team. If we find three or more similar studies for a comparison of interest, we will consider quantitative analysis i. We will also consider conducting mixed treatment comparisons meta-analysis using Bayesian methods to compare the pharmacological interventions with each other if we identify a sufficient number of studies with a common comparator e.
For all analyses, we will use random-effects models to estimate pooled or comparative effects. To determine whether quantitative analyses are appropriate, we will assess the clinical and methodological heterogeneity of the studies under consideration following established guidance. If we conduct quantitative syntheses i.
The importance of the observed value of I 2 depends on the magnitude and direction of effects and on the strength of evidence for heterogeneity e. If we include any meta-analyses with considerable statistical heterogeneity in this report, we will provide an explanation for doing so, considering the magnitude and direction of effects.
We will also examine potential sources of heterogeneity by using sensitivity analysis or subgroup analyses. Planned stratifications or categories for subgroup analyses include the subgroups listed in the analytic framework and geographic location of studies. When quantitative analyses are not appropriate e. We will grade the strength of evidence based on the guidance established for the Evidence-based Practice Center Program.
It also considers other optional domains that may be relevant for some scenarios, such as a dose-response association, plausible confounding that would decrease the observed effect, strength of association magnitude of effect , and publication bias. Table 5 describes the grades of evidence that can be assigned. Grades reflect the strength of the body of evidence to answer KQs on the comparative effectiveness, efficacy, and harms of the interventions included in this review.
Two reviewers will assess each domain for each key outcome, and differences will be resolved by consensus. We will grade the strength of evidence for the outcomes deemed to be of greatest importance to decisionmakers and those most commonly reported in the literature. We will assess applicability of the evidence following guidance from the Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Some factors identified a priori that may limit the applicability of evidence include the following: age of enrolled populations; sex of enrolled populations e. Absolute effectiveness: the effectiveness of an intervention relative to a nonactive control group, that is, either assigned to a waitlist group or receiving a placebo intervention.
Intensity: the length and number of treatment sessions for a psychological intervention; the equivalent of dosage for pharmacological interventions. Resilience: the ability to cope with adversity, such as traumatic exposures, and adapt to challenges or change The team decided that the subgroup focus of KQ 3 could be made clearer in the Analytic Framework with this revision. The team had originally planned to consider interventions not specifically named in the PICOTS for potential inclusion, but this was not made clear in the original version of the list. The team had originally planned to consider only clearly-defined, clinical interventions, but this was not made clear in the PICOTS or in the original version of Table 3.
In EMDR, the patient is asked to hold the distressing image in mind, along with the associated negative cognition and bodily sensations, while engaging in saccadic eye movements. The process is repeated until desensitization has occurred i. The saccadic eye movements were initially theorized to both interfere with working memory and elicit an orienting response, which lower emotional arousal so that the trauma can be resolved. The eye movements, or other alternative parallel stimulation, have since been found in dismantling studies to be unnecessary in achieving desensitization.
Although earlier versions of EMDR consisted of 1 to 3 sessions, current standards consist of 8 to 12 minute weekly sessions. Investigators conducting a concurrent CER of treatments for adult PTSD used the same original description of EMDR in their project protocol and received suggestions during their public comment period to update its description.
Post-traumatic stress disorder: Basic science and clinical practice — NYU Scholars
In Table 2, temazepam was missing from the list of benzodiazepines studied for the prevention or treatment of PTSD. Key Informants are the end-users of research, including patients and caregivers, practicing clinicians, relevant professional and consumer organizations, purchasers of health care, and others with experience in making health care decisions. Within the EPC program, the Key Informant role is to provide input into identifying the KQs for research that will inform health care decisions.
The EPC solicits input from Key Informants when developing questions for systematic review or when identifying high-priority research gaps and needed new research.
Key Informants are not involved in analyzing the evidence or writing the report and have not reviewed the report, except as given the opportunity to do so through the peer or public review mechanism. Because of their role as end-users, individuals are invited to serve as Key Informants, and those who present with potential conflicts may be retained.
Technical Experts comprise a multidisciplinary group of clinical, content, and methodological experts who provide input in defining populations, interventions, comparisons, or outcomes as well as identifying particular studies or databases to search.
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They are selected to provide broad expertise and perspectives specific to the topic under development. Divergent and conflicted opinions are common and perceived as healthy scientific discourse that results in a thoughtful, relevant systematic review. Technical Experts provide information to the EPC to identify literature search strategies and recommend approaches to specific issues as requested by the EPC.
Technical Experts do not perform analysis of any kind nor contribute to the writing of the report, and they have not reviewed the report, except as given the opportunity to do so through the public review mechanism. Because of their unique clinical or content expertise, individuals are invited to serve as Technical Experts, and those who present with potential conflicts may be retained.
Peer Reviewers are invited to provide written comments on the draft report based on their clinical, content, or methodological expertise. Peer review comments on the preliminary draft of the report are considered by the EPC in preparation of the final draft of the report. Peer Reviewers do not participate in writing or editing of the final report or other products.
The synthesis of the scientific literature presented in the final report does not necessarily represent the views of individual Reviewers. The dispositions of the peer review comments are documented and will, for Comparative Effectiveness Reviews and Technical Briefs, be published 3 months after the publication of the Evidence report.
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Peer Reviewers who disclose potential business or professional conflicts of interest may submit comments on draft reports through the public comment mechanism. This project was funded under Contract No. Department of Health and Human Services. The TOO reviewed contract deliverables for adherence to contract requirements, including the objectivity and independence of the research process and the methodological quality of the report.
Post-Traumatic Stress Disorder
The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U. Search Effective Health Care website Submit search. Table 1. Potential Preventive Interventions Potential preventive interventions span a variety of psychological and pharmacological domains. Psychological Interventions Specific psychological interventions that have been studied for the prevention of adult PTSD are described below and include the following: psychological debriefing interventions, including critical incident stress debriefing CISD and critical incident stress management CISM ; psychological first aid PFA ; trauma-focused cognitive-behavioral therapy CBT ; cognitive restructuring therapy; cognitive processing therapy; exposure-based therapies; coping skills therapy including stress inoculation therapy ; psychoeducation; normalization; and eye movement desensitization and reprocessing EMDR.
Psychological Debriefing, Critical Incident Stress Debriefing, and Critical Incident Stress Management Psychological debriefing interventions aim to educate victims about normal reactions to trauma and to encourage them to share their experiences and emotional responses to the event. Morphine The opiate analgesic, morphine, has shown promise in preventing PTSD in persons experiencing physical injury from a traumatic event.
Table 2. Prevention Intervention Outcomes One of the primary outcomes in the PTSD-prevention intervention literature is lack of trauma-related symptom development, which includes both clinician-rated and self-reported measures.