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Psychological interventions for ICD-11 Complex PTSD symptoms: Systematic review and meta-analysis

Karatzias, Thanos; Murphy, Philip; Cloitre, Marylene; Bisson, Jonathan; Roberts, Neil; Shevlin, Mark; Hyland, Philip; Maercker, Andreas; Ben-Ezra, Menachem; Coventry, Peter; Mason-Roberts, Susan; Bradley, Aoife; Hutton, Paul


Philip Murphy

Marylene Cloitre

Jonathan Bisson

Neil Roberts

Mark Shevlin

Philip Hyland

Andreas Maercker

Menachem Ben-Ezra

Peter Coventry

Aoife Bradley


Background: The 11th revision to the WHO International Classification of Diseases (ICD-11) identified Complex Posttraumatic Stress Disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions. Methods: We conducted a systematic review and meta-analysis of Randomised Controlled Trials (RCTs) of psychological interventions for Posttraumatic Stress Disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality. Results: Fifty-one RCTs met inclusion criteria. Cognitive Behavioural Therapy (CBT), Exposure alone (EA), and Eye Movement Desensitization and Reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = -0.90 (CBT; k=27, 95% CI -1.11, -0.68; moderate quality) to g = -1.26 (EMDR; k=4, 95% CI -2.01, -0.51; low quality). CBT and EA each had moderate-large or large effects on negative self-concept, but only 1 trial of EMDR reported this outcome. CBT, EA and EMDR each had moderate or moderate-large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared to non-specific interventions (e.g., befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome.
Conclusions: The development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.


Karatzias, T., Murphy, P., Cloitre, M., Bisson, J., Roberts, N., Shevlin, M., …Hutton, P. (2019). Psychological interventions for ICD-11 Complex PTSD symptoms: Systematic review and meta-analysis. Psychological Medicine, 49(11), 1761-1775.

Journal Article Type Article
Acceptance Date Feb 15, 2019
Online Publication Date Mar 12, 2019
Publication Date 2019-08
Deposit Date Feb 18, 2019
Publicly Available Date Mar 12, 2019
Journal Psychological Medicine
Print ISSN 0033-2917
Publisher Cambridge University Press
Peer Reviewed Peer Reviewed
Volume 49
Issue 11
Pages 1761-1775
Keywords CPTSD, psychological therapies, childhood trauma, systematic review, meta-analysis, randomised controlled trials,
Public URL


Psychological Interventions For ICD-11 Complex PTSD Symptoms: Systematic Review And Meta-analysis (accepted manuscript) (386 Kb)

Figures R3 - Psychological Interventions For ICD-11 Complex PTSD Symptoms (1 Mb)

Tables R3 - Psychological Interventions For ICD-11 Complex PTSD Symptoms (19 Kb)

Supplement to Psychological interventions for ICD-11 Complex PTSD symptoms (682 Kb)

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