Early cognitive-behavioural 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: 7.34). 02/2004; 184:63-9.
Source: PubMed

ABSTRACT 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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    • "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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    • "Relaxation therapy is not regarded as an effective standalone treatment for PTSD, but is used as an anxietyreducing technique within CBT treatments for ASD and PTSD to reduce and regain control over physical arousal and distress (Bisson et al., 2004; Bryant et al., 1998; Foa et al., 2009; Sijbrandij et al., 2007). In our intervention, instructions for stress management techniques (relaxation and breathing retraining exercises) are presented in two audio clips of approximately 7 min duration each: (1) ''Muscle relaxation'' focuses on progressive muscle relaxation through breathing retraining; (2) ''Safe place'' is an exercise that focuses on decreasing stress or tension levels by imagining a safe and secure place while retraining breathing. "
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    ABSTRACT: Injured trauma victims are at risk of developing Posttraumatic Stress Disorder (PTSD) and other post-trauma psychopathology. So far, interventions using cognitive behavioral techniques (CBT) have proven most efficacious in treating early PTSD in highly symptomatic individuals. No early intervention for the prevention of PTSD for all victims has yet proven effective. In the acute psychosocial care for trauma victims, there is a clear need for easily applicable, accessible, cost-efficient early interventions. To describe the design of a randomized controlled trial (RCT) evaluating the effectiveness of a brief Internet-based early intervention that incorporates CBT techniques with the aim of reducing acute psychological distress and preventing long-term PTSD symptoms in injured trauma victims. In a two armed RCT, 300 injured trauma victims from two Level-1 trauma centers in Amsterdam, the Netherlands, will be assigned to an intervention or a control group. Inclusion criteria are: being 18 years of age or older, having experienced a traumatic event according to the diagnostic criteria of the DSM-IV and understanding the Dutch language. The intervention group will be given access to the intervention's website (, and are specifically requested to login within the first month postinjury. The primary clinical study outcome is PTSD symptom severity. Secondary outcomes include symptoms of depression and anxiety, quality of life, and social support. In addition, a cost-effectiveness analysis of the intervention will be performed. Data are collected at one week post-injury, prior to first login (baseline), and at 1, 3, 6 and 12 months. Analyses will be on an intention-to-treat basis. The results will provide more insight into the effects of preventive interventions in general, and Internet-based early interventions specifically, on acute stress reactions and PTSD, in an injured population, during the acute phase after trauma. We will discuss possible strengths and limitations.
    European Journal of Psychotraumatology 11/2011; 2. DOI:10.3402/ejpt.v2i0.8294 · 2.40 Impact Factor
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    • "Using structured diagnostic interviews to establish all Axis 1 disorders allowed us to comprehensively assess the broad range of psychiatric consequences that may occur after injury. In contrast to the substantial body of research that has focused on posttraumatic stress disorder (Bisson et al. 2004; Hepp et al. 2005; Carty et al. 2006), our findings indicate that depression was the predominant diagnosis in the post-injury year. Further, in contrast to other studies that report high co-morbidity between depression and PTSD (O'Donnell et al. 2004; Shalev et al. 1998), only two participants were found to have this co-morbidity. "
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    ABSTRACT: Millions of people seek emergency department (ED) care for injuries each year, the majority for minor injuries. Little is known about the effect of psychiatric co-morbid disorders that emerge after minor injury on functional recovery. This study examined the effect of post-injury depression on return to pre-injury levels of function. This was a longitudinal cohort study with follow-up at 3, 6 and 12 months post-injury: 275 adults were randomly selected from those presenting to the ED with minor injury; 248 were retained over the post-injury year. Function was measured with the Functional Status Questionnaire (FSQ). Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR disorders (SCID). During the post-injury year, 18.1% [95% confidence interval (CI) 13.3-22.9] were diagnosed with depression. Adjusting for clinical and demographic covariates, the depressed group was less likely to return to pre-injury levels of activities of daily living [odds ratio (OR) 8.37, 95% CI 3.78-18.53] and instrumental activities of daily living (OR 3.25, 95% CI 1.44-7.31), less likely to return to pre-injury work status (OR 2.37, 95% CI 1.04-5.38), and more likely to spend days in bed because of health (OR 2.41, 95% CI 1.15-5.07). Depression was the most frequent psychiatric diagnosis in the year after minor injury requiring emergency care. Individuals with depression did not return to pre-injury levels of function during the post-injury year.
    Psychological Medicine 04/2009; 39(10):1709-20. DOI:10.1017/S0033291709005376 · 5.43 Impact Factor
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