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Terapias psicológicas para el trastorno de estrés postraumático y el trastorno por consumo de sustancias concomitante

Appendices

Appendix 1. Cochrane Central Register of Controlled Trials (CENTRAL)

We will search CENTRAL using the following terms:

[Condition]

#1 MeSH descriptor STRESS DISORDERS, TRAUMATIC, explode all trees

#2 (trauma* NEXT stress*)

#3 (psycho* NEXT trauma*)

#4 (stress* NEXT (extreme or disorder*))

#5 DESNOS [Disorders of Extreme Stress]

#6 (posttrauma* or post‐trauma* or (post NEXT trauma*) or PTSD)

#7 (#1 or #2 or #3 or #4 or #5 or #6)

[Population: comorbid substance abuse]

#8 MeSH descriptor SUBSTANCE‐RELATED DISORDERS explode all trees

#9 (substance use disorder or SUD)

#10 drug NEXT abuse

#11 (abuser* or abusing or addict* or depend* or habit* or misuse or user*)

#12 ((abuse) not (child* or sex*))

[Common drugs of abuse]

#13 (adinazolam or aerosol* or alcohol* or alprazolam or amphetamin* or anthramycin or anxiolytic* or ativan or barbituat* or bentazepam or benzodiazepin* or bromazepan or brotizolam or buprenorphin* or camazepam or cannabi* or chlordiazepoxid* or cinolazepam or clobazam or clonazepam or clorazepam or clotiazepam or cloxazolam or cocaine* or codeine or crack or crystal or cyprazepam or depressant* or diacetylmorphin* or diazepam* or doxefazepam or ecstasy or estazolam or etizolam or fentanyl or flunitrazepam or flurazepam or flutazoram or flutoprazepam or fosazepam or gases or GHB or girisopam or halazepam or hallucinogen* or haloxazepam or heroin* or hydromorphone or hydroquinone or hypnotic* or inhalant* or ketamin* or ketazolam or librium or loflazepate or loprazolam or lorazepam or lormetazepam or LSD or marihuana* or marijuana* or MDMA or meclonazepam or medazepam or meperidine or mephedrone or mescalin* or metaclazepam or methadone or methamphetamin* or methaqualone or mexazolam or midazepam or midazolam or morphine* or narcotic* or nerisopam or nimetazepam or nitrazepam or nitrites or (nitrous NEXT oxide) or n‐methyl‐3,4‐methylenedioxyamphetamine or nordazepam or opiate* or opiod* or opium or oxazepam or oxazolam or oxazypam or oxycodone or oxzepam or painkiller* or (pain NEXT killer*) or PCP or pethidin* or phencyclidin* or pinasepam or prazepam or propazepam or propoxyphene or psilocybin or psychedelic* or psychoactive* or psychostimulant* or quinazolinone or ripazepam or ritalin or sedative* or serazepin* or solvent* or steroid* or stimulant* or substance* or temazepam or tetrazepam or tofisopam or tramadol or triazolam or triflubazam or valium or vicodin)

#14 (drug* NEAR (recreational or street))

#15 (#8 or #9 or #10 or #11 or #12 or #13 or #14)

[Condition + Population]

#16 (#7 and #15)

Appendix 2. Researchers contacted through the search process

Sudie Back, Matthew Boden, Marcel Bonn Miller, Kathleen Brady, Pamela Brown, Karen Cusack, Marylene Cloitre, Scott Coffey, Mark Creamer, Colin Drummond, Edna Foa, David Forbes, Julian Ford, Elizabeth Forshay, Anna Cash Ghee, Benjamin Goldstein, Michael Hase, Denise Hien, Debra Kaysen, Daniel Kivlahan, Karen Krinsley, Mark McGovern, Sarah Meshberg‐Cohen, Nena Messina, Katherine Mills, Kim Mueser, Lisa Najavits, Sonya Norman, Paige Ouimette, Tae Woo Park, Barbera Rothbaum, Josef Ruzek, Elizabeth Santa Ana, Ingo Schäfer, Paula Schnurr, Jodie Trafton, Elisa Triffleman, Debora van Dam, Richard Velleman, Anka Vujanovic, Doug Zatzick, Caron Zlotnick.

Of these, Scott Coffey, David Forbes, Julian Ford, Denise Hien, Debra Kaysen, Katherine Mills, Kim Mueser, Lisa Najavits, Sonya Norman and Elizabeth Santa Ana responded with additional data.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 1 PTSD severity following treatment completion.
Figures and Tables -
Analysis 1.1

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 1 PTSD severity following treatment completion.

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 2 PTSD severity 3‐4 months following treatment completion.
Figures and Tables -
Analysis 1.2

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 2 PTSD severity 3‐4 months following treatment completion.

