Early intervention for trauma: Where are we and where do we need to go? A commentary

VA Boston Healthcare System, National Center for PTSD, Massachusetts Veterans Epidemiological Research and Information Center, Boston, MA 02130, USA.
Journal of Traumatic Stress (Impact Factor: 2.72). 12/2008; 21(6):503-6. DOI: 10.1002/jts.20373
Source: PubMed


In this commentary, the author underscores the importance of early intervention for trauma and describes the challenges that lie ahead for researchers, decision makers, and care providers. The author also provides a review of where things stand, briefly reviews psychological first aid strategies, and underscores where we need to go from here. Although the field has advanced considerably in the last decade or so, and there are compelling trials underway, there is much work that needs to be done, especially in terms of effectiveness and the task of integrating early intervention into various work cultures, such as the military.

1 Follower
6 Reads
  • Source
    • "Perhaps the most notable in terms of assessing feasibility was that the positive effects of BA were found with junior therapists in their second or third year of clinical training with no previous BA experience. This is consistent with a previous study finding that BA is a relatively straightforward, easily disseminable approach that requires less specialized training than prolonged exposure (Litz, 2008), making it accessible to paraprofessionals (Ekers, Richards, McMillan, Bland, & Gilbody, 2011). This study has a number of limitations. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study investigated the feasibility of using behavioral activation to treat enduring postbereavement mental health difficulties using a two-arm, multiple baseline design comparing an immediate start group to a delayed start group at baseline, 12-, 24-, and 36-weeks postrandomization. Participants received 12-14 sessions of behavioral activation within a 12-week intervention period starting immediately after the first assessment or after 12weeks for the delayed start group. Prolonged grief, posttraumatic stress, and depression symptoms were assessed as outcomes. Compared with no treatment, behavioral activation was associated with large reductions in prolonged, complicated, or traumatic grief; posttraumatic stress disorder; and depression symptoms in the intent-to-treat analyses. Seventy percent of the completer sample at posttreatment and 75 percent at follow-up responded to treatment with 45 percent at posttreatment and 40 percent at follow-up being classified as evidencing high-end state functioning at 12-week follow-up.
    Behavior therapy 12/2013; 44(4):639-650. DOI:10.1016/j.beth.2013.04.009 · 2.85 Impact Factor
  • Source
    • "It is important to note that many meta-analyses have demonstrated that CISD does not prevent the development of PTSD and is not recommended for the treatment of PTSD (Department of Veterans Affairs and Department of Defense, 2010; Ursano et al., 2004); in fact, it has been reported that in some populations it is associated with worsened outcomes. Although CISD has been widely used in military settings, a less prescriptive yet flexible, accepting, and respectful approach that helps service members feel connected as well as validated is recommended so that care-seeking behaviors can be maximized in the weeks and months following traumatic stress (Litz, 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this investigation was to understand the varied health care provider responses to traumas by identifying perceptions of control and self-efficacy, appraisal styles, and postevent coping strategies in active duty military nurses and physicians deployed to combat/terrorist regions. Twenty purposively sampled military health care providers completed a descriptive questionnaire, the Posttraumatic Stress Disorder Checklist, the General Self-Efficacy Scale, and a recorded semistructured interview that was later transcribed and content analyzed. Cognitive-behavioral determinants of healthy response to trauma were used to frame this descriptive interpretive study and to assist with developing a model for healthy adaptation in trauma-exposed health care providers. Participants felt they had the greatest control over their health care provider role in theater, and most expressed a belief that a sense of control and a sense of purpose were important to their coping. All used some form of social support to cope and many found calming activities that allowed for self-reflection to be helpful. Results from this analysis can be used to inform interventions and promote postevent coping behaviors that increase social support, strengthen important bonds, and enhance involvement in activities that elicit positive emotions. Health care providers experienced positive outcomes despite considerable traumatic exposure by using coping strategies that map closely to several principles of psychological first aid. This suggests a need to train all medical personnel in these concepts as they appear helpful in mitigating responses to the stress of combat-related exposures. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Psychological Services 07/2013; 11(2). DOI:10.1037/a0033165 · 1.08 Impact Factor
  • Source
    • "Loss of a friend in combat is not uncommon in the current wars: An estimated 80% of soldiers and Marines surveyed in Iraq or Afghanistan in 2003 knew someone seriously injured or killed during their deployment (Hoge et al., 2004). Although most service members will be able to recover from such a loss, a significant minority may develop more problematic and persistent grief reactions (Papa, Neria, & Litz, 2008). A valuable framework for understanding such reactions has in recent years been advanced by the construct of " complicated grief, " " traumatic grief, " or " prolonged grief, " which highlights grief reactions that are pathological and beyond what is considered normal bereavement (e.g., Gray, Prigerson, & Litz, 2004; Horowitz et al., 1997). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The growing number of service members in need of mental health care requires that empirically based interventions be tailored to the unique demands and exigencies of this population. We discuss a 6-session intervention for combat-related PTSD designed to foster willingness to engage with and disclose difficult deployment memories through a combination of imaginal exposure and subsequent cognitive restructuring and meaning-making strategies. Core corrective elements of existing PTSD treatments are incorporated and expanded, including techniques designed to specifically address traumatic loss and moral conflict.
    Cognitive and Behavioral Practice 02/2011; 18(1-18):98-107. DOI:10.1016/j.cbpra.2009.08.006 · 1.33 Impact Factor
Show more