Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.
Confidence in the evidence is moderate or low to moderate where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes.
Population: Children and young people (under 18 years) with clinically important post-traumatic stress symptoms (more than one month after a traumatic event) or clinically significant PTSD
Intervention: Trauma-focused cognitive behavioural therapies (CBT)
Comparison: No treatment, treatment as usual (TAU), waitlist, meditation, or counselling ᵃ
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Trauma-focused CBT versus meditation for the early treatment (1-3 months) of clinically important symptoms/PTSD | ||
PTSD symptomatology clinician-rated at 6-month follow-up (Child Post Traumatic Stress-Reaction Index change score) | No statistically significant difference | Low |
Number of people who met criteria for a diagnosis of PTSD at 6 months | No statistically significant difference | Low |
Discontinuation (follow-up mean 1 month; number of participants lost to follow-up) | See note ᵇ | Moderate |
Trauma-focused CBT versus waitlist, TAU, or no treatment for the delayed treatment (>3 months) of clinically important symptoms/PTSD | ||
PTSD symptomatology self-rated at endpoint (follow-up 0.4-13 weeks) ᶜ | Favours intervention | Very Low |
PTSD symptomatology self-rated at 6-month follow-up (Screen for Post-Traumatic Stress Symptoms [SPTSS] change score) | No statistically significant difference | Very Low |
PTSD symptomatology self-rated at 12-18 month follow-up (Child PTSD Symptom Scale [CPSS] or SPTSS change score) | Favours intervention | Very Low |
PTSD symptomatology clinician-rated at endpoint (follow-up 8-20 weeks) ᵈ | Favours intervention | Low |
PTSD symptomatology clinician-rated at 2-year follow-up (Kiddie Schedule for Affective Disorders and Schizophrenia [K-SADS-E] PTSD change score) | No statistically significant difference | Low |
Remission at 1-3 month follow-up | Favours intervention | Moderate |
Remission at 12-18 month follow-up | No statistically significant difference | Moderate |
Response at endpoint (follow-up 10-13 weeks; number of people showing clinically significant improvement) | Favours intervention | Very Low |
Discontinuation (follow-up mean 1 month; loss to follow-up) | No statistically significant difference | Moderate |
Trauma-focused CBT versus supportive counselling for the delayed treatment (>3 months) of clinically important symptoms/PTSD | ||
PTSD symptomatology self-rated at 12-17 month follow-up (Trauma Symptom Checklist for Children or CPSS change score) | Favours intervention | Low |
PTSD symptomatology clinician-rated at endpoint (follow-up 8-14 weeks) ᵉ | Favours intervention | Moderate |
PTSD symptomatology clinician-rated at 6-month follow-up (CAPS change score) | No statistically significant difference | Moderate |
PTSD symptomatology clinician-rated at 12-month follow-up (CAPS/CPSS change score) | Favours intervention | Moderate |
Remission at 12-month follow-up | Favours intervention | Moderate |
Response at 12-month follow-up (number of people showing clinically significant improvement) | Favours intervention | Moderate |
Discontinuation (follow-up 3-15 weeks; loss to follow-up for any reason) | No statistically significant difference | Moderate |
Recommendations as stated in the source guideline The National Institute of Health and Care Excellence (NICE) 2018 guideline on Post-traumatic stress disorder makes the following recommendations: Consider an individual trauma-focused CBT intervention for children aged 5 to 6 years with a diagnosis of PTSD or clinically important symptoms of PTSD who have presented more than 1 month after a traumatic event. Consider an individual trauma-focused CBT intervention for children and young people aged 7 to 17 years with a diagnosis of PTSD or clinically important symptoms of PTSD who have presented between 1 and 3 months after a traumatic event. Offer an individual trauma-focused CBT intervention to children and young people aged 7 to 17 years with a diagnosis of PTSD or clinically important symptoms of PTSD who have presented more than 3 months after a traumatic event.
Note Only outcomes that NICE considered critical to decision making are included in this table. In addition, where the guideline reported >1 time point but effectiveness was the same, only the longest length of follow-up is included in this table. Please see the full guideline for information on other outcomes. ᵃ NICE also included other comparisons, although they only found more evidence for delayed treatment. See full guideline for more information. ᵇ No events occurred in either group. ᶜ Thirteen studies, measured with the following change scores: Child PTSD Symptom Scale (CPSS); Child Post-Traumatic Symptom-Reaction Index (CPTS-RI); Children’s Revised Impact of Event Scale (CRIES); Children’s Response to Trauma Inventory (CRTI); Screen for Post-Traumatic Stress Symptoms (SPTSS); and UCLA PTSD-Reaction Index. ᵈ Seven studies, measured with the following change scores: Clinician Administered PTSD Symptom (CAPS); Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-E: PTSD); Anxiety Disorder Interview Schedule-Child version (ADIS-C:PTSD); and Children's PTSD Inventory (CPTSDI). ᵉ Three studies, measured with the following change scores: K-SADS: PTSD; CPSS; and Clinician Administered PTSD Symptom (CAPS).
