Effectiveness in routine care: trauma-focused treatment for PTSD

Objective: The efficacy of trauma-focused cognitive behaviour therapy (tf-CBT) has been well established in randomized controlled trials (RCTs). More research is needed to demonstrate the effectiveness of tf-CBT in routine clinical care settings.Method: Eighty-five patients (68 female) with a primary diagnosis of PTSD received tf-CBT at two German outpatient centres (M & uuml;nster and Mannheim) between 2014 and 2016. Treatment was delivered mainly by therapists in training and treatment duration was based on symptom course. The treatment consisted of a preparation phase, a trauma-focused phase (comprising imaginal exposure, discrimination training, changing dysfunctional appraisals) and a phase of reclaiming-your-life assignments, and relapse prevention. In an intent-to-treat-analysis (ITT), linear mixed effects models were fitted for self-assessments of traumatic symptom severity using the PTSD Checklist for DSM-5 (PCL-5) and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Potential moderators for treatment outcome, e.g. number of suicide attempts, were investigated.Results: The observed treatment effect was large for both the CAPS-5 (ITT: Cohen's d = 2.07, CI [1.62, 2.51]; completers d = 2.34, CI [1.84, 2.83]) and PCL-5 respectively (ITT: d = 2.02, CI [1.56, 2.48]; completers d = 2.15, CI [1.66, 2.64]), and remained stable six months and one-year post-treatment. N = 27 patients (31.48%) were defined as study dropout and of these, n = 12 (14.12%) dropped out of the study but completed treatment. None of the fixed-effect estimates for treatment predictors interacted significantly with the effect of time.Conclusions: Tf-CBT is well-tolerated and it can be effectively delivered in routine clinical care. Its large treatment effects underline the practicability and benefits of the approach. This trial demonstrates its broad applicability among individuals with diverse patterns of clinical characteristics and comorbidities. Objetivo: La eficacia de la terapia cognitivo-conductual centrada en el trauma (tf-CBT, por sus siglas en ingl & eacute;s) ha sido bien establecida en ensayos controlados aleatorizados (RCT). Se necesita m & aacute;s investigaci & oacute;n para demostrar la efectividad de la tf-CBT en entornos de atenci & oacute;n cl & iacute;nica rutinaria.M & eacute;todo: Ochenta y cinco pacientes (68 mujeres) con un diagn & oacute;stico primario de TEPT recibieron tf-CBT en dos centros ambulatorios alemanes (M & uuml;nster y Mannheim) entre el 2014 y el 2016. El tratamiento fue realizado principalmente por terapeutas en formaci & oacute;n y la duraci & oacute;n del tratamiento se bas & oacute; en el curso de los s & iacute;ntomas. El tratamiento consisti & oacute; en una fase de preparaci & oacute;n, una fase centrada en el trauma (que inclu & iacute;a exposici & oacute;n imaginada, entrenamiento por discriminaci & oacute;n, cambio de evaluaciones disfuncionales) y una fase de tareas de recuperaci & oacute;n de la vida y prevenci & oacute;n de reca & iacute;das. En un an & aacute;lisis por intenci & oacute;n-de-tratar (ITT), se ajustaron modelos de efectos mixtos lineales para las autoevaluaciones de la severidad de los s & iacute;ntomas traum & aacute;ticos utilizando la Lista de Chequeo del DSM-5 para TEPT (PCL-5) y la Escala TEPT Administrada-por-Clinicos (CAPS-5). Se investigaron los posibles moderadores del resultado del tratamiento, por ejemplo, el n & uacute;mero de intentos de suicidio.Resultados: Hubo un gran efecto observado del tratamiento tanto para el CAPS-5 (ITT: d de Cohen = 2.07, IC [1.62, 2.51]; pacientes completos d = 2.34, IC [1.84, 2.83]) como para el PCL-5 (ITT: d = 2.02, IC [1.56, 2.48]; pacientes completos d = 2.15, IC [1.66, 2.64]), y se mantuvo estable a los seis meses y un a & ntilde;o despu & eacute;s del tratamiento. Un total de 27 pacientes (31.48%) fueron definidos como abandonadores del estudio, de los cuales 12 (14.12%) abandonaron el estudio pero completaron el tratamiento. Ninguna de las estimaciones de efectos fijos para los predictores del tratamiento interactu & oacute; significativamente con el efecto del tiempo.Conclusiones: La tf-CBT es bien tolerada y puede ser aplicada efectivamente en la atenci & oacute;n cl & iacute;nica rutinaria. Sus grandes efectos terap & eacute;uticos destacan la viabilidad y los beneficios de este enfoque. Este ensayo demuestra su amplia aplicabilidad entre individuos con diversos patrones de caracter & iacute;sticas cl & iacute;nicas y comorbilidades.