Attention on harmful effects of psychological interventions for adult post-traumatic stress disorder (PTSD) has increased, yet a comprehensive meta-analysis is lacking.

To summarise incidences and relative risks of deterioration, adverse events (AEs) and serious adverse events (SAEs) in trials of psychological interventions for adult PTSD.

We searched MEDLINE, PsycInfo, Web of Science and PTSDpubs from inception to 21 April 2022 for sufficiently large (n ≥ 20) randomised controlled trials (RCTs) reporting on the incidence of harms.

We included 56 RCTs (4230 patients). Incidences of harms were generally low (0–5%). Psychological interventions were associated with decreased risk of deterioration relative to passive (RR = 0.21, 95% CI 0.15–0.28) and active control conditions (RR = 0.36, 95% CI 0.14–0.92). Decreased risk was even more pronounced in sensitivity analyses on trials exclusively delivering treatments face to face. When compared with other psychological interventions, trauma-focused cognitive–behavioural therapy (TF-CBT) was associated with decreased risk of SAEs (RR = 0.54, 95% CI 0.31–0.95) and with no differential risk of deterioration and AEs.

The current evidence base suggests that psychological interventions are safe for most adults with PTSD. In none of the analyses were psychological interventions associated with an increased risk of harm compared with control conditions. TF-CBT was found at least as safe as other psychological interventions. Individual face-to-face delivery might be the safest delivery format. However, more data are needed to draw firmer conclusions. We encourage research teams to routinely and thoroughly assess and report the incidence of harms and their causes.

人们越来越关注心理干预对成人创伤后应激障碍（PTSD）的有害影响，但缺乏全面的荟萃分析。

总结成人 PTSD 心理干预试验中恶化、不良事件 (AE) 和严重不良事件 (SAE) 的发生率和相对风险。

我们检索了 MEDLINE、PsycInfo、Web of Science 和 PTSDpubs，从开始到 2022 年 4 月 21 日，寻找足够大（ n ≥ 20）报告伤害发生率的随机对照试验 (RCT)。

我们纳入了 56 项随机对照试验（4230 名患者）。伤害发生率普遍较低（0-5%）。相对于被动控制条件（RR = 0.21，95% CI 0.15-0.28）和主动控制条件（RR = 0.36，95% CI 0.14-0.92），心理干预与恶化风险降低相关。在专门进行面对面治疗的试验的敏感性分析中，风险降低更为明显。与其他心理干预措施相比，以创伤为中心的认知行为治疗 (TF-CBT) 与 SAE 风险降低相关（RR = 0.54，95% CI 0.31-0.95），并且恶化风险和 AE 没有差异。

目前的证据基础表明，心理干预对于大多数患有创伤后应激障碍的成年人来说是安全的。在所有分析中，与控制条件相比，心理干预均未与伤害风险增加相关。研究发现 TF-CBT 至少与其他心理干预措施一样安全。单独的面对面交付可能是最安全的交付方式。然而，需要更多数据才能得出更确切的结论。我们鼓励研究团队定期、彻底地评估和报告伤害的发生率及其原因。