Military PTSD Treatments Differ in Strength of Internal Validity: A Meta Analysis of Pharmacological, Cognitivebehavioral, and Non-Traditional Therapies
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Therapies for PTSD for military veterans can be categorized as pharmacological, traditional (e.g., cognitive-behavioral therapy), or non-traditional approaches (e.g., exercise, yoga, and meditation/mindfulness). Previous meta-analyses focused exclusively on outcomes of PTSD treatment for military veterans (Stewart & Wrobel, 2009). Although treatment efficacy has been confirmed for all three approaches, the literature is sparse with regard to comparisons of methodological quality. This meta-analysis compared the methodological quality of these three broad treatment categories. From 1985-2014, 418 reports were published in 164 periodicals that were accessed via EBSCO online databases for military veterans with PTSD. There was little overlap for periodicals among the three treatment categories. Of these, 221 (53%) were empirical studies; pharmacological (n=63, 27%); traditional (n=102, 43%); and non-traditional (n=56, 24%). Reported methods describing appropriate relative comparisons and controls for fundamental confounds (e.g. pre-existing subject differences, order effects) were defined as having strong internal validity. Chi-square analysis confirmed a statistically significant difference (p=.008) between treatment types. Surprisingly, post-hoc paired-comparisons (2x2 Fisher tests, p < .001) showed that traditional cognitive-behavioral treatment had significantly weaker internal validity than the other two approaches. The expectation should be that cognitive-behavioral treatments are held to the same rigorous research standards as those of pharmacological treatments, and non-traditional treatments.