exposure therapy was compared with some other intervention.3 If evidence strongly supported equivalency of the other therapy compared with exposure therapy, it would add support for the other therapy. We identified seven such studies, but only one—a comparison of exposure therapy with cognitive restructuring in a mixed trauma population (Tarrier et al., 1999)—had no major limitations and it showed that the two therapies were equivalent. The study was small, however, so the committee could not judge whether it had adequate power to detect a clinically significant difference, and thus did not reach a conclusion regarding the equivalency of the two treatments.

Exclusion Notes

Several exposure trials were excluded because they were not randomized (or only partially randomized) (Brady et al., 2001;4 Cloitre and Koenen, 2001;5 Cooper and Clum, 1989;6 Humphreys et al., 1999;7 Monson et al., 20058). Trials that did not include a comparison or control group were also excluded (Basoglu et al., 2003;9 Forbes et al., 2002;10 Frommberger et al., 2004;11 Najavits et al., 1998). Three trials included participants not formally diagnosed with PTSD, or only part of the sample was diagnosed so were excluded (Foa et al., 1995;12 Lubin et al., 1998;13 Valentine and Smith, 2001). There were also two studies where PTSD was not the main

3

After this report was released an additional head-to-head study was brought to the committee’s attention (Ironson et al., 2002). Because of lack of clarity regarding inclusion criteria, the randomization protocol, and the treatment actually delivered, the study was uninformative regarding the principal comparison of PE to EMDR.

4

This study also looked at dual diagnosis (PTSD and cocaine addiction) and had a high dropout rate greater than 50 percent.

5

This was a naturalistic study where treatment was interpersonal process group therapy in patients with and without bipolar disorder.

6

Randomization was not 100 percent. Patients were assigned to standard treatment or standard treatment plus imaginal flooding.

7

Program evaluation.

8

This was a preliminary program effectiveness study that compared two variations of CBT in a veteran population.

9

Modified behavioral treatment given to N = 231 earthquake survivors; duration of treatment and improvement of symptoms were outcomes.

10

Longitudinal trial examining predictors of response versus treatment efficacy.

11

This trial compared paroxetine treatment (10–50 mg dosages given) versus CBT treatment (exposure and cognitive restructuring). PTSD and depression symptomatology were outcome variables.

12

Subjects diagnosed with PTSD per Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III), but mean duration of illness was 15 days (9.40 for control), corresponding to the current definition for acute stress disorder.

13

Patients only had PTSD symptoms, not PTSD diagnosis.



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