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.
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 [controlled-trials.com].