**3. Results**

In study 1, both NET and PCT were found to be safe and efficacious psychological treatments for older adults suffering from PTSD. Both interventions demonstrated low dropout rates. Markedly, none of the participants in either condition left treatment prematurely because of intolerable stress increase. During treatment, PCT showed a steeper decline than NET for CAPS-scores (all PTSD symptom clusters). In the NET-group, a more gradual symptom decline was observed. This divergence resulted in a significant superiority at post-treatment (Cohen's *d* = 0.44), which

#### *Treating Trauma-related Disorders in Later Life: Moving Forward DOI: http://dx.doi.org/10.5772/intechopen.102499*

was considered a medium effect [43]. At follow-up, however, the effects converged due to a partial symptom rebound in the PCT group and a persisting decline in the NET-group. The rebound in the PCT-group mainly involved the symptom clusters of re-experience and avoidance. **Figure 1** presents the outcomes for the PTSD total scale, centred around the post-treatment assessment timepoint.

The mean severity of PTSD symptoms in both groups decreased from severe at the mean timepoint pre-treatment to moderate at the mean follow-up. In addition to focusing on group means, an individual clinically significant change [34] was rated. On the individual level, 71% of NET completers achieved a clinically significant improvement, compared to 50% of the PCT completers.

In study 2, regarding self-rated PTSD, depression symptoms and perceived general distress, both groups (NET and PCT) showed equal, medium to large, within-group effects as well [25]. Whereas resilience (defined in terms of self-efficacy, quality of life, and personal growth) did not significantly improve in either group, it was not compromised, thereby confirming the treatment effects of both interventions.

In study 3, the question was addressed how the benefits of treatment by NET can be understood from a patients' perspective. Posttraumatic changes in thoughts and meanings are supposed to play an important role in recovering from PTSD [44, 45]. To explore cognitive processing during treatment, qualitative patient-reported outcomes were collected by analyzing autobiographic documents and interview responses. Would a cognitive and developmental framework clarify those outcomes? Would aging adults be able to change long-standing posttraumatic feelings and cognitions during treatment? In a sub-sample of NET-participants, the latter question could be answered with a convincing "Yes". The participants involved reported gradual, meaningful changes in self-awareness and self-esteem [24]. "*At the time of the violence in our family, I felt weak, helpless and guilty. Being a child, I was not able to defend my mother! Now I realize that I stood up for her when I was strong enough. Until this day, there is strength and endurance in me."* Initial self-blame, shame, social alienation and anger gradually gave way to the realization that somebody else had to be blamed, that shame was not appropriate, to new feelings of attachment and rightful anger. In a patient's own words: "*I am still here, the past didn't bring me to my knees".* And: "*With help of the document, I might tell more about myself to my children. Maybe we can have a better time together in the years ahead".* As for the developmental framework, negative cognitions were associated with

**Figure 1.** *RCT outcomes of CAPS-total [24].*

traumatic episodes, retaining a strong centrality in emotional life. New contexts and relationships, however, offered opportunities for more self-asserting cognitions alongside the self-defeating ones. "*Learning the craft of cabinet-making helped me finding my own strengths and reconnecting to people*."

Pulling together the strings from the presented studies, the short-term treatment effects of the PCT-group exceeded those in the NET-group. Nevertheless, this superiority was lost at follow-up. The within-group treatment effects in the NET-group were found to extend beyond PTSD, drawing depression symptoms and general distress into the scope of recovering from PTSD. Resilience, quantitatively measured, did not show significant responses for either group. In other words, compared with NET, the PCT-group showed significantly stronger short-term reductions in PTSD pathology (study 1), whereas this group did not show significantly improved resilience, neither comparatively, nor longitudinally (Study 2). The qualitative analysis, however, showed gradual cognitive and emotional changes on a personal level, reflecting the processing of adverse events and regaining self-esteem and initiative.
