Preditores de resposta à terapia cognitivo-comportamental em pacientes com transtorno de estresse pós-traumático: uma revisão sistemática

Paiva, Jéssica; Melani, Marina; Gonçalves, Raquel Menezes; Luz, Mariana Pires; Mendlowicz, Mauro Vitor; Figueira, Ivan; von Arcosy, Cheyenne; Ventura, Paula; Berger, William

Jéssica Paiva

Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.

https://orcid.org/0000-0002-8357-7678

Marina Melani

Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.

https://orcid.org/0000-0001-9906-8141

Raquel Menezes Gonçalves

Department of Neuroscience, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil.

Department of Postgraduation in Psychology, Universidade Salgado de Oliveira (UNIVERSO), Niterói, RJ, Brazil.

https://orcid.org/0000-0003-0006-4568

Mariana Pires Luz

Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.

https://orcid.org/0000-0002-0297-5245

Mauro Vitor Mendlowicz

Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.

Department of Psychiatry and Mental Health (MSM), Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil.

https://orcid.org/0000-0002-8891-0548

Ivan Figueira

Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.

https://orcid.org/0000-0002-8155-0519

Cheyenne von Arcosy

Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.

https://orcid.org/0000-0001-9525-4051

Paula Ventura

Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.

https://orcid.org/0000-0003-0607-2382

William Berger

Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.

https://orcid.org/0000-0001-7656-4548

Address for correspondence: Jéssica Paiva. Avenida Venceslau Brás, 71, Fundos, Botafogo – 22290-902 – Rio de Janeiro, RJ, Brasil. E-mail: jessicameirelles.p@gmail.com

INDIVIDUAL CONTRIBUTIONS

Jéssica Paiva – Conceptualization, methodology, study selection, and data extraction.

Marina Melani – Study selection, data extraction, and editing.

Raquel Gonçalves – Writing, critical review, and editing.

Mariana Luz – Writing, critical review, and editing.

Mauro Mendlowicz – Writing, critical review, and editing.

Ivan Figueira – Writing, critical review, and editing.

Cheyenne von Arcosy – Writing and editing.

Paula Ventura – Conceptualization, methodology, writing, and editing.

William Berger – Supervision, conceptualization, methodology, writing, critical review, and editing.

CONFLICT OF INTERESTS

The authors declare no conflict of interest.

Possible Predictor investigated	Number of RCTs
Age	7
Alcohol use	3
Anger	5
Anxiety	3
Comorbid personality disorders	3
Depression severity	6
Dissociative symptoms	3
Gender	6
Level of education	3
Multiple traumatic events	4
Presence of depression	8
PTSD severity	6
Race or ethnicity	3
Therapeutic relationship	3
Type of trauma	6

