Difficulties in Conducting Long Term Follow Ups in Psychotherapy Research—Issues in the Literature and Data From a Randomized Therapy Comparison Study for Posttraumatic Stress Disorder

Abstract

Studies of psychotherapy for posttraumatic stress disorder (PTSD) typically encompass short follow-up periods, leading to a dearth of information on the long-term course of symptoms after treatment. We summarize existing long-term follow-up studies and highlight the issues making such research difficult. In this context, we report on a 2-year follow-up on a randomized treatment study comparing dialogical exposure therapy and cognitive processing therapy for adults with PTSD after type I trauma. Many of the problems connected to long-term follow-up also pertained to this study. Attrition was high, and the recruited sample was not representative of the study completers. Gains made during therapy were mostly stable, with no significant differences between interventions. At least for an originally successful subset of patients, the gains made during both treatments in our study tended to stay stable 2 years after the end of treatment.

Gestalt therapy: A contemporary view.

“…As early as 2006, Uwe Strumpfel published the first extensive review of Gestalt therapy studies and Willi Butollo' s classic trauma treatment research comparing dialogic exposure therapy (DET; a form of Gestalt therapy) with cognitive processing therapy with similar effect sizes. Interestingly, effect sizes and average scores tend to increase both in 6-month and 2-year follow-up for both treatments, and for all measures, but with slightly bigger changes in favor of DET, especially in measures for interpersonal stress and 2 years end of therapy (König et al, 2018).…”

Long-term follow-up of a multimodal day clinic, group-based treatment program for patients with very high risk for complex posttraumatic stress disorder, and for patients with non-complex trauma-related disorders

“…One study also reported significant long-term improvements in depression, PTSD and anxiety symptoms 2.5 years after a mindfulness-based stress reduction (MBSR) program for adult survivors of childhood sexual abuse (17), a therapy component that was also included in our multimodal treatment program (see Section "Treatment description"). But, some studies had important limitations concerning the sample [e.g., exclusion of patients after childhood sexual abuse in König et al (13)], which were overcome by the present examination.…”

“…There was no link to trauma type, population type (i.e., military vs. civilian) or intended duration of treatment, suggesting efficacy for a wide variety of patients. Other studies showed encouraging results for long-term efficacy for various groups of patients, outpatient treatment types and different follow-up intervals (e.g., EMDR, cognitive processing therapy, cognitive-behavioral therapy, written exposure therapy) (9)(10)(11)(12)(13)(14)(15)(16). One study also reported significant long-term improvements in depression, PTSD and anxiety symptoms 2.5 years after a mindfulness-based stress reduction (MBSR) program for adult survivors of childhood sexual abuse (17), a therapy component that was also included in our multimodal treatment program (see Section "Treatment description").…”