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

<b>Objective:</b> 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. <b>Method:</b> 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 (<i>n</i> = 60) or waiting list control conditions (<i>n</i> = 60). <b>Results:</b> Participants who completed TF-CBT (<i>n</i> = 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 (<i>g_PCL-S</i> = 1.25; <i>g_BDI-II</i> = 1.03; <i>g_BAI</i> = 1.16), and between-groups effect sizes were medium-large (<i>g_PCL-S</i>= 0.94, <i>g_BDI-II</i> = 0.72, <i>g_BAI</i> = 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 (<i>n</i> = 22). Modified intention-to-treat analyses (<i>n</i> = 35 vs. <i>n</i> = 50) confirmed the significance of the findings for PTSD and were significant but less robust for MDD and anxiety disorders. <b>Conclusion:</b> TF-CBT appears to be efficacious when applied to victims of terrorism with long-term psychopathology.<b>Clinical or methodological significance of this article</b>TF-CBT was efficacious when applied to victims of terrorism with long-term PTSD. Results were significant but less robust for long-term MDD and anxiety disorders.