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Literature review on trauma-informed care and practice

The GPMHSC commissioned a rapid literature review to identify evidence of the effectiveness of trauma-informed care in the primary care setting.

In February 2022, the GPMHSC commissioned a rapid literature review to identify evidence of the effectiveness of trauma-informed care in the primary care setting. Evidence is presented for both the effectiveness of implementing trauma-informed care as a model of care in primary practice, and the effectiveness of trauma-specific interventions.

The 'Rapid review on trauma-informed care in primary care settings' consists of three parts:

For the full summary of identified trauma-informed care reviews and primary studies regarding implemetation of trauma-informed care as a model of care, download Part B: Tables

The below is a quick reference summary of identified systematic reviews on trauma-specific interventions*.

*Important note: Health care professional training is required to provide these interventions. The studies included in the reviews were conducted in a range of healthcare settings, not exclusive to primary care, with interventions usually delivered by mental health professionals. This summary presents available systematic review evidence for various interventions, however GPMHSC does not specifically endorse one intervention over another.

Citation Evidence-base Population/condition Intervention/Comparison Reported outcomes
Overall trauma-focused interventions - adults


Jericho 202221 82 RCTs
Evidence up to Jan 2020b
PTSD in adults Interventions: Trauma-focused therapies, including EMDR, PE, CBT, NET, MCT, WET, VRET, BET, TARGET, SIT
Comparison: waitlist or other psychotherapies
Network estimates indicated superior efficacy of meta-CT and CPT over other psychotherapies
WET and NET were found to be the most tolerable and acceptable treatments
WET, IPT and EMDR appear in the superior half of therapies for both efficacy and acceptability
Weber 202122 22 RCTs
Evidence up to Nov 2019
PTSD in adults Interventions: psychological treatments for PTSD, including TF-CBT, EMDR, CBT
Comparisons: active or passive nonpharmacological controls or other psychological treatments
TF and non-TF interventions yielded large effect size for PTSD severity from pre-test to follow-up
  • Higher effect sizes were observed for civilian compared to military populations and for studies with larger proportions of female participants
Medium effect sizes were observed for depressive symptoms

PTSD and comorbid conditions

Grubaugh 202126 14 studies: 5 RCTs, 8 open trials, 1 within-group controlled trial
Evidence up to Mar 2020
PTSD and comorbid severe mental illness Intervention: PTSD psychotherapy, including CBT, PE, EMDR, brief treatment program Interventions reduced PTSD symptomatology from pre- to post-treatment, with slightly larger effects observed for PE, EMDR and BTP than CBT. Positive effects were also observed on general psychopathology and psychotic symptoms
Rozek 202128 33 studies – 23 PTSD-specific, 4 suicide-specific, 6 combined;
Evidence up to Jan 2021
PTSD co-occurring with suicidal thoughts and behaviours Interventions: PTSD-specific - CBT, PE, EMDR, PCT, NET, COPE; combined - DBT-PE, DBT-PTSD; suicide-specific - BCBT, PACT, DBT
Comparison: various, some studies did not include comparison or control groups
Interventions appeared to decrease both PTSD and suicide-related symptoms, with most research relating to PTSD treatments, particularly CPT and PE

PTSD related to specific populations/situations

Slade 202132 18 studies, including 5 studies on clinical effectiveness of interventions and 13 qualitative studies
Evidence up to Oct 2020
Post-traumatic stress following childbirth Interventions: psychological interventions, including EMDR, TF-CBT, debriefing and expressive writing All interventions showed some effectiveness reducing post-traumatic stress symptoms however the review authors note that further research is needed to determine true effects
Baas 202031 13 studies, including 3 RCTs. 6 of the studies were for TF-therapy
Evidence up to Jun 2019
PTSD during pregnancy Interventions: various, including TF-CBT, exposure therapy, EMDR EMDR reduced PTSD symptoms in short term and in follow-up (up to 36 months) (note all EMDR studies were case series)
TF-CBT also reduced PTSD symptoms

Complex trauma

Han 202137 32 studies – 19 RCTs
Evidence up to Jun 2019
Trauma in adults in primary care or community setting (not military, refugee or war-related trauma populations or incarcerated populations), most studies focused on child abuse, sexual assault, or domestic violence Interventions: Trauma-informed interventions, including EMDR, TF-CBT/CBT, mindfulness-based stress reduction program, TREM, general trauma-focused therapy, psychodynamic therapy, stress inoculation therapy, present-focused therapy, CPT Reports that evidence to support trauma informed interventions for psychological outcomes is inconsistent:
  • 15 studies found trauma-informed interventions led to improvements in 3 main psychological outcomes:
    • PTSD symptoms (11 of 23 studies)
    • depression (9 of 16)
    • anxiety (5 of 10)
Coventry 202038 116 studies (of which 24 were in community settings, 2 in primary care clinics); 94 RCTs
Evidence up to Apr 2017
Complex trauma – subgroups included post-combat deployment veterans, war-related, childhood sexual abuse, refugees, domestic violence Interventions: psychological and pharmacological interventions; trauma-focused psychological interventions included: TF-CBT and EMDR Trauma-focused psychological interventions reduced PTSD symptoms more than non-trauma-focused interventions across trauma subgroups, however effects among veterans and war-affected populations were not as strong
TF-CBT was consistently associated with the largest effects
TF-CBT and EMDR also reduced depressive and anxiety symptoms

Other mental health conditions

Dominguez 202140 11 RCTs
Evidence up to Oct 2019
Depression Interventions: TF therapy, predominately EMDR
Comparison: any other psychological and pharmacological treatments including standard care and waitlist
TF treatments (predominately EMDR) reduced depressive symptoms post-treatment, compared to control conditions
Martinez 202141 14 studies, including 8 RCTs
Evidence up to Oct 2019
Depressive or bipolar disorders in adults exposed to adverse stress early in life
Note no studies bipolar disorder patients were identified
Interventions: any intervention (psychological, pharmacological, psychosocial, or a combination) aimed at treating depressive or bipolar disorders in adults with early adverse stress
Comparison: various, no control group, no intervention, waitlist, other therapies
Psychological, pharmacological, and combined treatment interventions reduced depressive symptoms in the short- and mid-term
Sensitivity analyses suggest psychological or combined treatment interventions had greater effect sizes than pharmacological interventions (although no statistically significant differences)

BET: brief eclectic therapy; BPD: borderline personality disorder; BT: behavioural therapy; CBT: cognitive behavioural therapy; CPT: cognitive processing therapy; CT: cognitive therapy; EMDR: eye movement desensitization and reprocessing; ET: exposure therapy; IPT: interpersonal therapy; IPV: intimate partner violence; MCT: metacognitive therapy; NET: narrative exposure therapy; PCT: present centred therapy; PE: prolonged exposure; PMR: progressive muscle relaxation; PTSD: posttraumatic stress disorder; RCT: randomised controlled trial; SIT: stress inoculation training; SUD: substance use disorder; TARGET: trauma affect regulation: guide for education and therapy; TAU: treatment-as-usual; TF: trauma-focused; VRET: virtual reality exposure therapy; WET: written exposure therapy.

Download Rapid review on trauma-informed care in primary care settings