Randomized trial of trauma-focused group therapy for posttraumatic stress disorder: results from a department of veterans affairs cooperative study.
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.
Department of Veterans Affairs (VA) National Center for Posttraumatic Stres Disorder, White River Junction, VT 05009, USA. paula.schnurr@dartmouth.edu
Paula P
PP
Schnurr
Matthew J
MJ
Friedman
David W
DW
Foy
M Tracie
MT
Shea
Frank Y
FY
Hsieh
Philip W
PW
Lavori
Shirley M
SM
Glynn
Melissa
M
Wattenberg
Nancy C
NC
Bernardy
D000553:Ambulatory Care; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007171:Implosive Therapy / Q000379:methods; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D010352:Patient Dropouts; D018579:Patient Selection; D011615:Psychotherapy, Group / Q000379:methods*; D012107:Research Design; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology; D014743:Videotape Recording