***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT The prevalence of posttraumatic stress disorder ( PTSD ) is elevated among women who have served in the military , but no prior study has evaluated treatment for PTSD in this population . Prior research suggests that cognitive behavioral therapy is a particularly effective treatment for PTSD . OBJECTIVE To compare prolonged exposure , a type of cognitive behavioral therapy , with present-centered therapy , a supportive intervention , for the treatment of PTSD . DESIGN , SETTING , AND PARTICIPANTS A r and omized controlled trial of female veterans ( n=277 ) and active-duty personnel ( n=7 ) with PTSD recruited from 9 VA medical centers , 2 VA readjustment counseling centers , and 1 military hospital from August 2002 through October 2005 . INTERVENTION Participants were r and omly assigned to receive prolonged exposure ( n = 141 ) or present-centered therapy ( n = 143 ) , delivered according to st and ard protocol s in 10 weekly 90-minute sessions . MAIN OUTCOME MEASURES Posttraumatic stress disorder symptom severity was the primary outcome . Comorbid symptoms , functioning , and quality of life were secondary outcomes . Blinded assessors collected data before and after treatment and at 3- and 6-month follow-up . RESULTS Women who received prolonged exposure experienced greater reduction of PTSD symptoms relative to women who received present-centered therapy ( effect size , 0.27 ; P = .03 ) . The prolonged exposure group was more likely than the present-centered therapy group to no longer meet PTSD diagnostic criteria ( 41.0 % vs 27.8 % ; odds ratio , 1.80 ; 95 % confidence interval , 1.10 - 2.96 ; P = .01 ) and achieve total remission ( 15.2 % vs 6.9 % ; odds ratio , 2.43 ; 95 % confidence interval , 1.10 - 5.37 ; P = .01 ) . Effects were consistent over time in longitudinal analyses , although in cross-sectional analyses most differences occurred immediately after treatment . CONCLUSIONS Prolonged exposure is an effective treatment for PTSD in female veterans and active-duty military personnel . It is feasible to implement prolonged exposure across a range of clinical setting s. TRIAL REGISTRATION clinical trials.gov Identifier : NCT00032617 BACKGROUND Department of Veterans Affairs Cooperative Study 420 is a r and omized clinical trial of 2 methods of group psychotherapy for treating posttraumatic stress disorder ( PTSD ) in male Vietnam veterans . METHODS Vietnam veterans ( 360 men ) were r and omly assigned to receive trauma-focused group psychotherapy or a present-centered comparison treatment that avoided trauma focus . Treatment was provided weekly to groups of 6 members for 30 weeks , followed by 5 monthly booster sessions . Severity of PTSD was the primary outcome . Additional measures were other psychiatric symptoms , functional status , quality of life , physical health , and service utilization . Follow-up assessment s were conducted at the end of treatment ( 7 months ) and at the end of the booster sessions ( 12 months ) ; 325 individuals participated in 1 or both assessment s. Additional follow-up for PTSD severity was performed in a subset of participants at 18 and 24 months . RESULTS Although posttreatment assessment s of PTSD severity and other measures were significantly improved from baseline , intention-to-treat analyses found no overall differences between therapy groups on any outcome . Analyses of data from participants who received an adequate dose of treatment suggested that trauma-focused group therapy  reduced avoidance and numbing and , possibly , PTSD symptoms . Dropout from treatment was higher in trauma-focused group treatment . Average improvement was modest in both treatments , although approximately 40 % of participants showed clinical ly significant change . CONCLUSIONS This study did not find a treatment effect for trauma-focused group therapy . The difference between the effectiveness and adequate dose findings suggests the possible value of methods to enhance the delivery of cognitive-behavioral treatments in clinical practice setting Little is known about the usefulness of psychotherapeutic approaches for traumatized refugees who continue to live in dangerous conditions .  