Because time does not heal all wounds: Efficacy of trauma-focused cognitive behavioral therapy for very long-term posttraumatic stress in victims of terrorism

One hundred and twenty victims of terrorism who had suffered a terrorist attack an average of 18 years ago and who mainly had posttraumatic stress disorder (PTSD) or posttraumatic stress symptomatology were randomized to a 16-session trauma-focused cognitive-behavioral therapy (TF-CBT) or to a waiting-list control group. No victim who completed treatment had a PTSD diagnosis at posttreatment; these victims showed significantly lower levels of posttraumatic stress symptomatology at posttreatment than at pretreatment, with a large pre-posttreatment difference (d = 1.39), and 78.3% of them showed normal levels of symptomatology at posttreatment. These results were significantly better than those of the control group, with a large treatment-control difference (d = 0.91). TF-CBT is efficacious and is currently the treatment of choice for victims of terrorism who suffer from PTSD or posttraumatic stress symptomatology, even in the very long term, between 6 and 51 years after the terrorist attack