Intended for healthcare professionals


Post-traumatic stress disorder in the context of terrorism and other civil conflict in Northern Ireland: randomised controlled trial

BMJ 2007; 334 doi: (Published 31 May 2007) Cite this as: BMJ 2007;334:1147
  1. Michael Duffy, director, cognitive therapy course1,
  2. Kate Gillespie, consultant psychiatrist2,
  3. David M Clark, professor of psychology3
  1. 1University of Ulster at Magee, Londonderry, Northern Ireland BT48 7JL
  2. 2Northern Ireland Centre for Trauma and Transformation, Omagh, Northern Ireland
  3. 3King's College London
  1. Correspondence to: M Duffy m.duffy1{at}
  • Accepted 22 March 2007


Objective To evaluate the effectiveness of cognitive therapy for post-traumatic stress disorder related to terrorism and other civil conflict in Northern Ireland.

Design Randomised controlled trial.

Setting Community treatment centre, Northern Ireland.

Participants 58 consecutive patients with chronic post-traumatic stress disorder (median 5.2 years, range 3 months to 32 years) mostly resulting from multiple traumas linked to terrorism and other civil conflict.

Interventions Immediate cognitive therapy compared with a waiting list control condition for 12 weeks followed by treatment. Treatment comprised a mean of 5.9 sessions during 12 weeks and 2.0 sessions thereafter.

Main outcome measures Primary outcome measures were patients' scores for post-traumatic stress disorder (post-traumatic stress diagnostic scale) and depression (Beck depression inventory). The secondary outcome measure was scores for occupational and social functioning (work related disability, social disability, and family related disability) on the Sheehan disability scale.

Results At 12 weeks after randomisation, immediate cognitive therapy was associated with significantly greater improvement than the waiting list control group in the symptoms of post-traumatic stress disorder (mean difference 9.6, 95% confidence interval 3.6 to 15.6), depression (mean difference 10.1, 4.8 to 15.3), and self reported occupational and social functioning (mean difference 1.3, 0.3 to 2.5). Effect sizes from before to after treatment were large: post-traumatic stress disorder 1.25, depression 1.05, and occupational and social functioning 1.17. No change was observed in the control group.

Conclusion Cognitive therapy is an effective treatment for post-traumatic stress disorder related to terrorism and other civil conflict.

Trial registration Current Controlled Trials ISRCTN16228473.


  • The therapists were Sean Collins, MD, KG, Susan McGandy, and John McLaren. Tracy McCrossan assisted with data collection. DMC is supported by the Wellcome Trust. We thank David Bolton, director of the Northern Ireland Centre for Trauma and Transformation, for supporting the research.

  • Contributors: All authors contributed to the design, execution, analysis, and writing up of the trial. MD is guarantor.

  • Funding: Northern Ireland Victims Liaison Unit.

  • Competing interests: None declared.

  • Ethical approval: This study was approved by the ethics committee of Queen's University of Belfast School of Medicine.

  • Accepted 22 March 2007
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