The effects of psychological interventions on neurocognitive functioning in posttraumatic stress disorder: a systematic review

Posttraumatic stress disorder (PTSD) is a serious mental disorder, which is associated with emotional and cognitive functioning problems. Psychological interventions, such as trauma-focused cognitive behavioural therapy (tf-CBT) and eye movement desensitization and reprocessing (EMDR) are effective in reducing PTSD symptoms. Despite evidence showing that PTSD is associated with neurocognitive deficits, there is no systematic overview available on neurocognitive outcomes following treatment for PTSD. The current systematic review examined whether psychological treatments for PTSD improve neurocognitive functioning outcomes related to memory, attention, information processing, and executive functioning. A literature search in PubMed, PsycINFO, PTSDpubs, and Cochrane Library was performed up to March 7, 2022, in collaboration with a medical information specialist. Eligible PTSD treatment studies examining neurocognitive outcomes (memory, attention, information processing and executive function) in patients with a DSM-IV or ICD diagnosis of PTSD were included. Of the 3023 titles and abstracts identified, 9 articles met inclusion criteria, of which 5 randomized controlled trials (RCTs) and 4 non-randomized studies. Treatments included were cognitive behavioural therapy (CBT), cognitive processing therapy (CPT), brief eclectic psychotherapy (BEP), eye movement desensitization and reprocessing (EMDR), virtual reality graded exposure therapy (VR-GET), and resilience-oriented treatment (ROT). This systematic review showed that psychological treatments for PTSD do not affect most neurocognitive functions, with exception of the memory outcomes. Future research, high-quality studies are needed to provide evidence of the effect of psychological treatment in improving neurocognitive functioning in PTSD. This systematic review investigated the effects of psychological treatments on neurocognitive functioning in adults with PTSD.This review showed that most studies were very heterogeneous in design, method, and analysis.This review supports the evidence for psychological treatments for PTSD on improving memory outcomes. This systematic review investigated the effects of psychological treatments on neurocognitive functioning in adults with PTSD. This review showed that most studies were very heterogeneous in design, method, and analysis. This review supports the evidence for psychological treatments for PTSD on improving memory outcomes.创伤后应激障碍（Posttraumatic stress disorder, PTSD）是一种严重的精神障碍，与情绪及认知功能损伤密切相关。针对创伤的认知行为疗法（trauma-focused cognitive behavioural therapy, tf-CBT）与眼动脱敏与再加工疗法（eye movement desensitization and reprocessing, EMDR）等心理干预手段，在缓解PTSD症状方面疗效确切。尽管已有研究证实PTSD与神经认知缺陷存在关联，但目前尚无针对PTSD治疗后神经认知转归的系统性综述。本项系统性综述旨在探讨PTSD的心理治疗是否能够改善与记忆、注意、信息处理及执行功能相关的神经认知功能。本研究联合医学信息专员，于2022年3月7日前在PubMed、PsycINFO、PTSDpubs及Cochrane Library数据库中开展文献检索。纳入研究需满足以下条件：针对采用DSM-IV或ICD诊断标准确诊的PTSD患者，且考察了神经认知转归（包括记忆、注意、信息处理与执行功能）的PTSD治疗研究。最终从检索获得的3023篇题录及摘要中，共筛选出9篇符合纳入标准的文献，其中5项为随机对照试验（randomized controlled trials, RCTs），4项为非随机研究。纳入分析的治疗手段包括认知行为疗法（Cognitive behavioural therapy, CBT）、认知加工疗法（Cognitive processing therapy, CPT）、简短折中心理治疗（brief eclectic psychotherapy, BEP）、眼动脱敏与再加工疗法（EMDR）、虚拟现实分级暴露疗法（virtual reality graded exposure therapy, VR-GET）及复原导向治疗（resilience-oriented treatment, ROT）。本项系统性综述结果显示，PTSD的心理治疗对多数神经认知功能无显著影响，仅在记忆转归方面存在改善效果。研究同时发现，纳入的多数研究在设计、方法及分析环节均存在较高异质性。本综述为PTSD心理治疗可改善记忆转归的证据提供了支持。未来仍需开展高质量研究，以进一步证实心理治疗对改善PTSD患者神经认知功能的作用。