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 3 PTSD severity 5‐7 months following treatment completion.
Figures and Tables -
Analysis 1.3

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 3 PTSD severity 5‐7 months following treatment completion.

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 4 Drug or alcohol use, or both following treatment completion.
Figures and Tables -
Analysis 1.4

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 4 Drug or alcohol use, or both following treatment completion.

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 5 Drug or alcohol use, or both 3‐4 months following treatment completion.
Figures and Tables -
Analysis 1.5

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 5 Drug or alcohol use, or both 3‐4 months following treatment completion.

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 6 Drug or alcohol use, or both 5‐7 months following treatment completion.
Figures and Tables -
Analysis 1.6

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 6 Drug or alcohol use, or both 5‐7 months following treatment completion.

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 7 Treatment completers.
Figures and Tables -
Analysis 1.7

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 7 Treatment completers.

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 8 PTSD diagnosis following treatment completion.
Figures and Tables -
Analysis 1.8

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 8 PTSD diagnosis following treatment completion.

Study

Individual intervention

Coffey 2006

Not reported

Coffey submitted

Not reported

Foa 2013

Twelve participants were removed from the study because of serious adverse events (serious suicidal ideation, n = 7; serious medical illness, n = 3; psychotic symptoms, n = 1; death, n = 1; however, none of these events was determined to be related to the study).

Mills 2012

Two participants from the treatment group (3.6%) and 5 participants from the control group (10.4%) attempted suicide during the study (OR, 0.32 [95% CI, 0.06‐1.76]). Although it is possible that these attempts were related to participation in the study, all 7 individuals reported that this was not the case and elected to remain involved with the study. Additionally, 1 participant from the treatment group (1.8%) died as a result of a preexisting medical condition.

Figures and Tables -
Analysis 1.9

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 9 Adverse events.

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 10 Adverse events.
Figures and Tables -
Analysis 1.10

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 10 Adverse events.

Study

Mean number sessions attended

by intervention group (& SD)

Number sessions available

Percentage attended

Studies including intervention for SUD

Coffey submitted

8.16 (3.26) approximated

12

68.0%

Foa 2013

6.33 (5.31)

18

35.2%

Mills 2012

5.83 (4.94)

13

44.9%

Figures and Tables -
Analysis 1.11

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 11 Mean number of sessions attended for intervention group.

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 12 Sensitivity analysis: PTSD severity following treatment completion.
Figures and Tables -
Analysis 1.12

Comparison 1 Trauma‐focused psychological therapy vs control therapy, Outcome 12 Sensitivity analysis: PTSD severity following treatment completion.

Comparison 2 Trauma‐focused psychological therapy vs active psychological therapy for SUD only, Outcome 1 PTSD severity following treatment completion.
Figures and Tables -
Analysis 2.1

Comparison 2 Trauma‐focused psychological therapy vs active psychological therapy for SUD only, Outcome 1 PTSD severity following treatment completion.

Comparison 2 Trauma‐focused psychological therapy vs active psychological therapy for SUD only, Outcome 2 PTSD severity 5‐7 months following treatment completion.
Figures and Tables -
Analysis 2.2

Comparison 2 Trauma‐focused psychological therapy vs active psychological therapy for SUD only, Outcome 2 PTSD severity 5‐7 months following treatment completion.

Comparison 2 Trauma‐focused psychological therapy vs active psychological therapy for SUD only, Outcome 3 PTSD severity 8‐10 months following treatment completion.
Figures and Tables -
Analysis 2.3

Comparison 2 Trauma‐focused psychological therapy vs active psychological therapy for SUD only, Outcome 3 PTSD severity 8‐10 months following treatment completion.

Comparison 2 Trauma‐focused psychological therapy vs active psychological therapy for SUD only, Outcome 4 Drug or alcohol use, or both following treatment completion.
Figures and Tables -
Analysis 2.4

Comparison 2 Trauma‐focused psychological therapy vs active psychological therapy for SUD only, Outcome 4 Drug or alcohol use, or both following treatment completion.

Comparison 2 Trauma‐focused psychological therapy vs active psychological therapy for SUD only, Outcome 5 Drug or alcohol use, or both 5‐7 months following treatment completion.
Figures and Tables -
Analysis 2.5

Comparison 2 Trauma‐focused psychological therapy vs active psychological therapy for SUD only, Outcome 5 Drug or alcohol use, or both 5‐7 months following treatment completion.

Comparison 2 Trauma‐focused psychological therapy vs active psychological therapy for SUD only, Outcome 6 Drug or alcohol use, or both 8‐10 months following treatment completion.
Figures and Tables -
Analysis 2.6

Comparison 2 Trauma‐focused psychological therapy vs active psychological therapy for SUD only, Outcome 6 Drug or alcohol use, or both 8‐10 months following treatment completion.

