While there is literature that examines the relationship between statistically and clinically significant changes, this was not discussed in detail within four5,14,21,36 of the included studies. It is important to note that the eight unique primary studies38–45 summarized from the three systematic reviews5,14,21 likely examined additional outcomes that were not discussed within the systematic reviews. It is typical for systematic reviews to consolidate data on primary outcomes or a specific outcome of interest (in this case PTSD symptom severity), rather than completely summarizing all findings from primary studies. A total of 962 English-language studies and 144 Chinese-language studies were identified through electronic databases searches, with an additional 8 articles manually retrieved from other sources. After the removal of duplicate records based on titles and abstracts, 528 articles remained for further assessment. A thorough full-text review resulted in the exclusion of 375 articles due to various reasons, including non-randomized controlled trial design, incomplete data, inappropriate publication types (e.g., conference proceedings, review articles), or failure to meet the predefined intervention criteria or target population.
Network meta-analysis
- Skilled examiners attend to behavioral indicators of emotional distress, fatigue, and even dissociation, to support clients to perform at their best by offering breaks and non-specific support.
- Use of a narrative review style also allowed for an iterative approach to provide a general overview of “brain fog” in PTSD as further information was gathered and common themes in the research were identified.
- To enhance the quality of future research, it is essential to improve the clarity and accuracy of the literature used.
- For example, over the last few years, four different scales have been developed to operationalize “brain fog”.
It is essential to use both verbal and non-verbal behaviour to express empathy and compassion when the patient is speaking. People with CPTSD may be particularly sensitive to signals of rejection or judgement, and hence the therapist must demonstrate unconditional positive regard. Being present and remembering small cognitive behavioral therapy details of the person’s history and their life is important, as it demonstrates that the therapist is holding them in mind. Patients who present with CPTSD have had awful experiences in their life and, understandably, forming a trusting therapeutic relationship is unlikely to be easy. Developing and sustaining the therapeutic relationship is central in trauma-focused CBT (Cohen Reference Cohen, Mannarino and Murray2011) for CPTSD. Treatment needs to focus on the strengths of the patient – what can they do well and what resources do they have in their life?
Literature screening process and results
Objective neuropsychological assessment is conducted in neutral, distraction-free, quiet, standardized settings intended to allow individuals to perform at their best. Skilled examiners attend to behavioral indicators of emotional distress, Sober living home fatigue, and even dissociation, to support clients to perform at their best by offering breaks and non-specific support. The results can then be used to extrapolate how well an individual might perform in less optimal, real-world settings characterized by distractions, fatigue, and emotional distress, in which cognitive failures may be more likely to occur.
Intervention
This study aims to inform clinical guidelines by providing a treatment framework that balances personalization and flexibility, offering a more comprehensive and holistic therapeutic approach. The NMA methodology allows for the integration of evidence from multiple interventions, enabling both direct and indirect comparisons while maintaining the rigor of randomization. Consistency analysis conducted within the NMA revealed no significant discrepancies between direct and indirect evidence regarding changes in PTSD symptom scores. Although the included studies exhibited moderate to high heterogeneity, the interventions were deemed sufficiently comparable.
Both the iCBT and psycho-educational website groups reported statistically significant decreases in symptoms of anxiety at post-treatment and three month follow-up compared to pre-treatment scores. There were no statistically significant differences in anxiety symptoms between groups at any time point. In addition, over half of the participants in either treatment group reported a clinically significant decrease in anxiety symptoms (measured using the reliable change index). The Littleton et al.37 RCT measured symptoms depression using the Center for Epidemiological Studies-Depression Scale (CES-D). Participants in both treatment programs experienced significant reductions in symptoms of depression at post-treatment and thee month follow-up compared to baseline.
Problems with operationalization and variance in psychometric validation methodology may be tied to the inconsistent definition of “brain fog” within the literature, as selection of measures for comparison with new scales is tied to construct conceptualization. Clearly, the lack of a unifying definition for “brain fog” is a significant limiting factor for its study across various conditions, PTSD included. The RCT38 comparing iCBT with an exposure component to iCBT without an exposure component reported a dropout rate of 12% in the exposure group and 14% in the group without an exposure component. The remaining primary study44 reported a 41.7% dropout rate in the iCBT group compared to 19% in the internet supportive counselling group. The systematic review by Sijbrandij et al.5 included three primary relevant studies39,42,45 comparing iCBT to waiting list, one relevant primary study44 comparing iCBT to internet-based supportive counselling, and one primary study38 comparing iCBT with an exposure component to iCBT without an exposure component.
- In the first level of screening, titles and abstracts were reviewed and potentially relevant articles were retrieved and assessed for inclusion.
- At this point the memories can be altered or manipulated so that they are different from what occurred.
- In spite of reports of efficacy in many studies, nonresponse to CBT for PTSD can be as high as 50%.
- Finally, only Knowles et al30 evaluated their measure of “brain fog” for convergence with neuropsychological test performance, with weak and non-significant results.
- Complex post-traumatic stress disorder (CPTSD) is a severe mental disorder which was adopted as a new diagnosis in ICD-11 (World Health Organization 2018).
Thirteen studies detailed blinding of patients, and only eight studies blinded those who assessed the results of the study. Data completeness was good in all 20 studies, with no selective reporting identified and one study did not clearly articulate the results of the research ethics review. A 2018 literature review found CBT to be effective in treating anxiety-related disorders but found a higher dropout rate of people who had PTSD, especially when it came to the exposure part of the therapy.