This evidence table is related to the following section/s:
This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Adults with PTSD
Intervention: Trauma-focused cognitive behavioural therapies (CBT)
Comparison: No treatment, treatment as usual (TAU), waitlist, or counselling ᵃ
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Trauma-focused CBT versus waitlist or no treatment for early treatment (1-3 months) of clinically important symptoms/PTSD | ||
PTSD symptomatology self-rated at endpoint (follow-up mean 4 weeks; Impact of Event Scale [IES] change score) | No statistically significant difference | Low |
PTSD symptomatology self-rated at 10-month follow-up (IES change score) | Favours intervention | Low |
PTSD symptomatology clinician-rated at 10-month follow-up (Clinician-administered PTSD scale [CAPS] endpoint) | No statistically significant difference | Moderate |
Remission at 4-month follow-up | No statistically significant difference | Very Low |
Response self-rated at endpoint (follow-up mean 4 weeks; at least 50% improvement from baseline on IES) | No statistically significant difference | Very Low |
Response self-rated at 10-month follow-up (at least 50% improvement from baseline on IES) | Favours intervention | Low |
Discontinuation (loss to follow-up for any reason) | No statistically significant difference | Very Low |
Trauma-focused CBT versus waitlist for delayed treatment (>3 months) of clinically important symptoms/PTSD | ||
PTSD symptomatology self-rated at 3-month follow-up (Harvard Trauma Questionnaire change score) | No statistically significant difference | Low |
PTSD symptomatology self-rated at 1-year follow-up (IES change score) | Favours intervention | Very Low |
PTSD symptomatology clinician-rated at endpoint (follow-up 2-20 weeks) ᵇ | Favours intervention | Very Low |
Remission at 3-6 months' follow-up | Favours intervention | Very Low |
Response self-rated at 6-month follow-up (at least 50% improvement on Post-traumatic Diagnostic Scale) | Favours intervention | Low |
Response clinician-rated (follow-up 2-12 weeks; improvement on CAPS) | Favours intervention | Low |
Discontinuation (loss to follow-up for any reason) | Favours comparison | Low |
Trauma-focused CBT (+/- TAU) versus counselling (+/- TAU) for delayed treatment (>3 months) of clinically important symptoms/PTSD | ||
PTSD symptomatology self-rated at endpoint (follow-up 3-16 weeks) ᶜ | Favours intervention | Very Low |
PTSD symptomatology self-rated at 2-year follow-up (PTSD checklist change score) | No statistically significant difference | Low |
PTSD symptomatology clinician-rated at 1-year follow-up ᵈ | Favours intervention | Very Low |
PTSD symptomatology clinician-rated at 2-year follow-up (CAPS change score) | No statistically significant difference | Low |
Remission at 1-year follow-up | Favours intervention | Low |
Response clinician-rated (follow-up mean 5 weeks; improvement on PTSD symptom scale-interview [PSS-I]) | No statistically significant difference | Very Low |
Discontinuation (loss to follow-up for any reason) | No statistically significant difference | Low |
Recommendations as stated in the source guideline The National Institute of Health and Care Excellence (NICE) 2018 guideline on Post-traumatic stress disorder makes the following recommendation: Offer an individual trauma-focused CBT intervention to adults with a diagnosis of PTSD or clinically important symptoms of PTSD who have presented more than 1 month after a traumatic event.
Note The guideline committee noted that no evidence was identified for group CBT. Only outcomes that NICE considered critical to decision making are reported in this table. In addition, where the guideline reported >1 timepoint but effectiveness was the same, only the longest length of follow-up is included in this table. Please see the full guideline for information on other outcomes. The guideline committee noted the benefits of trauma-focused CBT both on critical outcomes (clinician-rated and self-rated measures of PTSD symptomatology, the rate of remission, and response) and on important outcomes (depression, anxiety, dissociative symptoms, global functioning, functional impairment, and relationship difficulties); and that many of these benefits were potentially long term. The committee also observed the breadth of clinical efficacy of trauma-focused CBT including: a range of trauma types (including childhood sexual abuse, and sexual assault or abuse in adulthood); single and multiple incident index traumas; and in people with a diagnosis of PTSD and those without a diagnosis who have clinically important symptoms. ᵃ NICE also included other comparisons, although they only found more evidence for delayed treatment. See full guideline for more information. ᵇ Twelve studies, measured with the following change scores: Clinician-administered PTSD scale (CAPS); Harvard Trauma Questionnaire (HTQ); Structured interview for PTSD (SI–PTSD); and PTSD symptom scale-interview (PSS-I). ᶜ Six studies, measured with the following change scores: PTSD checklist (PCL); PTSD Diagnostic Scale (PDS); and PTSD symptom scale - self reported (PSS-SR). ᵈ Three studies, measured with the following change scores: CAPS; PSS-I; and Composite International Diagnostic Interview-PTSD (CIDI-PTSD).
This evidence table is related to the following section/s:
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