Comparison 2 Trauma‐focused psychological therapy vs active psychological therapy for SUD only, Outcome 7 Treatment completers.
Figures and Tables -
Analysis 2.7

Comparison 2 Trauma‐focused psychological therapy vs active psychological therapy for SUD only, Outcome 7 Treatment completers.

Comparison 2 Trauma‐focused psychological therapy vs active psychological therapy for SUD only, Outcome 8 PTSD diagnosis following treatment completion.
Figures and Tables -
Analysis 2.8

Comparison 2 Trauma‐focused psychological therapy vs active psychological therapy for SUD only, Outcome 8 PTSD diagnosis following treatment completion.

Comparison 2 Trauma‐focused psychological therapy vs active psychological therapy for SUD only, Outcome 9 SUD diagnosis following treatment completion.
Figures and Tables -
Analysis 2.9

Comparison 2 Trauma‐focused psychological therapy vs active psychological therapy for SUD only, Outcome 9 SUD diagnosis following treatment completion.

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 1 PTSD severity following treatment completion.
Figures and Tables -
Analysis 3.1

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 1 PTSD severity following treatment completion.

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 2 PTSD severity 3‐4 months following treatment completion.
Figures and Tables -
Analysis 3.2

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 2 PTSD severity 3‐4 months following treatment completion.

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 3 PTSD severity 5‐7 months following treatment completion.
Figures and Tables -
Analysis 3.3

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 3 PTSD severity 5‐7 months following treatment completion.

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 4 PTSD severity 12 months following treatment completion.
Figures and Tables -
Analysis 3.4

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 4 PTSD severity 12 months following treatment completion.

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 5 Drug or alcohol use, or both following treatment completion.
Figures and Tables -
Analysis 3.5

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 5 Drug or alcohol use, or both following treatment completion.

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 6 Drug or alcohol use, or both 3‐4 months following treatment completion.
Figures and Tables -
Analysis 3.6

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 6 Drug or alcohol use, or both 3‐4 months following treatment completion.

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 7 Drug or alcohol use, or both 5‐7 months following treatment completion.
Figures and Tables -
Analysis 3.7

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 7 Drug or alcohol use, or both 5‐7 months following treatment completion.

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 8 Drug or alcohol use, or both 12 months following treatment completion.
Figures and Tables -
Analysis 3.8

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 8 Drug or alcohol use, or both 12 months following treatment completion.

Study

Individual intervention

Mueser 2008

12/16 (70.6%)

Group intervention

Frisman 2008

39/141 (28%)

Figures and Tables -
Analysis 3.9

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 9 Treatment completers.

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 10 Treatment completers.
Figures and Tables -
Analysis 3.10

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 10 Treatment completers.

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 11 PTSD diagnosis following treatment completion.
Figures and Tables -
Analysis 3.11

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 11 PTSD diagnosis following treatment completion.

Study

Group intervention

Boden 2012

No harmful or unintended effects were observed during the trial.

Frisman 2008

Not reported

Hien 2009

83 study related adverse events were identified (Killeen 2008). Of these 61 were rated as moderate to severe: 28 for the experimental condition; 33 for the control condition.

Najavits 2006a

Not reported

Norman unpublished

No adverse events occurred during the study.

Zlotnick 2009

Not reported

Figures and Tables -
Analysis 3.12

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 12 Adverse events.

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 13 Study‐related adverse events.
Figures and Tables -
Analysis 3.13

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 13 Study‐related adverse events.

Study

Mean number treatment condition sessions attended by intervention group (& SD)

Number sessions available

Percentage active intervention sessions attended

Mean number sessions attended by control group (& SD)

Percentage attended

Group intervention

Boden 2012

Not reported

Not reported

Frisman 2008

3.41 (3.38) active intervention sessions + 30.67 (37.38) TAU sessions

9 active intervention sessions plus TAU sessions

37.9%

39.0 (69.62) TAU sessions

Hien 2009

6.2 (4.5)

12

51.7%

6.9 (4.3)

57.5%

Najavits 2006a

9.67(5.05) active intervention session (11.78 (6.25) active intervention +TAU sessions)

25 active intervention sessions plus TAU sessions

38.7%

Not reported

Norman unpublished

12.5 (8.77)

24

52.1%

7.78 (5.78)

32.4%

Zlotnick 2009

15.6 (6.2)

25

62.4%

Not reported

Figures and Tables -
Analysis 3.14

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 14 Mean number of sessions attended for intervention group.

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 15 Mean number of sessions attended.
Figures and Tables -
Analysis 3.15

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 15 Mean number of sessions attended.

