Examining military population and trauma type as moderators of treatment outcome for first-line psychotherapies for PTSD: A meta-analysis

Casey L. Straud, Jedidiah Siev, Stephen Messer, Alyson K. Zalta

Research output: Contribution to journalReview articlepeer-review

65 Scopus citations


There is conflicting evidence as to whether military populations (i.e., veteran and active-duty military service members) demonstrate a poorer response to psychotherapy for posttraumatic stress disorder (PTSD) compared to civilians. Existing research may be complicated by the fact that treatment outcomes differences could be due to the type of trauma exposure (e.g., combat) or population differences (e.g., military culture). This meta-analysis evaluated PTSD treatment outcomes as a function of trauma type (combat v. assault v. mixed) and population (military v. civilian). Unlike previous meta-analyses, we focused exclusively on manualized, first-line psychotherapies for PTSD as defined by expert treatment guidelines. Treatment outcomes were large across trauma types and population; yet differences were observed between trauma and population subgroups. Military populations demonstrated poorer treatment outcomes compared to civilians. The combat and assault trauma subgroups had worse treatment outcomes compared to the mixed trauma subgroup, but differences were not observed between assault and combat subgroups. Higher attrition rates predicted poorer treatment outcomes, but did not vary between military populations and civilians. Overall, manualized, first-line psychotherapies for PTSD should continue to be used for civilians and military populations with various trauma types. However, greater emphasis should be placed on enhancing PTSD psychotherapies for military populations and on treatment retention across populations based on findings from this meta-analysis.

Original languageEnglish (US)
Article number102133
JournalJournal of Anxiety Disorders
StatePublished - Oct 2019


  • Civilians
  • First-Line treatments
  • Meta-Analysis
  • Military
  • Posttraumatic stress disorder
  • Trauma type
  • Veterans

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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