Early cognitive-behavioral therapy for post-traumatic stress symptoms after physical injury. Randomised controlled trial

Department of Liaison Psychiatry, Cardiff and Vale NHS Trust, University Hospital of Wales, Cardiff, UK.
The British Journal of Psychiatry (Impact Factor: 7.99). 02/2004; 184:63-9.
Source: PubMed


Early single-session psychological interventions, including psychological debriefing following trauma, have not been shown to reduce psychological distress. Longer early psychological interventions have shown some promise.
To examine the efficacy of a four-session cognitive-behavioural intervention following physical injury.
A total of 152 patients attending an accident and emergency department displaying psychological distress following physical injury were randomised 1-3 weeks post-injury to a four-session cognitive-behavioural intervention that started 5-10 weeks after the injury or to no intervention and then followed up for 13 months.
At 13 months, the total Impact of Event Scale score was significantly more reduced in the intervention group (adjusted mean difference=8.4,95% CI 2.4-14.36). Other differences were not statistically significant.
A brief cognitive-behavioural intervention reduces symptoms of post-traumatic stress disorder in individuals with physical injury who display initial distress.

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    • "Recently, a pilot study found that 3 sessions of prolonged exposure therapy administered within 2 weeks after trauma reduced post-traumatic stress reactions at 1 and 3 months post-trauma [10]. Other secondary preventive psychological interventions, such as brief Cognitive Behavioral Therapy (CBT), have yielded promising results [11,12] but can be applied only several weeks after trauma, when trauma-exposed individuals may already have developed acute PTSD. "
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    ABSTRACT: Currently few evidence based interventions are available for the prevention of PTSD within the first weeks after trauma. Increased risk for PTSD development is associated with dysregulated fear and stress responses prior to and shortly after trauma, as well as with a lack of perceived social support early after trauma. Oxytocin is a potent regulator of these processes. Therefore, we propose that oxytocin may be important in reducing adverse consequences of trauma. The 'BONDS' study is conducted in order to assess the efficacy of an early intervention with intranasal oxytocin for the prevention of PTSD. In this multicenter double-blind randomized placebo-controlled trial we will recruit 220 Emergency Department patients at increased risk of PTSD. Trauma-exposed patients are screened for increased PTSD risk with questionnaires assessing peri-traumatic distress and acute PTSD symptoms within 7 days after trauma. Baseline PTSD symptom severity scores and neuroendocrine and psychophysiological measures will be collected within 10 days after trauma. Participants will be randomized to 7.5 days of intranasal oxytocin (40 IU) or placebo twice a day. Follow-up measurements at 1.5, 3 and 6 months post-trauma are collected to assess PTSD symptom severity (the primary outcome measure). Other measures of symptoms of psychopathology, and neuroendocrine and psychophysiological disorders are secondary outcome measures. We hypothesize that intranasal oxytocin administered early after trauma is an effective pharmacological strategy to prevent PTSD in individuals at increased risk, which is both safe and easily applicable. Interindividual and contextual factors that may influence the effects of oxytocin treatment will be considered in the analysis of the results.Trial registration: Netherlands Trial Registry: NTR3190.
    BMC Psychiatry 03/2014; 14(1):92. DOI:10.1186/1471-244X-14-92 · 2.21 Impact Factor
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    • "Identifying subgroups at risk for PTSD is important for the targeting of PTSD prevention and to facilitate early treatment when PTSD has developed. Research has shown that PTSD can be effectively treated at an early stage [14]. However, symptoms of PTSD may not always develop immediately after the injury. "
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    ABSTRACT: Background Among trauma patients relatively high prevalence rates of posttraumatic stress disorder (PTSD) have been found. To identify opportunities for prevention and early treatment, predictors and course of PTSD need to be investigated. Long-term follow-up studies of injury patients may help gain more insight into the course of PTSD and subgroups at risk for PTSD. The aim of our long-term prospective cohort study was to assess the prevalence rate and predictors, including pre-hospital trauma care (assistance of physician staffed Emergency Medical Services (EMS) at the scene of the accident), of probable PTSD in a sample of major trauma patients at one and two years after injury. The second aim was to assess the long-term course of