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 16 Sensitivity analysis: PTSD severity 5‐7 months following treatment completion.
Figures and Tables -
Analysis 3.16

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 16 Sensitivity analysis: PTSD severity 5‐7 months following treatment completion.

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 17 Sensitivity analysis: PTSD severity 12 months following treatment completion.
Figures and Tables -
Analysis 3.17

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 17 Sensitivity analysis: PTSD severity 12 months following treatment completion.

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 18 Sensitivity analysis: drug or alcohol use, or both 5‐7 months following treatment completion.
Figures and Tables -
Analysis 3.18

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 18 Sensitivity analysis: drug or alcohol use, or both 5‐7 months following treatment completion.

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 19 Sensitivity analysis: drug or alcohol use, or both 12 months following treatment completion.
Figures and Tables -
Analysis 3.19

Comparison 3 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy, Outcome 19 Sensitivity analysis: drug or alcohol use, or both 12 months following treatment completion.

Comparison 4 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only, Outcome 1 PTSD severity following treatment completion.
Figures and Tables -
Analysis 4.1

Comparison 4 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only, Outcome 1 PTSD severity following treatment completion.

Comparison 4 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only, Outcome 2 PTSD severity 3‐4 months following treatment completion.
Figures and Tables -
Analysis 4.2

Comparison 4 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only, Outcome 2 PTSD severity 3‐4 months following treatment completion.

Comparison 4 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only, Outcome 3 PTSD severity 5‐7 months following treatment completion.
Figures and Tables -
Analysis 4.3

Comparison 4 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only, Outcome 3 PTSD severity 5‐7 months following treatment completion.

Comparison 4 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only, Outcome 4 Drug or alcohol use, or both following treatment completion.
Figures and Tables -
Analysis 4.4

Comparison 4 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only, Outcome 4 Drug or alcohol use, or both following treatment completion.

Comparison 4 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only, Outcome 5 Drug or alcohol use, or both 3‐4 months following treatment completion.
Figures and Tables -
Analysis 4.5

Comparison 4 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only, Outcome 5 Drug or alcohol use, or both 3‐4 months following treatment completion.

Comparison 4 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only, Outcome 6 Drug or alcohol use, or both 5‐7 months following treatment completion.
Figures and Tables -
Analysis 4.6

Comparison 4 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only, Outcome 6 Drug or alcohol use, or both 5‐7 months following treatment completion.

Comparison 4 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only, Outcome 7 Treatment completers.
Figures and Tables -
Analysis 4.7

Comparison 4 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only, Outcome 7 Treatment completers.

Comparison 4 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only, Outcome 8 PTSD diagnosis following treatment completion.
Figures and Tables -
Analysis 4.8

Comparison 4 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only, Outcome 8 PTSD diagnosis following treatment completion.

Comparison 4 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only, Outcome 9 Mean number of sessions attended.
Figures and Tables -
Analysis 4.9

Comparison 4 Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only, Outcome 9 Mean number of sessions attended.

Trauma‐focused psychological therapy compared to control intervention

Patient or population: Individuals with post‐traumatic stress disorder and comorbid substance use disorder
Settings: Community addiction and mental health services
Intervention: Individual‐based psychological therapy including a trauma‐focused component
Comparison: Treatment as usual/minimal intervention/placebo intervention

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

TAU/ minimal intervention

Individual‐based psychological therapyincluding a trauma‐focused component

PTSD severity following treatment completion

As assessed by the CAPS, PSS‐I, or IES‐R. High scores indicate greater symptom severity

The mean PTSD severity following treatment completion in the intervention groups was
0.41 standard deviations lower
(0.72 to 0.1 lower)

405
(4 studies)

⊕⊝⊝⊝
very low1,2,3

SMD ‐0.41 (‐0.72 to ‐0.1)

Effect sizes of the range 0.2 to 0.5 indicate a small treatment effect

Drug or alcohol use, or both following treatment completion

As assessed by the TLFB or CIDI. High scores indicate greater symptom severity

The mean drug/alcohol use following treatment completion in the intervention groups was
0.13 standard deviations lower
(0.41 lower to 0.15 higher)

388
(3 studies)

⊕⊝⊝⊝
very low1,2,3

SMD ‐0.13 (‐0.41 to 0.15)

Not significant

Treatment completers

Study population

RR 0.80
(0.69 to 0.93)

316
(3 studies)

⊕⊕⊝⊝
low1,3

Indicates higher drop‐out in the intervention group

761 per 1000

609 per 1000
(525 to 708)

Moderate

718 per 1000

574 per 1000
(495 to 668)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CAPS: Clinician Administered PTSD Scale; CI: confidence interval; CIDI: Composite International Diagnostic Interview; IES‐R: Impact of Events Scale‐Revised; PSS‐I: PTSD Symptom Scale‐Interview; PTSD: post‐traumatic stress disorder; RR: risk ratio; SMD: standardised mean difference; TAU: treatment as usual; TLFB: Timeline Followback Interview

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Quality of evidence downgraded by one point because the risk of bias in most trials was high or unclear in several domains.
2Quality of evidence downgraded by one point because of a high level of unexplained statistical heterogeneity.
3Quality of evidence downgraded by one point as a result of significant clinical heterogeneity.

