TABLE 4-6 Cognitive Restructuring

Study

Populationa

Arm (N)

Handling of Dropouts and % Completed Tx by Arm

PTSD Outcome Measure

Ehlers et al., 2003

Sex NR, MVA

Total (85)

ITT

CAPS frequency (F) and intensity (I) scorese,f

CR (28)

100%

MCc (28)

89%

MCd (29)

93%

Tarrier, et al., 1999h

Mixed sex, crime

Total (72)

NR

CAPS

CR (37)

89%

 

E (35)

83%

 

Marks et al., 1998i

Mixed sex, mixed trauma

Total (87)

ITT (LOCF)

CAPS

E (23)

57%

 

CR (19)

63%

 

E+CR (24)

54%

 

CS (21)

67%

 

aIn the population column, male alone or female alone denotes that at least 80% of the study population was male or female. If only one trauma type is listed, at least 80% of the study population reported that type of trauma.

bPTSD outcome measure change data were obtained either directly from the study, when provided, or by subtracting data reported at treatment completion (not follow-up data) from baseline data (before treatment began). Average baseline score when reported or when baseline scores for all arms are nearly the same; otherwise, baseline scores listed individually in order of arm.

COPING SKILLS THERAPIES

The committee found 10 RCTs of coping skills training compared to minimum care, or compared to another treatment modality and minimum care. Most of the trials had major limitations including high rates of dropout, inadequate handling of missing values, high differential dropout among arms, and lack of assessor blinding or independence. Only 2 of 10 studies had no noteworthy limitations, but neither found an effect (Carlson et al, 1998; Neuner et al., 2004). Most of the remaining studies (six of eight) (Blanchard et al., 2004; Foa et al., 1999; Hien et al, 2004; McDonagh et al., 2005; Silver et al., 1995; Zlotnick et al., 1997) showed an effect, but had major limitations that severely weakened confidence in the results.


Synthesis: The committee judged that the overall body of evidence on coping skills training was low quality to inform a conclusion regarding efficacy. The committee is uncertain about the presence of an effect, and believes



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