veteran populations. Ideally there would be evidence regarding the comparative effectiveness of a given therapy in individual and group formats, with some indication of the population or subpopulation characteristics that would make one or the other more effective. However, only four studies examining group formats, and all using CBT approaches31 met the committee’s inclusion criteria, combining various components of exposure, restructuring, and coping skills training. They are discussed below.

In general, studies of exposure (including studies of exposure plus cognitive restructuring and exposure plus coping skills training) administered the treatment in individual, rather than group sessions. Exceptions include Schnurr et al. (2003), Falsetti et al. (2001), and Chard et al. (2005), which are discussed in more detail below. The committee also identified a fourth study that employed a group therapy comparing affect management (a type of coping skills training) used as an adjunct to ongoing psychotherapy and pharmacotherapy to wait list (Zlotnick et al., 1997). This study found a benefit to group therapy, but had dropout rates of 25 and 29 percent handled only with completers analysis. The authors further acknowledge that the lack of standardization in concurrent treatment (including drugs administered) limited the validity of the study.

Schnurr el al. (2003), Falsetti et al. (2001), and Chard et al. (2005) showed mixed effect of various types of group therapy on PTSD symptoms. The large and well-conducted Schnurr et al., 2003, study in veterans compared group trauma-focused to group present-focused therapy. Although post-treatment assessments of PTSD severity significantly improved from baseline, there were no differences between treatment groups for any outcome. The Falsetti et al. (2001) study had a small sample size, was conducted in a population with mixed trauma, and showed an effect but was a preliminary analysis (study was not complete) and included a control-then-treatment group. The medium-size Chard et al. (2005) study did not have major limitations and found an effect, but it alternated individual and group therapy (9 weeks of both, 7 weeks of group therapy, and the final week of individual therapy) in its treatment arm, making it difficult to ascertain which component of the therapeutic approach was efficacious. In addition to the Schnurr et al. (2003) study in a veteran population, the committee made note of another large study (Creamer et al., 2006) in veterans that showed mixed effect on PTSD symptoms, but the Creamer study was a large case-series without a control (so was not included in the committee’s review). Schnurr et al. (2003) found no significant differences in outcome between the two types of group intervention (analysis of patients receiving

31

Foa et al. (2000) describe two other types of group therapy for which the committee did not find RCTs: group psychodynamic therapy and supportive group therapy.



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