SUD based adjunctive therapy was not a formal part of either the experimental or control condition in one study (Coffey 2006). However, participants were recruited through an SUD based service and it is likely that they would have had access to adjunctive SUD‐ based therapy on an informal basis. All other studies in this comparison included formal access SUD‐based adjunctive therapy.

Figures and Tables -
Summary of findings 2. Trauma‐focused psychological intervention compared to active psychological intervention for SUD only

Trauma‐focused psychological therapy compared to active psychological therapy for SUD only

Patient or population: Individuals with post‐traumatic stress disorder and comorbid substance use disorder
Settings: Community addiction and mental health services
Intervention: Individual‐based psychological therapy including a trauma‐focused component
Comparison: Active psychological therapy for SUD only

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Active psychological therapyfor SUD only

Individual‐based psychological therapyincluding a trauma‐focused component

PTSD severity following treatment completion

As assessed by the CAPS. High scores indicate greater symptom severity

The mean PTSD severity following treatment completion in the intervention groups was
3.91 lower
(19.16 lower to 11.34 higher)

46
(1 study)

⊕⊕⊝⊝
low1

Not significant

Drug or alcohol use, or both following treatment completion

As assessed by the TLFB. High scores indicate greater symptom severity

The mean drug/alcohol use following treatment completion in the intervention groups was
1.27 lower
(5.76 lower to 3.22 higher)

46
(1 study)

⊕⊕⊝⊝
low1

Not significant

Treatment completers

Study population

RR 1
(0.74 to 1.36)

62
(1 study)

⊕⊕⊝⊝
low1

Not significant

724 per 1000

724 per 1000
(536 to 985)

Moderate

724 per 1000

724 per 1000
(536 to 985)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CAPS: Clinician Administered PTSD Scale; CI: confidence interval; PTSD: post‐traumatic stress disorder; RR: risk ratio; SUD: substance use disorder; TLFB: Timeline Followback Interview

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Quality of evidence downgraded by two points because findings were based on outcomes from one study with a small sample size.

SUD based adjunctive therapy was not a formal part of either the experimental or control condition in the study contributing to this comparison.

Figures and Tables -
Summary of findings 2. Trauma‐focused psychological intervention compared to active psychological intervention for SUD only
Summary of findings 3. Non‐trauma‐focused psychological intervention for PTSD and SUD or PTSD only compared to control intervention

Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only compared to control intervention

Patient or population: Individuals with post‐traumatic stress disorder and comorbid substance use disorder
Settings: Community addiction services and prison service
Intervention: Group‐ and individual‐based non‐trauma‐focused psychological therapy

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

TAU/minimal intervention

Group or Indvidual based non‐trauma‐focused psychological therapy

PTSD severity following treatment completion ‐ Individual‐based intervention

As assessed by the CAPS. High scores indicate greater symptom severity

The mean PTSD severity following treatment completion in the intervention groups was
0.22 standard deviations lower
(0.83 lower to 0.39 higher)

44
(1 study)

⊕⊕⊝⊝
low1

SMD ‐0.22 (‐0.83 to 0.39)

PTSD severity following treatment completion ‐ Group‐based intervention

As assessed by the CAPS or IES‐R. High scores indicate greater symptom severity

The mean PTSD severity following treatment completion in the intervention groups was
0.02 standard deviations lower
(0.19 lower to 0.16 higher)

513
(4 studies)

⊕⊕⊝⊝
low2,3

SMD ‐0.02 (‐0.19 to 0.16)

Drug or alcohol use, or both following treatment completion ‐ Individual‐based intervention

No data

Not estimable

Drug or alcohol use, or both following treatment completion ‐ Group‐based intervention

As assessed by the ASI, TLFB or CIDI. High scores indicate greater symptom severity

The mean drug/alcohol use following treatment completion in the intervention groups was
0.41 standard deviations lower
(0.97 lower to 0.14 higher)

464
(3 studies)

⊕⊝⊝⊝
very low2,3,4

SMD ‐0.41 (‐0.97 to 0.14)

Not significant

Treatment completers ‐ Individual‐based intervention

No data

Not estimable

Treatment completers ‐ Group‐based intervention

Study population

RR 1.13
(0.88 to 1.45)

381
(2 studies)

⊕⊕⊝⊝
low2,3

538 per 1000

608 per 1000
(473 to 780)

