Chronic PTSD Treated With Metacognitive Therapy: An Open Trial

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Abstract

This paper reports on an open trial of metacognitive therapy (MCT) for chronic PTSD. MCT does not require imaginal reliving, prolonged exposure, or challenging of thoughts about trauma. It is based on an information-processing model of factors that impede normal and in-built recovery processes. It is targeted at modifying maladaptive styles of worry/rumination and attention so that emotional processing can proceed spontaneously. Eleven out of 13 patients with a mean duration of PTSD of 19.5 months completed treatment. Therapists followed the treatment manual by Wells and Sembi (2004b). Self-report measures of PTSD symptoms, anxiety and depression, and assessor ratings of PTSD were administered at pre- and posttreatment, and at 3- and 6-month follow-up. Treatment appeared to result in large and significant improvements on all measures of PTSD and general measures of anxiety and depression. Statistically significant treatment gains were maintained at 3- and 6-month follow-up. Jacobson's criteria for recovery showed that 90% of patients were recovered at posttreatment. At 6-month follow-up approximately 89% were recovered or reliably improved. Results suggest that MCT could be highly effective and extend evidence of its applicability to more treatment-resistant chronic PTSD cases. Comparisons against other active interventions are now clearly indicated.

Section snippets

Participants

All patients were recruited from a clinical psychology waiting list of referrals made by doctors or psychiatrists. First, the waiting list was screened for patients referred for emotional problems following trauma. In order to identify potential chronic cases, only those patients for whom the trauma had occurred at least 3 months earlier were considered appropriate. Twenty-three patients were identified as potential chronic cases and were offered assessments, from which 19 attended for an

Results

Of the 13 patients initially entering treatment, 11 completed treatment and 2 dropped out (i.e., failed to attend two subsequent sessions), with no reason given. Among the 11 completers, a range of 3 to 15 sessions were delivered (mean: 8.5). Two of the completers were retraumatized during follow-up. These traumas consisted of being physically attacked by intruders at home, and being threatened with a weapon during a robbery. Another completer was retraumatized at the beginning of treatment

Discussion

The present open trial was intended as a preliminary investigation of whether MCT is associated with recovery or improvement in symptoms when applied in the treatment of chronic PTSD. Patients treated had experienced consistent symptoms for 6 to 39 months (mean: 19.5) before commencing treatment.

Posttreatment and follow-up scores on all self-report and assessor ratings showed statistically significant improvements in specific PTSD symptoms and in more general measures of anxiety and depression.

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