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Randomized Trial of Trauma-Focused Group Therapy for Posttraumatic Stress Disorder
Results From a Department of Veterans Affairs Cooperative Study
Paula P. Schnurr, PhD;
Matthew J. Friedman, MD, PhD;
David W. Foy, PhD;
M. Tracie Shea, PhD;
Frank Y. Hsieh, PhD;
Philip W. Lavori, PhD;
Shirley M. Glynn, PhD;
Melissa Wattenberg, PhD;
Nancy C. Bernardy, PhD
Arch Gen Psychiatry. 2003;60:481-489.
Background Department of Veterans Affairs Cooperative Study 420 is a randomized clinical trial of 2 methods of group psychotherapy for treating posttraumatic stress disorder (PTSD) in male Vietnam veterans.
Methods Vietnam veterans (360 men) were randomly 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 assessments 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 assessments. Additional follow-up for PTSD severity was performed in a subset of participants at 18 and 24 months.
Results Although posttreatment assessments 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 clinically 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 settings.
From the Department of Veterans Affairs (VA) National Center for Posttraumatic Stres Disorder, White River Junction, Vt (Drs Schnurr, Friedman, and Bernardy); Departments of Psychiatry (Drs Schnurr, Friedman, and Bernardy) and Pharmacology (Dr Friedman), Dartmouth Medical School, Hanover, NH; Department of Psychology, Pepperdine University, Culver City, Calif (Dr Foy); Mental Health and Behavioral Sciences Service, Providence VA Medical Center, Providence, RI (Dr Shea); Department of Psychiatry, Brown University, Providence (Dr Shea); VA Cooperative Studies Program, Menlo Park, Calif (Drs Hsieh and Lavori); Department of Health Research and Policy, Stanford University, Palo Alto, Calif (Dr Lavori); Research Service, West Los Angeles VA Medical Center, Los Angeles, Calif (Dr Glynn); Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles (Dr Glynn); VA Outpatient Clinic, Boston, Mass (Dr Wattenberg); and Department of Psychiatry, Tufts University School of Medicine, Boston (Dr Wattenberg).
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