This article describes the design and methods of the study. American Psychiatric Association; To participate in the study, therapists had to be masters- or doctoral-level clinicians with prior experience in treating PTSD in a group format. Prior to being accepted into the last phase of screening, potential participants who reported any indication of cardiovascular problems were referred to a cardiologist to determine whether the problems would make it dangerous for the participant to tolerate the physiological arousal that can occur during the exposure component of TFGT. People who have PTSD are often troubled by memories of past traumatic events, nervousness, depression, and feeling distant from others. Clinical validation of the Quality of Life Inventory: Instead, to ensure that therapist effects were balanced across treatments, we randomized therapists to the single treat- ment each was to deliver.

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How- ever, the size of CSP made these issues particularly challenging. With a large sample, the inclusion of even one questionnaire measured at pretreat- ment, posttreatment, and follow-up can create many total hours of work for study personnel and participants alike.

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Statistical Analysis with Missing Data. We initiated case management at this time to respond to their clinical needs, with the hope of preventing dropout before participants entered active treatment.

Dealing with war traumas constituted a major focus of treatment for only Four domains were assessed: Many VA officfcenter exhibit a high level of symptoms and functional difficulties even after treatment [7]. These data showed that veterans received an average of Although we were not able to use videoconferencing for meetings and supervision, investigators should consider this for future studies.


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Past, present, and future practices. Clin Psychol Psychother ;3: Health status, somatization, and severity of posttraumatic stress disorder in Vietnam combat veterans with posttraumatic stress disorder. Data collection was completed in June Failing to include additional participants to compensate for this inflation could have substantial effects on type II error. There were minor logistic challenges as well, such as finding a time when all group members could attend a session when individuals would not know their group assignment until after randomization.

Assuming that this correlation is 0. By addressing individual participant needs as they arise, case management can allow the work of group treatments to remain consistent and focused.

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The pivotal comparison was at the end of treatment. American Psychiatric Press; In addition to the logistic and methodological challenges of any multisite study, psychotherapy research presents complex issues that are not encountered in medication trials.

However, we rejected this approach because of a concern that having therapists deliver both treatments would make it hard for them to keep the treatments distinct in application. A measure of life satisfaction for use in treatment planning and outcome assessment.

In addition to these methodological implications, the substantive findings of CSP will provide information relevant to the treatment of chronic PTSD, as well as a unique, group-based model of exposure therapy [10].

Even though patients are randomized individually, the analysis still must take the cluster effect into account because of the correlation of outcomes within groups. The pivotal comparison was immediately following the end of treatment 7 months because this was the time when improvements were expected to be most evident. Designing and implementing CSP raised a number of general issues concerning large-scale multisite psychotherapy research.


The Cooperative Studies Program relies officeenter fax-based transmission of data, making centralized data collection much faster and more efficient than it might be through other means. Exclusion criteria included current alcohol or drug dependence, unwilling- ness to refrain from substance abuse at treatment or work, current or lifetime DSM-IV psychotic disorder, current major depression with psychotic features, current or lifetime mania or bipolar disorder, significant cognitive impairment, or a cardiovascular disorder that was judged by a cardiologist to prevent participation in the exposure component of the TFGT.

A correct analysis of the data must take the cluster effect ,b account. It is our offjcecenter that sharing the details of CSP builds upon this remarkable contribution by providing information relevant to multisite trials of group interventions.

A cause for officecentre optimism. The current project manager is Nancy Bernardy, PhD. American Psychiatric Association; Fontana A, Rosenheck R. Global ratings of protocol adherence and therapist competence were made for all tapes in each condition by the senior therapist for that condition. In addition, two-thirds of participants were assessed at 18 months and one-third were assessed at 24 months following study entry.

Some fea- tures to note are: