Abstract
ObjectiveTrauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area. MethodA consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects. ResultsCT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience. ConclusionsThe results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.
Highlights
Trauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice
This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area
Gillespie, and Clark (2007) further successfully disseminated this treatment to an unselected group of patients who had experienced traumas in connection with the civil conflict in Northern Ireland, the majority of whom had experienced multiple traumatic events. Whilst these initial studies evaluating the effectiveness of TFCBT for PTSD are promising, they are limited in number, and further studies of larger samples of unselected patients with PTSD following the wide range of traumatic events seen in clinical settings are needed to determine the effectiveness of trauma-focused cognitive behavioral treatments (TF-CBT) programs
Summary
Trauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. Duffy, Gillespie, and Clark (2007) further successfully disseminated this treatment to an unselected group of patients who had experienced traumas in connection with the civil conflict in Northern Ireland, the majority of whom had experienced multiple traumatic events Whilst these initial studies evaluating the effectiveness of TFCBT for PTSD are promising, they are limited in number, and further studies of larger samples of unselected patients with PTSD following the wide range of traumatic events seen in clinical settings are needed to determine the effectiveness of TF-CBT programs. In RCTs, Ehlers et al (2003, 2005, see Baldwin et al, 2011) and Kubany et al (2004) found no therapist effects, while Duffy et al (2007) reported significantly worse outcome for one therapist who was inexperienced in delivering the treatment protocol
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