Study (year)	Population, sample size	Mean Age (SD)	Diagnostic criterion for PTSD	Type of trauma	Type of intervention	Comparison (active/passive)	Treatment	Independent variables evaluated (instrument)	Influence on CBT response (Effect size)
Beck et al., 2021	Military n =175	CBT: 54.9 (11.54); Present centered therapy: 57.7 (12.10)	CAPS-5	Combat trauma	CBT	Present centered therapy	16 weeks and 14 sessions	(1) Age (pretreatment assessment)	(1) None (NR)
Karatzias et al., 2007	Civilian, n = 48	40.6 (11.4)	DSM-IV	Accident, crime, other	EMDR	Imaginal exposure + cognitive restructuring (Active)	12 weeks and sessions	(1) Gender (SDQ)	(1) None (NR)
Rauch et al., 2021	Military n =196	34.4 (8.4)	DSM-IV-TR	Combat related PTSD	PE plus placebo	PE + sertraline Sertraline + enhanced medication management	12 weeks, and 3 sessions	(1) Age (NR)	(1) None (NR)
Resick et al., 2020	Military, n =165	34.2 (7.3)	DSM-IV	Combat- related, dath (noncombat), sexual assault, physical assault, and accident	Individual CPT	Group CPT (Active)	12 sessions, and 6 weeks	(1) Younger age (Form developed by the research group) (2) Military and deployment variables (Form developed by the research group)	(1)Positive (NR) (2)None (NR)
Rizvi et al., 2009	Civilian, n =145	31.7 (9.8)	CAPS	Discrete incident of completed rape in childhood or adulthood	PE	CPT (Active) Waiting list (Passive)	CPT: 12 weeks and sessions PE: 9 weeks and sessions	(1) Age (Standardized trauma interview) (2) Level of education (Standardized trauma interview)	(1) None (d=0.41) (2) None (d=0.02)
Ruglass & Yali, 2019	Civilian, n =107	Black/African American: 45.49 (8.77); White/Caucasian: 44.00 (9.07); Hispanic/Latino: 41.86 (11.10)	SCID-I	Physical assault, sexual assault, accident or disaster, sudden injury or death of other, other	Concurrent Treatment with PE	Relapse Prevention Therapy (Active) Relaxation Groups (Active)	12 weeks	(1) Race/ethnicity (baseline interview)	(1) None (NR)
Tarrier et al., 2000	Civilian, n =62	36.82 (11.60)	DSM III-R	Crime, accident and other	Cognitive therapy	Imaginal exposure (Active)	16 weeks and sessions	(1) Gender (NR)	(1) Positive (NR)
Thrasher et al., 2010	Civilian, n=77	Active treatment: 38.85 (9.92); Relaxation 35.60 (10.00)	DSM-III-R	Injury, death, disability, and disfigurement	Exposure therapy and /or cognitive restructuring	Relaxation Groups (Active)	10 weeks and sessions	(1) Gender (CI) (2) Age (CI)	(1) None (NR) (2) None (NR)
Zandberg et al., 2016	Civilian and military n =165	42.78 (9.76)	DSM-IV	Sexual assault, combat, physical assault, other trauma	Placebo and PE	Naltrexone and PE (Active) Naltrexone and no PE (Active) Placebo and no PE (Passive)	24 weeks, 18 sessions	(1) Level of education (NR)	(1) None (NR)
Zang et al., 2019	Civilian, n=96	32.20 (9.94)	PSS-I	Childhood sexual abuse or adulthood sexual or physical assault	PE with cognitive restructuring	PE with cognitive restructuring Waitlist (Passive)	8 sessions	(1) Age (SAI)	(1) None (OR=0.98)