Narrative exposure therapy ( NET ) is a short-term approach based on cognitive-behavioral therapy and testimony therapy . The efficacy of narrative exposure therapy was evaluated in a r and omized controlled trial . Sudanese refugees living in a Ug and an refugee settlement ( N = 43 ) who were diagnosed as suffering from posttraumatic stress disorder ( PTSD ) either received 4 sessions of NET , 4 sessions of supportive counseling ( SC ) , or psychoeducation ( PE ) completed in 1 session . One year after treatment , only 29 % of the NET participants but 79 % of the SC group and 80 % of the PE group still fulfilled PTSD criteria . These results indicate that NET is a promising approach for the treatment of PTSD for refugees living in unsafe conditions CTT-BW includes trauma history exploration , PTSD psychoeducation , stress management , psychoeducation about dysfunctional self-talk and self-monitoring of self-talk , exposure to abuse reminders , Cognitive Therapy for Trauma-Related Guilt ( E. S. Kubany & F. P. Manke , 1995 ) , and modules on assertiveness , managing contacts with former partners , self-advocacy strategies , and avoiding revictimization . Thirty-seven ethnically diverse women were assigned to Immediate or Delayed CTT-BW .  PTSD remitted in 30 of 32 women who completed CTT-BW . Gains were maintained at 3-month follow-up . CTT-BW was efficacious across ethnic background s. Issues related to disseminability of CTT-BW are discussed CONTEXT Noninferiority and equivalence trials aim to show that the experimental treatment is not clinical ly worse than ( noninferior ) or clinical ly similar to ( equivalent ) a control active treatment . These study objectives imply particular planning and analysis . OBJECTIVE To assess the method ologic quality of reports of r and omized controlled trials of noninferiority and equivalence . DESIGN We search ed MEDLINE and the Cochrane Central Register of Controlled Trials for reports of r and omized controlled trials of noninferiority and equivalence hypotheses published between January 1 , 2003 , and December 31 , 2004 . MAIN OUTCOME MEASURES Data extracted by use of a st and ardized form involved assessment of choice of noninferiority or equivalence margins , sample size calculation , sets of patients analyzed , method of statistical testing and reporting results , and conclusions . RESULTS A total of 162 reports were included in the analysis ( 116 reports of noninferiority and 46 of equivalence ) . The margin defining noninferiority or equivalence was described in most reports ( 156 [ 96.3 % ] ) , with justification of the margin in only 33 ( 20.4 % ) . Almost one quarter of the reports ( 35 [ 21.6 % ] ) did not describe a sample size calculation , and an additional 11 ( 6.8 % ) did not take into account a prespecified noninferiority or equivalence margin . Less than half of the reports ( 69 [ 42.6 % ] ) described both an intent-to-treat ( ITT ; all r and omized patients are included in the analysis ) or modified ITT ( patients who never received treatment are excluded ) and per- protocol ( patients who did not complete the treatment are excluded ) analysis , and only about half of those ( 39 [ 56.5 % ] ) described both types of results . Results were displayed with confidence intervals in 136 reports ( 84.0 % ) . Only 33 articles ( 20.3 % ) fulfilled reporting requirements specific to noninferiority and equivalence trials , 4 of them ( 12.1 % ) with misleading conclusions . CONCLUSIONS Reporting of noninferiority and equivalence trials has important deficiencies : absence of noninferiority or equivalence margin , only an ITT ( or a per- protocol ) analysis performed , and results not adequately reported . Moreover , even for articles fulfilling these requirements , conclusions are sometimes misleading Previous studies have reported that adding cognitive restructuring ( CR ) to exposure therapy does not enhance treatment gains in posttraumatic stress disorder ( PTSD ) . This study investigated the extent to which CR would augment treatment response when provided with exposure therapy . The authors r and omly allocated 118 civilian trauma survivors with PTSD to receive 8 individually administered sessions of either ( a ) imaginal exposure ( IE ) , ( b ) in vivo exposure ( IVE ) , ( c ) IE combined with IVE ( IE/IVE ) , or ( d ) IE/IVE combined with CR ( IE/IVE/CR ) . There were fewer patients with PTSD in the IE/IVE/CR ( 31 % ) condition than the IE ( 75 % ) , IVE ( 69 % ) , and IE/IVE ( 63 % ) conditions at a 6-month follow-up assessment . The IE/IVE/CR condition result ed in larger effect sizes than each of the other conditions in terms of PTSD and depressive symptoms . These findings suggest that optimal treatment outcome may be achieved by combining CR with exposure therapy in treating PTSD patients The CONSORT ( Consoli date d St and ards of Reporting Trials ) Statement , including a checklist and a flow diagram , was developed to help authors improve their reporting of r and omized controlled trials . Its primary focus