The proposed research responds to NIMH PA-93-093, Exploratory/Developmental Grants for Psychosocial Treatment Research. This revised Phase I proposal is aimed at utilizing a manual for time-limited trauma-focused dynamically oriented group psychotherapy of Post Traumatic Stress Disorder [PTSD], and developing and implementing the training, adherence, and competence methodology necessary to standardize and test this treatment approach in preparation for a future randomized controlled trial. This research with Vietnam combat veterans comprises the first in a series of steps whose ultimate aim is to test the efficacy of this method of treatment for a variety of groups of both genders who have been exposed to traumatic stress in civilian or military contexts. If found effective, the standardized treatment manual and model can then be applied, with appropriate modifications generated in consultation with recognized outside experts regarding the type of trauma, to other non- veteran traumatized groups suffering from PTSD. These include women who have been sexually assaulted, emergency services personnel, men and women who have been the targets of violent crime, or those who have been exposed to a natural disaster, such as hurricane Hugo, the Loma Prieta earthquake, or the Georgia floods. We propose to accomplish the following in this project: 1.1 Conduct three 30-week 1.5 hour per week trauma-focused psychotherapy groups each with 6-8 male Vietnam veterans diagnosed with current combat- related PTSD; 1.2 Finalize and implement a training procedure to teach experienced therapists how to conduct the treatment according to the manual; 1.3 Develop a measure of therapy adherence appropriate for our group psychotherapy manual and conduct studies of its reliability and validity; 1.4 Develop a measure to assess therapists' competence in providing the group treatment and conduct studies of its reliability and validity as a measure of quality of treatment; 1.5 Conduct a preliminary assessment of the efficacy of our manualized treatment by conducting periodic assessments during the treatment and following our patients for an additional 6 months after the termination of the group; 1.6 Gather data on two measures of group process and relate these process variables to each other, to the measures of therapy adherence and competence, and to outcome.