Moderate

493 per 1000

557 per 1000
(434 to 715)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
ASI: Addiction Severity Index; CAPS: Clinician Administered PTSD Scale; CI: confidence interval; CIDI: Composite International Diagnostic Interview; IES‐R: Impact of Events Scale‐Revised; PTSD: post‐traumatic stress disorder; RR: risk ratio; SMD: standardised mean difference; SUD: substance use disorder; TAU: treatment as usual; TLFB: Timeline Followback Interview

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Quality of evidence downgraded by two points because findings were based on outcomes from one study with a small sample size.
2Quality of evidence downgraded by one point because the risk of bias in most trials was high or unclear in several domains.
3Quality of evidence downgraded by one point because of significant clinical heterogeneity.
4Quality of evidence downgraded by one point because of a high level of unexplained statistical heterogeneity.

The individual‐based study (Mueser 2008) in this comparison did not include access to SUD based adjunctive therapy. Participants in all other studies were able to access SUD‐based adjunctive therapy.

Figures and Tables -
Summary of findings 3. Non‐trauma‐focused psychological intervention for PTSD and SUD or PTSD only compared to control intervention
Summary of findings 4. Non‐trauma‐focused psychological intervention for PTSD and SUD or PTSD only compared to active psychological intervention for SUD only

Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only compared to active psychological therapy for SUD only

Patient or population: Individuals with post‐traumatic stress disorder and comorbid substance use disorder
Settings: Community substance abuse treatment programs
Intervention: Individual‐based combined non‐trauma‐focused psychological therapy
Comparison: Active psychological therapy for SUD only

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Active psychological therapyfor SUD only

Individual‐based combined non‐trauma‐focused psychological therapy

PTSD severity following treatment completion

As assessed by the CAPS. High scores indicate greater symptom severity

The mean PTSD severity following treatment completion in the intervention groups was
0.26 standard deviations lower
(1.29 lower to 0.77 higher)

128
(2 studies)

⊕⊝⊝⊝
very low1,2,3

SMD ‐0.26 (‐1.29 to 0.77)

Not significant

Drug or alcohol use, or both following treatment completion

As assessed by the SUI or ASI. High scores indicate greater symptom severity

The mean drug/alcohol use following treatment completion in the intervention groups was
0.22 standard deviations higher
(0.13 lower to 0.57 higher)

128
(2 studies)

⊕⊕⊝⊝
low1,3

SMD 0.22 (‐0.13 to 0.57)

Not significant

Treatment completers

Study population

RR 0.91
(0.68 to 1.20)

128
(2 studies)

⊕⊝⊝⊝
very low1,3

Not significant

618 per 1000

563 per 1000
(420 to 742)

Moderate

591 per 1000

538 per 1000
(402 to 709)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
ASI: Addiction Severity Index; CAPS: Clinician Administered PTSD Scale; CI: confidence interval; PTSD: post‐traumatic stress disorder; RR: risk ratio; SMD: standardised mean difference; SUD: substance use disorder; SUI: Substance Use Inventory

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Quality of evidence downgraded by one point because the risk of bias in most trials was high or unclear in several domains.
2Quality of evidence downgraded by two points because of a high level of unexplained statistical heterogeneity.
3Quality of evidence downgraded by one point because findings were based on outcomes from two studies with small sample sizes.

Both studies in this comparison involved access to adjunctive SUD‐based therapy.

Figures and Tables -
Summary of findings 4. Non‐trauma‐focused psychological intervention for PTSD and SUD or PTSD only compared to active psychological intervention for SUD only
Comparison 1. Trauma‐focused psychological therapy vs control therapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD severity following treatment completion Show forest plot

4

405

Std. Mean Difference (IV, Random, 95% CI)

‐0.41 [‐0.72, ‐0.10]

1.1 Individual intervention

4

405

Std. Mean Difference (IV, Random, 95% CI)

‐0.41 [‐0.72, ‐0.10]

2 PTSD severity 3‐4 months following treatment completion Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2.1 Individual intervention

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 PTSD severity 5‐7 months following treatment completion Show forest plot

3

388

Std. Mean Difference (IV, Random, 95% CI)

‐0.34 [‐0.58, ‐0.10]

3.1 Individual intervention

3

388

Std. Mean Difference (IV, Random, 95% CI)

‐0.34 [‐0.58, ‐0.10]

4 Drug or alcohol use, or both following treatment completion Show forest plot

3

388

Std. Mean Difference (IV, Random, 95% CI)

‐0.13 [‐0.41, 0.15]

4.1 Individual intervention

3

388

Std. Mean Difference (IV, Random, 95% CI)

‐0.13 [‐0.41, 0.15]

5 Drug or alcohol use, or both 3‐4 months following treatment completion Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5.1 Individual intervention