Study (year)	Population, sample size	Mean Age (SD)	Diagnostic criterion for PTSD	Type of trauma	Type of intervention	Comparison (active/passive)	Treatment	Independent variables evaluated (instrument)	Influence on CBT response (Effect size)
Assmann et al., 2021	Civilian (155)	38.54 (11.17)	CAPS-5	Childhood trauma	EMDR	Imagery rescripting (Active)	6 weeks, and 12 sessions	(1) Presence of Depression (BDI-II)	(1) None (d=1.22)
Beck, et al., 2021	Military (175)	CBT: 54.9 (11.54); Present centered therapy: 57.7 (12.10)	CAPS-5	Combat trauma	CBT	Present centered therapy (Active)	16 weeks, and 14 sessions	(1) PTSD severity (PCL-5) (2) Depression severity (BDI-II) (3) Type of trauma (Traumatic Life Events Checklist (TLEQ)	(1) Positive (d=1.31) (2) None (NR) (3) None (NR)
Bosch et al., 2020	Civilian and military, n = 126	46.5 (11.9)	CAPS-IV	Neglect, sexual abuse, and physical abuse	CPT via videoteleconferencing	CPT inperson (Active)	12 sessions, once or twice per week	(1) Type of trauma (Childhood traumatic events)	(1)Negative (NR)
Cahill et al., 2003	Civilian, n = 67	34.6 (10.5)	DSM-III-R	Female assault victims	PE	SIT (Active) PE and SIT (Active)	5 weeks, 9 sessions	(1) Anger (STAEI)	(1) None (d=3.43)
Cloitre et al., 2017	Civilian, n = 104	36.48 (9.39)	DSM-IV	Childhood sexual and/or physical abuse	STAIR	Narrative therapy (Active)	16 weeks and sessions	(1) Depression severity (BDI-II)	(1) Positive (d=0.29)
Cloitre et al., 2002	Civilian, n = 58	34 (7.22)	DSM-IV	Childhood abuse	STAIR and Modified PE	Waiting list (Passive)	12 weeks, 16 sessions	(1) Therapeutic alliance (WAI)	(1) Positive (NR)
Cloitre et al., 2016	Civilian, n = 104	36.48 (9.39)	DSM-IV	Childhood sexual and/or physical abuse occurring before the age of 18	STAIR and PE	STAIR and supportive counselling (Active)	16 weeks and sessions	(1) PTSD severity (CAPS) (2) Presence of depression (BDI-II) (3) Dissociation (Dissociation subscale of the Trauma Symptoms Inventory) (4) Anger (STAEI) (5) Negative mood regulation (NMR)	(1) None (NR) (2) None (NR) (3) None (NR) (4) None (NR) (5) None (NR)
Feeny et al., 2002	Civilian, n = 72	34.9 (10.06)	DSM-III-R	Female victims of sexual and nonsexual assault	PE	SIT (Active) PE and SIT (Active) Waiting list (Passive)	9 weeks and sessions	(1) Borderline personality characteristics (SCID-II)	(1) Negative (NR)
Gobin et al., 2018	Civilian and military, n = 126	Veterans: 42.05 (10.58) Civilians: 47.30 (12.03)	DSM-IV	Physical assault, child sexual abuse, adult sexual assault)	CPT via clinical vídeo teleconferencing	Treatment traditional (in-person modality) (Active)	12 weeks and sessions	(1) PTSD severity (CAPS) (2) Presence of depression (BDI-II)	(1) Negative (NR) (2) None (NR)
Haagen et al., 2017	Civilian and military, n = 72	41.5 (11.3)	DSM-IV-TR	Murder of friends/family , combat situation, physical torture, imprisonment , serious injury, rape or sexual abus	EMDR	Stabilization therapy (Active)	EMDR: 9 weeks and sessions; Stabilizatio n therapy: 12 weeks and sessions	(1) Presence of depression (HSCL) (2) Depression severity (HSCL)	(1) Negative (NR) (2) Negative (NR)
Halvorsen et al., 2014	Military, n = 81	35.55 (11.05)	DSM-5	Severely traumatised asylum seekers and refugees	Narrative exposure therapy	Treatment as usual (Active)	10 weeks and sessions	(1) Dissociative symptoms such as derealisation and depersonalisation (CAPS)	(1) None (Derealisation: g=1.36; Depersonalisation: g=0.97)
Hembree et al., 2004	Civilian, n = 75	32 (10)	DSM-IV	Rape or nonsexual assault in adulthood or sexual abuse in childhood	PE	PE with cognitive restructuring (Active)	NR	(1) Comorbid personality disorders (SCID II)	(1) Negative (NR)
Hembree et al., 2004	Civilian, n = 73	35.7 (10.1)	DSM–III–R	Female assault victims	PE	SIT (Active)	5–6 weeks, 9 sessions	(1) Multiple traumatic events (SAI)	(1) Negative (NR)
Karatzias et al., 2007	Civilian, n = 48	40.6 (11.4)	DSM-IV	Accident, crime, other	EMDR	Treatment as usual (Active)	12 weeks and sessions	(1) PTSD severity (CAPS, IES and PCL)	(1) Positive (NR)
