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J Anxiety Disord. 2019 Apr;63:26-35. doi: 10.1016/j.janxdis.2019.01.008. Epub 2019 Jan 29.

An initial review of residual symptoms after empirically supported trauma-focused cognitive behavioral psychological treatment.

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Clement J. Zablocki, Milwaukee VAMC, Milwaukee, WI, USA; Department of Psychiatry, Medical College of Wisconsin, 1155 North Mayfair Road, Milwaukee, WI, 53226, USA. Electronic address:
Pfeiffer University, Department of Social Sciences, 48380 US-52, Misenheimer, NC, 28109, USA.
University of Illinois at Urbana Champaign, Department of Kinesiology and Community Health, 1206 South Fourth Street MC-588, Champaign, IL, 61874, USA.
Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, c/o OSI Clinic, Deer Lodge Centre, 2109 Portwidage Ave, Winnipeg, MB, RCJ 0L3, Canada.
University of Kentucky College of Social Work, 669 Patterson Office Tower, Lexington, KY, 40506, USA.
Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A, 3600 Forbes Ave, Pittsburgh, PA, 15261, USA.



Although residual symptoms remain following clinical treatment for posttraumatic stress disorder (PTSD), little is known about the characteristics of these residual symptoms. We aimed to determine the type, severity, and frequency of symptoms that remain after trauma-focused psychotherapy.


We conducted a systematic review of 51 randomized controlled trials of empirically supported psychosocial interventions for PTSD (68 total treatment arms). Outcomes included: 1) PTSD symptoms and 2) conditions commonly comorbid with PTSD: depression, anxiety, and quality of life impairment.


In general, the results revealed that participants who completed PTSD treatment continued to report residual PTSD symptoms: 31% reported clinical symptom levels, and 59% reported subthreshold levels at posttreatment, particularly within the hyperarousal cluster. Residual symptoms also emerged for depression (19% clinical), anxiety (55% clinical), and quality of life (36% clinical). Few differences emerged across treatment types, but differential patterns were revealed for sample/trauma types.


Results suggest a need for focused research attention to and clinical assessment of individual residual symptoms following empirically supported treatment for PTSD to determine whether further treatment sessions are warranted.


Cognitive behavioral therapy; PTSD; Posttraumatic stress disorder; Refractory symptoms; Residual symptoms

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