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Drug or alcohol use, or both 5‐7 months following treatment completion Show forest plot

3

388

Std. Mean Difference (IV, Random, 95% CI)

‐0.28 [‐0.48, ‐0.07]

6.1 Individual intervention

3

388

Std. Mean Difference (IV, Random, 95% CI)

‐0.28 [‐0.48, ‐0.07]

7 Treatment completers Show forest plot

3

316

Risk Ratio (M‐H, Random, 95% CI)

0.78 [0.64, 0.96]

7.1 Individual intervention

3

316

Risk Ratio (M‐H, Random, 95% CI)

0.78 [0.64, 0.96]

8 PTSD diagnosis following treatment completion Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

8.1 Individual intervention

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Adverse events Show forest plot

Other data

No numeric data

9.1 Individual intervention

Other data

No numeric data

10 Adverse events Show forest plot

2

268

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.34, 1.90]

10.1 Individual intervention

2

268

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.34, 1.90]

11 Mean number of sessions attended for intervention group Show forest plot

Other data

No numeric data

11.1 Studies including intervention for SUD

Other data

No numeric data

12 Sensitivity analysis: PTSD severity following treatment completion Show forest plot

3

388

Std. Mean Difference (IV, Random, 95% CI)

‐0.33 [‐0.56, ‐0.10]

12.1 Individual intervention

3

388

Std. Mean Difference (IV, Random, 95% CI)

‐0.33 [‐0.56, ‐0.10]

Figures and Tables -
Comparison 1. Trauma‐focused psychological therapy vs control therapy
Comparison 2. Trauma‐focused psychological therapy vs active psychological therapy for SUD only

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD severity following treatment completion Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 Individual intervention

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 PTSD severity 5‐7 months following treatment completion Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2.1 Individual intervention

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 PTSD severity 8‐10 months following treatment completion Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 Individual intervention

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Drug or alcohol use, or both following treatment completion Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.1 Individual intervention

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Drug or alcohol use, or both 5‐7 months following treatment completion Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5.1 Individual intervention

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Drug or alcohol use, or both 8‐10 months following treatment completion Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

6.1 Individual intervention

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Treatment completers Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

7.1 Individual intervention

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 PTSD diagnosis following treatment completion Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

8.1 Individual intervention

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 SUD diagnosis following treatment completion Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

9.1 Individual intervention

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 2. Trauma‐focused psychological therapy vs active psychological therapy for SUD only
Comparison 3. Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD severity following treatment completion Show forest plot

5

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Individual intervention

1

44

Std. Mean Difference (IV, Random, 95% CI)

‐0.22 [‐0.83, 0.39]

1.2 Group intervention

4

513

Std. Mean Difference (IV, Random, 95% CI)

‐0.02 [‐0.19, 0.16]

2 PTSD severity 3‐4 months following treatment completion Show forest plot

5

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Individual intervention

1

44

Std. Mean Difference (IV, Random, 95% CI)

‐0.25 [‐0.86, 0.36]

2.2 Group intervention

4

499

Std. Mean Difference (IV, Random, 95% CI)

0.00 [‐0.17, 0.18]

3 PTSD severity 5‐7 months following treatment completion Show forest plot

5

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

3.1 Individual intervention

1

44

Std. Mean Difference (IV, Random, 95% CI)

‐0.20 [‐0.81, 0.41]

3.2 Group intervention

4

566

Std. Mean Difference (IV, Random, 95% CI)

‐0.14 [‐0.31, 0.03]

4 PTSD severity 12 months following treatment completion Show forest plot

2

518

Std. Mean Difference (IV, Random, 95% CI)

‐0.07 [‐0.25, 0.10]

4.1 Group intervention

2

518

Std. Mean Difference (IV, Random, 95% CI)

‐0.07 [‐0.25, 0.10]

5 Drug or alcohol use, or both following treatment completion Show forest plot

3

464

Std. Mean Difference (IV, Random, 95% CI)

‐0.41 [‐0.97, 0.14]

5.1 Group intervention

3

464

Std. Mean Difference (IV, Random, 95% CI)

‐0.41 [‐0.97, 0.14]

6 Drug or alcohol use, or both 3‐4 months following treatment completion Show forest plot

4

499

Std. Mean Difference (IV, Random, 95% CI)

‐0.08 [‐0.40, 0.23]

6.1 Group intervention

4

499

Std. Mean Difference (IV, Random, 95% CI)

‐0.08 [‐0.40, 0.23]

7 Drug or alcohol use, or both 5‐7 months following treatment completion Show forest plot

4

572

Std. Mean Difference (IV, Random, 95% CI)

‐0.06 [‐0.23, 0.11]

7.1 Group intervention

4

572

Std. Mean Difference (IV, Random, 95% CI)

