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Aim To assess the effectiveness of the long-term group psychotherapy in the treatment of posttraumatic stress disorder (PTSD) in war veterans on the basis of clinical picture of PTSD, associated neurotic symptoms, and adopted models of psychological defense mechanisms. Methods Prospective cohort study involved 59 war veterans who participated in dynamic-oriented supportive group psychotherapy for five years. The groups met once a week for 90 minutes. Forty-two veterans finished the program. The Clinician-Administered PTSD Scale structured interview was used to assess the intensity of PTSD. Crown-Crisp Index was used to evaluate other neurotic symptoms, and Life Style Questionnaire was used to assess the defense mechanisms. The assessments were done at the beginning of psychotherapy, after the second, and after the fifth year of treatment. Comorbid diagnoses, hospitalizations, and outpatient clinic treatments were also recorded. Results Long-term group psychotherapy reduced the intensity of PTSD symptoms in our patients (the difference between Clinician-Administered PTSD Scale score at the beginning and the end of treatment, F = 9.103, P = 0.001). Other neurotic symptoms and the characteristic profile of defense mechanisms did not change significantly during the course of treatment. Predominant defense mechanisms were projection (M = 82.0 ± 14.4) and displacement (M = 69.0 ± 16.8). None of the symptoms or defense mechanisms present at the beginning of the treatment changed significantly after two or five years of treatment. The number of diagnosed major depressive episodes, which increased after the second year of psychotherapy, decreased by the end of treatment. Conclusion Psychotherapy can reduce the intensity of PTSD symptoms, but the changes in the personality of veterans with PTSD are deeply rooted. Traumatic experiences lead to the formation of rigid defense mechanisms, which cannot be significantly changed by long-term group psychotherapy. [ABSTRACT FROM AUTHOR]