Review Article

Cognitive-Behavioral Therapy versus Other PTSD Psychotherapies as Treatment for Women Victims of War-Related Violence: A Systematic Review

Table 1

Participants, measures, characteristics of interventions, and assessments’ timing in the included trials.

Studies
(author, year)
Form of CBT offered (number of sessions and length)Description of traumaParticipants and repartition by sexPTSD diagnosis and severity assessmentDepression assessmentNumber of assessments and timing

Hinton et al., 2009 [27]Culturally Adapted CPT, immediate versus delayed treatment.
Participants received 12 weekly sessions of adapted CPT, (duration not reported)
Type of trauma not specified24 Cambodians with a pharmacology-resistant PTSD. Participants passed through Cambodian genocide and were at least 6 years old at the beginning of the genocide.
60% of participants were women
PTSD severity assessed with Clinician Administered PTSD Scale or CAPS (CAPS; Weather et al., 2001) [44] validated within the Cambodian population.None3 assessments for the immediate-treatment group and 2 for the delayed-treatment group.

Hinton et al. 2004 [17]Culturally Adapted CPT versus control (delayed treatment)
Each group followed 11 sessions (duration not reported)
Types of trauma not specified.12 Vietnamese participants affected to either Immediate treatment (IT) group or Delayed-treatment (DT) group.
Women represent 50% of participants.
PTSD diagnosed with Structured Clinical Interview for DSM-IV (SCID; First et al., 1995) [45]. PTSD severity assessed with the Havard Trauma Questionnaire (HTQ) translated and validated for the Vietnamese population (Mollica et al., 1992) [46].Hopkins Symptom CheckList-25 (HSCL-25)3: at pretreatment, after IT finished sessions of CPT and after DT had undergone CPT.

Hinton et al. 2005 [24]Culturally Adapted CBT versus control (delayed treatment)
Each group followed 12 weekly sessions (duration not reported)
Types of trauma not specified.40 Cambodian participants (survivors of the 1975–1979 Cambodian genocide) affected to either IT or DT groups.
Women represent 60% of participants of each group.
PTSD diagnosed with SCID. PTSD severity assessed with CAPS validated within the Cambodian population.Symptom Checklist-90-R’s depression subscale.4: at pretreatment, after IT finished CPT, after DT finished CPT and at 3 months posttreatment for both groups (followup).

Otto et al. 2003 [25]Culturally Adapted CPT versus control (sertraline alone)
Ten sessions (duration not reported) of CBT were delivered to the intervention group.
Types of trauma not specified.10 participants were allocated to pharmacotherapy alone or pharmacotherapy + psychotherapy.
All participants were women.
PTSD diagnosed with SCID (First et al., 1995) [45]. PTSD severity was assessed with CAPS. PTSD subscales (re-experiencing, avoidance and arousal) were examined as separate outcome variables.HSCL-25 validated for the Khmer population.One: posttreatment

Bischescu et al., 2007 [28]NET versus PED
NET group received 4 weekly or biweekly sessions of 120 minutes each. Treatments were performed within a time period of 10 weeks.
Trauma was experienced during imprisonment. Types were not specified.18 participants (former political detainees) were allocated to either NET or PED.
Distribution of participants’ sex was not reported.
Composite International Diagnostic Interview (CIDI; WHO, 1997) [47]. Patients were also asked to describe their specific symptoms or give examples during assessments.Beck Depression scale (Beck, 1978; Beck and Steer, 1987) [48, 49].2: before and after treatment (six months postintervention)

Neuner et al., 2010 [29]NET versus Treatment As Usual.
Patients of the NET group followed between 5 and 17 sessions (mean = 9 and sd = 3.77) of approximately 120 mins. The 2 groups received one PED session at trial beginning.
Witnessing a violent assault on a familiar person, torture, being in a war zone, and experiencing a violent assault by a stranger.32 Asylum seekers with a history of victimisation by organised violence allocated to either NET or treatment as usual (TAU) representing the control.
Women represent 31.2% of participants.
Posttraumatic Diagnostic Scale (PDS; Foa et al., 1995) [50].HSCL-25.2: pre and post treatment

Neuner et al., 2004 [16]NET versus PED (no treatment)
NET versus SC
PED group had 1 session of treatment. NET and SC groups had 4 sessions of therapy. Sessions lasted 90 mins, exceptionally 120 mins.
Witnessing people badly injured or killed; threats with weapons, kidnappings, attacks, torture, combat experiences, sexual assaults and natural disasters.43 participants allocated to either NET or SC interventions with PED as control.
Women represent, respectively, 75%, 57.1% and 53.3% of PED, SC and NET groups.
CIDI (CIDI; WHO, 1997) [47] and Posttraumatic Diagnostic Scale (PDS; Foa et al., 1995) [50].Self-reporting Questionnaire-20 (SRQ-20; Harding et al., 1980) [51].4: pre-treatment, post-treatment, 4 months and 1 year after treatment.

Neuner et al., 2008 [30]NET versus no treatment (MG)
NET versus TC
Participants received six sessions (lasting between 1 and 2 hrs) of NET or TC.
Number of traumatic events was reported, but types of trauma were not.277 participants (Rwandan and Somalian refugees) were allocated to either NET, TC (Trauma counselling), or MG (monitoring group).
Women represent, respectively, 49.1%, 53.2% and 50.5% of MG, TC, and NET groups.
CIDI and PDS.None3 times for NET and TC groups: at pre-treatment,
3 and 6 months posttreatment. MG was tested at pretreatment, 6 and 9 months.

Ertl et al. 2011 [31]NET versus Academic catch-up or waiting list.
Participants received 8 sessions of NET.
Abduction/
experienced or witnessed trauma.
85 formerly abducted youths were allocated to one the 3 groups.
Between 42 and 67% of the participants of each group were women.
CAPS.MINI.4 assessments for each group at pretreatment, 3, 6 and 12 months.

Kruse et al. 2009 [26]CPT versus usual care.
25 hours of manualized trauma-focused psychotherapy (CPT)
Torture, mass rape, genocide, expulsionParticipants (Bosnian) were between 18 and 61 years old and without no serious illness or alcohol/drug dependence.
67.7% of participants were women.
Havard Trauma Questionnaire (PTSD event section); Symptom Checklist (SCL-90R)None2 assessments: before and after intervention.