‐0.06 [‐0.23, 0.11]

8 Drug or alcohol use, or both 12 months following treatment completion Show forest plot

2

528

Std. Mean Difference (IV, Random, 95% CI)

0.02 [‐0.15, 0.20]

8.1 Group intervention

2

528

Std. Mean Difference (IV, Random, 95% CI)

0.02 [‐0.15, 0.20]

9 Treatment completers Show forest plot

Other data

No numeric data

9.1 Individual intervention

Other data

No numeric data

9.2 Group intervention

Other data

No numeric data

10 Treatment completers Show forest plot

2

381

Risk Ratio (M‐H, Random, 95% CI)

1.13 [0.88, 1.45]

10.1 Group intervention

2

381

Risk Ratio (M‐H, Random, 95% CI)

1.13 [0.88, 1.45]

11 PTSD diagnosis following treatment completion Show forest plot

2

77

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.66, 1.54]

11.1 Group intervention

2

77

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.66, 1.54]

12 Adverse events Show forest plot

Other data

No numeric data

12.1 Group intervention

Other data

No numeric data

13 Study‐related adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

13.1 Group intervention

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

14 Mean number of sessions attended for intervention group Show forest plot

Other data

No numeric data

14.1 Group intervention

Other data

No numeric data

15 Mean number of sessions attended Show forest plot

2

381

Std. Mean Difference (IV, Random, 95% CI)

0.10 [‐0.59, 0.79]

15.1 Group intervention

2

381

Std. Mean Difference (IV, Random, 95% CI)

0.10 [‐0.59, 0.79]

16 Sensitivity analysis: PTSD severity 5‐7 months following treatment completion Show forest plot

3

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

16.1 Group intervention

3

425

Std. Mean Difference (IV, Random, 95% CI)

‐0.12 [‐0.34, 0.10]

17 Sensitivity analysis: PTSD severity 12 months following treatment completion Show forest plot

1

353

Std. Mean Difference (IV, Random, 95% CI)

‐0.04 [‐0.25, 0.17]

17.1 Group intervention

1

353

Std. Mean Difference (IV, Random, 95% CI)

‐0.04 [‐0.25, 0.17]

18 Sensitivity analysis: drug or alcohol use, or both 5‐7 months following treatment completion Show forest plot

3

425

Std. Mean Difference (IV, Random, 95% CI)

‐0.11 [‐0.30, 0.08]

18.1 Group intervention

3

425

Std. Mean Difference (IV, Random, 95% CI)

‐0.11 [‐0.30, 0.08]

19 Sensitivity analysis: drug or alcohol use, or both 12 months following treatment completion Show forest plot

1

353

Std. Mean Difference (IV, Random, 95% CI)

0.0 [‐0.21, 0.21]

19.1 Group intervention

1

353

Std. Mean Difference (IV, Random, 95% CI)

0.0 [‐0.21, 0.21]

Figures and Tables -
Comparison 3. Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs control therapy
Comparison 4. Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD severity following treatment completion Show forest plot

2

128

Std. Mean Difference (IV, Random, 95% CI)

‐0.26 [‐1.29, 0.77]

1.1 Individual intervention

2

128

Std. Mean Difference (IV, Random, 95% CI)

‐0.26 [‐1.29, 0.77]

2 PTSD severity 3‐4 months following treatment completion Show forest plot

2

128

Std. Mean Difference (IV, Random, 95% CI)

0.12 [‐0.31, 0.55]

2.1 Individual intervention

2

128

Std. Mean Difference (IV, Random, 95% CI)

0.12 [‐0.31, 0.55]

3 PTSD severity 5‐7 months following treatment completion Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 Individual intervention

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Drug or alcohol use, or both following treatment completion Show forest plot

2

128

Std. Mean Difference (IV, Random, 95% CI)

0.22 [‐0.13, 0.57]

4.1 Individual intervention

2

128

Std. Mean Difference (IV, Random, 95% CI)

0.22 [‐0.13, 0.57]

5 Drug or alcohol use, or both 3‐4 months following treatment completion Show forest plot

2

128

Std. Mean Difference (IV, Random, 95% CI)

0.18 [‐0.18, 0.53]

5.1 Individual intervention

2

128

Std. Mean Difference (IV, Random, 95% CI)

0.18 [‐0.18, 0.53]

6 Drug or alcohol use, or both 5‐7 months following treatment completion Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

6.1 Individual intervention

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

7 Treatment completers Show forest plot

2

128

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.68, 1.20]

7.1 Individual intervention

2

128

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.68, 1.20]

8 PTSD diagnosis following treatment completion Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

8.1 Individual intervention

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Mean number of sessions attended Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

9.1 Individual intervention

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 4. Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only vs active psychological therapy for SUD only