was on individually r and omized trials with 2 parallel groups that assess the possible superiority of one treatment compared with another but is now being extended to other trial design s. Noninferiority and equivalence trials have method ological features that differ from superiority trials and present particular difficulties in design , conduct , analysis , and interpretation . Although the rationale for such trials occurs frequently , those design ed and described specifically as noninferiority or equivalence trials appear less commonly in the medical literature . The quality of reporting of those that are published is often inadequate . In this article , we present an adapted CONSORT checklist  for reporting noninferiority and equivalence trials and provide illustrative examples and explanations for those items amended from the original CONSORT checklist . The intent is to improve reporting of noninferiority and equivalence trials , enabling readers to assess the validity of their results and conclusions BACKGROUND Psychological debriefing is widely used for trauma victims but there is uncertainty about its efficacy . We have previously reported a r and omised controlled trial which concluded that at 4 months it was ineffective . AIMS To evaluate the 3-year outcome in a r and omised controlled trial of debriefing for consecutive subjects admitted to hospital following a road traffic accident . METHOD Patients were assessed in hospital by the Impact of Event Scale ( IES ) , Brief Symptom Inventory ( BSI ) and question naire and re-assessed at 3 months and 3 years . The intervention was psychological debriefing as recommended and described in the literature . RESULTS The intervention group had a significantly worse outcome at 3 years in terms of general psychiatric symptoms ( BSI ) , travel anxiety when being a passenger , pain , physical problems , overall level of functioning , and financial problems . Patients who initially had high intrusion and avoidance symptoms ( IES ) remained symptomatic if they had received the intervention , but recovered if they did not receive the intervention . CONCLUSIONS Psychological debriefing is ineffective and has adverse long-term effects . It is not an appropriate treatment for trauma victims The paper describes the development of a cognitive therapy ( CT ) program for  post-traumatic stress disorder ( PTSD )  that is based on a recent cognitive model ( Behav . Res . Therapy 38 ( 2000 ) 319 ) . In a consecutive case series , 20 PTSD patients treated with CT showed highly significant improvement in symptoms of PTSD , depression and anxiety .  A subsequent r and omized controlled trial compared CT ( N = 14 ) and a 3-month waitlist condition ( WL , N = 14 ) . CT led to large reductions in PTSD symptoms , disability , depression and anxiety , whereas the waitlist group did not improve . In both studies , treatment gains were well maintained at 6-month follow-up . CT was highly acceptable , with an overall dropout rate of only 3 % . The intent-to-treat effect sizes for the degree of change in PTSD symptoms from pre to post-treatment were 2.70 - 2.82 ( self-report ) , and 2.07 ( assessor-rated ) . The controlled effect sizes for CT versus WL post-treatment scores were 2.25 ( self-report ) and 2.18 ( assessor-rated ) . As predicted by the cognitive model , good treatment outcome was related to greater changes in dysfunctional post-traumatic cognitions . Patient characteristics such as comorbidity , type of trauma , history of previous trauma , or time since the traumatic event did not predict treatment response , however , low educational attainment and low socioeconomic status were related to better outcome Ninety-six female assault victims with chronic posttraumatic stress disorder ( PTSD ) were r and omly assigned to 4 treatment conditions : prolonged exposure ( PE ) , stress inoculation training ( SIT ) , combined treatment ( PE-SIT ) , or wait-list control ( WL ) . Treatment consisted of 9 twice-weekly , individual sessions . Independent evaluations were conducted at pretreatment ; posttreatment ; and 3- , 6- , and 12-month follow-ups . All 3 active treatments reduced severity of PTSD and depression compared with WL but did not differ significantly from each other , and these gains were maintained throughout the follow-up period . However , in the intent-to-treat sample , PE was superior to SIT and PE- 
    Output:
    
A recent meta- analysis by Benish , Imel , and Wampold ( 2008 , Clinical Psychology Review , 28 , 746 - 758 ) concluded that all bona fide treatments are equally effective in posttraumatic stress disorder ( PTSD ) .