Trauma-focused cognitive-behavioral therapy for long-term posttraumatic stress disorder, major depressive disorder and anxiety disorders in victims of terrorism: a randomized clinical trial

Abstract

A parallel randomized clinical trial evaluated the efficacy of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) for victims of terrorist attacks with long-term psychopathology. Method: 120 adult Spanish victims, who met the criteria for current posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and/or anxiety disorders related to exposure to terrorist attacks that occurred 18 years ago, on average, were randomly assigned to 16 weekly sessions of TF-CBT (n = 60) or waiting list control conditions (n = 60). Results: Participants who completed TF-CBT (n = 25) experienced significant pre-post decreases in diagnostic rates and in posttraumatic stress, depression, and anxiety symptoms. Pre/post effect sizes for the TF-CBT-treated participants were large (gPCL-S = 1.25; gBDI-II = 1.03; gBAI = 1.16), and between-groups effect sizes were medium-large (gPCL-S = 0.94, gBDI-II = 0.72, gBAI = 0.95). Most TF-CBT completers (78.3% to 91.7%) achieved sub-syndromal symptom levels by post-treatment. The benefits persisted to the 6-month follow-up (n = 22). Modified intention-to-treat analyses (n = 35 vs. n = 50) confirmed the significance of the findings for PTSD and were significant but less robust for MDD and anxiety disorders. Conclusion: TF-CBT appears to be efficacious when applied to victims of terrorism with long-term psychopathology.