Cognitive Therapy Can Help Survivors Of Terrorist Attacks
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.
At 12 weeks, patients after immediate therapy 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.
BMJ. 2007 May 11; [Epub ahead of print]Post-traumatic stress disorder in the context of terrorism and other civil conflict in Northern Ireland: randomised controlled trial.Duffy M, Gillespie K, Clark DM.
University of Ulster at Magee, Londonderry, Northern Ireland BT48 7JL.
OBJECTIVE: To evaluate the effectiveness of cognitive therapy for post-traumatic stress disorder related to terrorism and other civil conflict in Northern Ireland. DESIGN: Randomised controlled trial. SETTING: Community treatment centre, Northern Ireland. PARTICIPANTS: 58 consecutive patients with chronic post-traumatic stress disorder (median 5.2 years, range 3 months to 32 years) mostly resulting from multiple traumas linked to terrorism and other civil conflict. INTERVENTIONS: Immediate cognitive therapy compared with a waiting list control condition for 12 weeks followed by treatment. Treatment comprised a mean of 5.9 sessions during 12 weeks and 2.0 sessions thereafter. MAIN OUTCOME MEASURES: Primary outcome measures were patients’ scores for post-traumatic stress disorder (post-traumatic stress diagnostic scale) and depression (Beck depression inventory). The secondary outcome measure was scores for occupational and social functioning (work related disability, social disability, and family related disability) on the Sheehan disability scale. RESULTS: At 12 weeks after randomisation, immediate cognitive therapy was associated with significantly greater improvement than the waiting list control group in the symptoms of post-traumatic stress disorder (mean difference 9.6, 95% confidence interval 3.6 to 15.6), depression (mean difference 10.1, 4.8 to 15.3), and self reported occupational and social functioning (mean difference 1.3, 0.3 to 2.5). Effect sizes from before to after treatment were large: post-traumatic stress disorder 1.25, depression 1.05, and occupational and social functioning 1.17. No change was observed in the control group. CONCLUSION: Cognitive therapy is an effective treatment for post-traumatic stress disorder related to terrorism and other civil conflict.Trial registration Current Controlled Trials ISRCTN16228473.
PMID: 17495988 [PubMed – as supplied by publisher]