Cognitive behaviour therapy, treatment of choice for post-traumatic stress disorder

Cognitive therapy is an effective treatment for post-traumatic stress disorder related to acts of terrorism and other civil conflict, finds a study published on bmj.com.

Recent NICE guidelines recommend cognitive behaviour therapy as a treatment of choice (alone or in conjunction with drugs) for post-traumatic stress disorder. However, this recommendation is largely based on trials focusing on non-terrorism related traumatic events, such as road traffic crashes and rape. Little is known about how to best treat those traumatised by terrorist incidents.

So researchers at the Northern Ireland Centre for Trauma and Transformation undertook the first controlled trial aimed at assessing the effectiveness of cognitive therapy for people affected by terrorism and other civil conflict.

The trial involved 58 people with chronic post-traumatic stress disorder, mostly resulting from multiple traumas linked to terrorism and other civil conflict.

Patients were split into two groups, the first received immediate cognitive therapy while the other group were placed on a 12 week waiting list, followed by treatment.

Levels of post-traumatic stress disorder and depression were measured at the start of the trial and at the end of the treatment period. Work and social functioning was also assessed in both groups. Further assessments were carried out after one, four and 12 months.

At 12 weeks, patients in the immediate therapy group showed significant and substantial reductions in the symptoms of post-traumatic stress disorder and depression. In contrast, patients in the waiting list group showed no change.

The therapy group also had improved levels of work and social functioning. Thirty-eight per cent of those in the waiting list group deteriorated during the 12 week period compared to just seven per cent the therapy group. The treatment gains made were well maintained at the follow-up assessments.

The improvements made by those in the therapy group varied between individuals. The authors suggest this may be in part due to the complexity of the problems and in part due to the methods of the therapist. It is recommended that therapists involved in this sort of therapy are given sufficient training and ongoing supervision.

They conclude that cognitive therapy is effective in the treatment of post-traumatic stress disorder related to terrorism and other civil conflict.