probable PTSD following injury. Methods A prospective cohort study was conducted of 332 major trauma patients with an Injury Severity Score (ISS) of 16 or higher. We used data from the hospital trauma registry and self-assessment surveys that included the Impact of Event Scale (IES) to measure probable PTSD symptoms. An IES-score of 35 or higher was used as indication for the presence of probable PTSD. Results One year after injury measurements of 226 major trauma patients were obtained (response rate 68%). Of these patients 23% had an IES-score of 35 or higher, indicating probable PTSD. At two years after trauma the prevalence rate of probable PTSD was 20%. Female gender and co-morbid disease were strong predictors of probable PTSD one year following injury, whereas minor to moderate head injury and injury of the extremities (AIS less than 3) were strong predictors of this disorder at two year follow-up. Of the patients with probable PTSD at one year follow-up 79% had persistent PTSD symptoms a year later. Conclusions Up to two years after injury probable PTSD is highly prevalent in a population of patients with major trauma. The majority of patients suffered from prolonged effects of PTSD, underlining the importance of prevention, early detection, and treatment of injury-related PTSD.
    BMC Psychiatry 12/2012; 12(1):236. DOI:10.1186/1471-244X-12-236 · 2.21 Impact Factor
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    • "Study Reason for exclusion Austin et al., 1999 Review Bisson et al., 2004 Adulthood Brill et al., 2001 Review Bronchard et al., 2001 Review Bryant et al., 1998 Adulthood Bryant et al., 2005 Adulthood Brymer et al., 2009 Review Caffo & Belaise, 2003 Review Casswell, 1997 Unsatisfactory methodological quality Catani et al., 2009 Typ II Trauma Chapman et al., 2001 Unsatisfactory methodological quality Chemtob et al., 2002 no brief early intervention (intervention more than 6 weeks after the event or more than 6 intervention sessions) Cohen et al., 2010 Review Cohen, J., 2003 Review Espie, 2009 no brief early intervention (intervention more than 6 weeks after the event or more than 6 intervention sessions) Foa et al, 2006 Adulthood Fremont, 2004 Review Galante & Foa, 1986 no brief early intervention (intervention more than 6 weeks after the event or more than 6 intervention sessions) Giannopoulou et al., 2006 no brief early intervention (intervention more than 6 weeks after the event or more than 6 intervention sessions) Gidron et al., 2001 Adulthood Goenjian et al., 1997 no brief early intervention (intervention more than 6 weeks after the event or more than 6 intervention sessions) Grant et al., 1997 No Intervention Hoagwood, 2007 no brief early intervention (intervention more than 6 weeks after the event or more than 6 intervention "
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    ABSTRACT: Single traumatising events are associated with an elevated rate of psychological disorders in children and adolescents. To date, it remains unclear whether early psychological interventions can reduce longer term psychological maladjustment. To systematically review the literature to determine the characteristics and efficacy of early psychological interventions in children and adolescents after a single, potentially-traumatising event. Systematic searches were conducted of all relevant bibliographic databases. Studies on early psychological interventions were included if the first session was conducted within 1 month of the event. Two independent observers assessed each study for eligibility, using pre-determined inclusion and exclusion criteria, and rated the study's methodological quality. A meta-analysis was conducted on the group effects between individuals allocated to intervention versus control groups. Hence, effect sizes (ES) and confidence intervals were computed as well as heterogeneity and analogue-to-the ANOVA analyses. Seven studies (including four randomised controlled trials) met the inclusion criteria. Depending on the specific outcome variable (e.g., dissociation, anxiety and arousal), small to large beneficial ES were noted. Although the meta-analysis revealed unexplained heterogeneity between the ES of the included studies, and although studies varied greatly with regards to their methodological quality and the interventions tested, findings suggest that early interventions should involve psycho-education, provide individual coping-skills and probably involve some kind of trauma exposure. Also, a stepped procedure that includes an initial risk screen and the provision of multiple sessions to those children at risk may be a promising strategy. To date, research on the effectiveness of early interventions in children after a potentially traumatising event remains scarce. However, our review suggests that early interventions may be helpful.
    European Journal of Psychotraumatology 12/2011; 2. DOI:10.3402/ejpt.v2i0.7858 · 2.40 Impact Factor
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