Negeye, Huda; (2024) An examination of bi-directional change in PTSD, depression, and anxiety symptoms during CBT for PTSD. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Aim: Post-traumatic stress disorder (PTSD) has significant comorbidity with depression. National Institute for Health and Care Excellence (NICE) guidance recommends trauma-focused cognitive-behavioural therapy (tfCBT) and eye movement desensitisation and reprocessing (EMDR) as first-line treatments for individuals with PTSD, including those with co-occurring symptoms of depression. This systematic review and meta-analysis examined the impact of evidence-based PTSD interventions on symptoms of depression. Methods: A systematic search of PTSDpubs, Medline, PsycInfo and Embase databases (database inception to 08 December 2023) was conducted to find studies assessing the impact of trauma-focused psychological interventions on symptoms of depression in adults diagnosed with PTSD. Studies were included if they used validated measures to assess depression symptoms before and after PTSD treatment, on individuals who received either tf-CBT or EMDR. Random-effects meta-analysis was performed on pre-post change in depression symptoms. The risk of bias in the methodology of the included studies was assessed using the Critical Appraisal Tools from the Joanna Briggs Institute (JBI) Manual of Evidence Synthesis. Results: The systematic review included 29 studies that demonstrated that trauma-focused therapies significantly reduced symptoms of depression in individuals with PTSD. EMDR showed a large, pooled effect size (g = -1.38 [95% CI1.63, -1.12]). The overall pooled effect size for all therapies included in the analyses was g= -1.07 [95% CI -1.22, -0.93], highlighting the effectiveness of trauma-focused psychological interventions in reducing depressive symptoms in patients with PTSD. Significant heterogeneity was observed among the studies, illustrating the diverse efficacy of the interventions. Conclusion: TfCBT and EMDR treatments for PTSD are effective in reducing symptoms of depression, even when symptoms of depression are not specifically targeted. These findings align with current clinical guidelines, which recommend offering TfCBT or EMDR as first-line treatments for PTSD, even when co-occurring symptoms are present. However further research is needed to explore the mechanisms by which these treatments reduce symptoms of depression. Understanding these mechanisms will help to identify the most effective aspects of therapy of various stages, enabling clinicians to make stronger recommendations for individuals with PTSD and co-occurring symptoms.

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