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Cognitive therapy for post-traumatic stress disorder: development and evaluation.

Anke Ehlers1, David M Clark, Ann Hackmann

  • 1Department of Psychology PO77, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. a.ehlers@iop.kcl.ac.uk

Behaviour Research and Therapy
|February 11, 2005
PubMed
Summary

Cognitive therapy (CT) significantly reduces post-traumatic stress disorder (PTSD) symptoms, depression, and anxiety. These improvements in PTSD patients are maintained long-term and linked to changes in post-traumatic cognitions.

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Area of Science:

  • Psychology
  • Psychiatry
  • Clinical Psychology

Background:

  • Post-traumatic stress disorder (PTSD) is a debilitating condition.
  • Cognitive models offer a framework for understanding PTSD.
  • Effective therapeutic interventions are needed for PTSD.

Purpose of the Study:

  • To develop and evaluate a cognitive therapy (CT) program for PTSD based on a cognitive model.
  • To assess the efficacy and acceptability of CT for PTSD.

Main Methods:

  • A consecutive case series of 20 PTSD patients treated with CT.
  • A subsequent randomized controlled trial comparing CT (N=14) with a 3-month waitlist (WL, N=14).
  • Assessment of PTSD symptoms, depression, anxiety, and disability pre- and post-treatment, with 6-month follow-up.

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Main Results:

  • CT led to highly significant improvements in PTSD, depression, and anxiety symptoms in both studies.
  • The waitlist group showed no improvement.
  • Treatment gains were maintained at 6-month follow-up, with large effect sizes (2.07-2.82).
  • Good treatment outcome correlated with changes in dysfunctional post-traumatic cognitions.

Conclusions:

  • Cognitive therapy is an effective, acceptable, and well-maintained treatment for PTSD.
  • Changes in post-traumatic cognitions are key to successful CT outcomes.
  • Patient characteristics like comorbidity or trauma history did not predict response, but lower socioeconomic status was linked to better outcomes.