Knaevelsrud & Maercker, 2007	Civilian, n = 96	35	DSM-IV	Sexual abuse/ rape, death of close person, accident, physical disease	Internet-based CBT	Waiting list (Passive)	5 weeks, and 10 sessions	(1) Online therapeutic relationship (WAI)	(1) Positive (NR)
Lloyd et al., 2014	Military, n = 59	CPT: 53.13 (13.97); Treatment as usual: 53.62 (13.33)	CAPS	Military-related PTSD	CPT	Treatment as usual (Active)	12 sessions, and 6 weeks	(1) Anger (Dimensions of Anger Reactions Scale) (2) Anxiety (STAI) (3) Depression (BDI-II) (4) Alcohol (Alcohol Use Disorders Identification Test)	(1) Negative (d=0.36) (2) None (d=0.76) (3) None (d=0.55) (4) None (d=0.23)
Markowitz et al., 2017	Mainly civilian, n = 110	40.1 (11.6)	DSM-IV	Interpersonal trauma, sexual trauma, and physical trauma	PE	Interpersonal Psychotherapy (Active)	14 weeks and sessions	(1) Type of trauma (LEC)	(1) None
Price et al., 2012	Military, n = 111	31.66 (8.37)	DSM-IV	Multiple potentially traumatic events	Exposure therapy via telehealth	Exposure therapy inperson (Active)	8 weeks and sessions	(1) Type of trauma (CES)	(1) Negative
Rauch et al., 2021	Military, n = 196	34.4 (8.4)	DSM-IVTR	Combat-related PTSD	PE plus Placebo	PE + sertraline Sertraline + Enhanced Medication management	12 weeks, and 3 sessions	(1) Alcohol use (number of alcoholic drinks per day) (2) Presence of depression (BDI-II)	(1) None (NR) (2) None (NR)
Rizvi et al., 2009	Civilian, n = 145	31.7 (9.8)	CAPS	Discrete incident of completed rape in childhood or adulthood	PE	CPT (Active) Waiting list (Passive)	CPT: 12 weeks and sessions PE: 9 weeks and sessions	(1) Anger (STAXI) (2) Depression severity (BDI)	(1) None (d=0.07) (2) Positive (d=0.05)
Taylor et al., 2003	Civilian, n = 45	37 (10)	DSM-IV	Sexual assault, physical assault, transport accidents, and being exposed to a sudden death	Exposure therapy	EMDR (Active)	8 weeks and sessions	(1) Multiple traumatic events (CAPS) (2) Dissociative symptoms (CAPS) (3) Anger (PTCI) (4) Depression severity (BDI) (5) Anxiety sensitivity (Anxiety sensitivity Index) (6) Dissociative symptoms (CAPS)	(1) None (NR) (2) None (NR) (3) None (NR) (4) None (NR) (5) None (NR) (6) None (NR)
Thrasher et al., 2010	Civilian, n = 77	Active treatment: 38.85 (9.92) Relaxation only: 35.60 (10.00)	DSM-III-R	Injury, death, disability	Exposure therapy and/or cognitive restructuring	Waiting list (Passive)	10 weeks and sessions	(1) Type of trauma (CI) (2) Multiple traumatic events (DSM-III-R and CAPS)	(1) None (NR) (2) None (NR)
Wagner et al., 2012	Civilian, n = 47	27.7 (7.0)	Posttraumatic Diagnostic Scale	Killing of a family member, torture/viole nce, sexual violence related to war, others	Internet-based CBT	Waiting list (Passive)	5 weeks, and 10 sessions	(1) Therapeutic alliance (WAI)	(1) Positive
Zandberg et al., 2016	Civilian and military, n = 165	42.78 (9.76)	DSM-IV	Sexual assault, combat, physical assault, other trauma	Placebo and PE	Naltrexone and PE (Active) Naltrexone and no PE (Active) Placebo and no PE (Passive)	24 weeks, 18 sessions	(1) Alcohol features (TFBI and PACS) (2) Type of trauma (NR) (3) PTSD severity (PSS-I)	(1) None (NR) (2) Negative (NR) (3) Negative (NR)
Zang et al., 2019	Civilian, n = 96	32.20 (9.94)	PSS-I	Childhood sexual abuse or adulthood sexual or physical assault	PE with cognitive restructuring	PE (Active) Waiting list (Passive)	8 sessions	(1) Presence of depression (SCID-I) (2) Pretreatment PTSD severity (PSS-SR)	(1) Positive (OR=5.82) (2) None (OR=1.17)

[1] Address for correspondence: Jéssica Paiva. Avenida Venceslau Brás, 71, Fundos, Botafogo – 22290-902 – Rio de Janeiro, RJ, Brasil. E-mail: jessicameirelles.p@gmail.com

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Preditores de resposta à terapia cognitivo-comportamental em pacientes com transtorno de estresse pós-traumático: uma revisão sistemática

RESUMO

Objetivo

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Conclusões