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Unread February 19th, 2009, 03:33 PM
James Pretzer James Pretzer is offline
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Default Individual vs Group CBT for PTSD

Between PTSD due to combat, PTSD due to natural disasters and terrorist attacks, PTSD due to crime and child abuse, and PTSD due to "ordinary" traumas such as serious motor vehicle accidents, it has been estimated that 5-10% of the population will have PTSD at some point in their lifetime. Obviously, it is important to find practical ways to provide effective treatment.

Several related approaches to CBT for PTSD in individual therapy have been developed and tested empirically. While the details vary among protocols, CBT for PTSD typically involves 1) education about PTSD and about using prolonged exposure to reduce anxiety, 2) training in skills for coping with anxiety (such as relaxation training and/or mindfulness), 3) prolonged exposure to anxiety-provoking cues (including both external stimuli and internal stimuli such as memories and physical sensations), 4) education about the impact of cognitions on mood and behavior combined with cognitive interventions targeting dysfunctional thoughts, attributions, and beliefs, 5) interventions designed to address estrangement, social isolation, and anger, and 6) relapse prevention.

Individual CBT for PTSD has done quite well when tested empirically. For example, when individuals who have PTSD following a serious motor vehicle accident receive 10-15 sessions of CBT for PTSD, 75-80% of them no longer meet DSM criteria for PTSD following treatment. This compares favorably with the effects of supportive therapy (about 50% still meet criteria for PTSD), bibliotherapy (about 75% still meet criteria), and waiting-list or assessment-only control groups (about 75% still meet criteria).

This sounds good, but there are a limited number of therapists trained in CBT for PTSD and individual therapy isn't cheap. Group CBT for PTSD could reach more individuals with PTSD and be less expensive. It also could have advantages since group treatment can provide social support, can motivate participants to follow through on treatment, and can allow participants to learn from others' experiences.

Unfortunately, simply taking individual protocols and using them in a group setting doesn't work well. PTSD groups can be emotionally volatile, exposure to other group members' traumatic experiences can be problematic, etc. In one study where an individual CBT protocol for PTSD was tested in a group setting, it was less effective (38% no longer meeting criteria for PTSD).

Work is under way to provide CBT for PTSD effectively in groups and initial results are promising. A recent study tested a group CBT treatment for PTSD which had been modified by having two therapist co-lead the group sessions, by adding interventions designed to increase group cohesion, by re-thinking the sequencing of interventions, by adapting exposure-based interventions to minimize exposure to other group members' traumatic experiences, and by explicitly addressing anxiety due to group participation. Treatment consisted of 14 two-hour sessions and included psychoeducation, exposure (in-vivo, imaginal, and written) through homework assignments, mindfulness meditation, progressive relaxation training, cognitive interventions, assertion training, behavioral activation, and relapse prevention.

The outcome of an initial outcome study was quite good. 88% no longer met criteria for PTSD at the end of treatment and 93% no longer met criteria at a 3 month follow-up. 69% of participants in a minimal-contact control group still met criteria for PTSD. It did appear that group treatment had less impact on co-morbid depression and anxiety than individual CBT for PTSD. It appears that this is because it is easier to tailor individual treatment to the needs of the individual.
  • Beck, J. G., et al. (2009).Group cognitive behavior therapy for chronic posttraumatic stress disorder: An individual randomized pilot study. Behavior Therapy, 40, 82-92.
  • Beck, J. G. & Coffee, S. F. (2005). Group cognitive behavioral treatment for PTSD: Treatment of motor vehicle accident survivors. Cognitive and Behavioral Practice, 12, 267-277.
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