Early Psychosocial Intervention Following Traumatic Events

Department of Psychological Medicine, Cardiff University, University Hospital of Wales, Cardiff, Wales, UK.
American Journal of Psychiatry (Impact Factor: 12.3). 08/2007; 164(7):1016-9. DOI: 10.1176/appi.ajp.164.7.1016
Source: PubMed


Bill, a 35-year-old journalist working for a local radio station, was sent to report from the scene of a bomb attack that resulted in several fatalities. What he witnessed at the scene distressed him greatly. Immediately afterward, he began repeatedly to reexperience what had happened, leading him to avoid either discussing or thinking about it. He continued to work, but he lost interest in things around him. He became withdrawn, irritable, and hypervigilant. These symptoms rapidly diminished over the first few weeks, but then 1 month after the attack they began to increase again for no apparent reason. What is the differential diagnosis? How should Bill's symptoms be managed?.

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Available from: Jonathan I Bisson, Jun 03, 2014
    • "refinement of numerous interventions.45678Evidencebased psychotherapeutic and psychopharmacological PTSD treatments include cognitive behavioral therapies (CBTs: prolonged exposure[PE]and cognitive processing therapy) and selective serotonin reuptake inhibitors (SSRIs), respectively. "
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    ABSTRACT: Background Posttraumatic stress disorder (PTSD) is associated with abnormal functioning of the hypothalamic–pituitary–adrenal (HPA) axis; however, limited research has examined whether cortisol levels change following successful PTSD treatment. The current study examined the impact of successful PTSD treatment on the cortisol awakening response (CAR).Method Twenty-nine adults participating in a treatment trial for chronic PTSD provided saliva samples (upon waking, and 30-, 45-, and 60 min postwaking) before and after receiving either prolonged exposure therapy or sertraline. PTSD responder status (i.e., loss or retention of a PTSD diagnosis) served as the predictor variable. Outcome measures included area under the curve with respect to ground and increase, reflecting total cortisol output and HPA axis reactivity, respectively.ResultsA series of hierarchical regressions revealed no significant main effects of PTSD responder status for either CAR outcome. However, a significant gender by treatment response interaction for cortisol reactivity revealed that female treatment nonresponders displayed higher cortisol reactivity following treatment than female responders, whereas cortisol reactivity did not change pre- to posttreatment for male responders. Findings remained after controlling for age, trauma history, baseline medication status, baseline PTSD, and baseline depressive symptoms.Conclusion Loss of a PTSD diagnosis may contribute to decreased cortisol reactivity in females. Neuroendocrine changes following treatment may emerge only for specific subgroups, highlighting the importance of exploring treatment moderators.
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    • "If the initial distress is steadily diminishing, the symptoms will often be self-limiting. It is argued that if reactions persist, are increasing, or are particularly problematic, a comprehensive mental health assessment is required to determine needs, with attention paid to presentation, background, mental state examination, risk assessment, social factors including support network, and information from other sources including relatives (Bisson et al., 2007). While we would not disagree with this, we would strongly argue for the assessment before the watchful waiting period, as this would predict the longer term psychological trajectory, allow for more robust case management , and minimize further psychological complications. "
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    ABSTRACT: It is has been argued that early interventions for individuals, groups or others affected by traumatic events should not be routinely offered as there is the danger of causing more harm. The notion of “watchful waiting” has been espoused in clinical guidelines for the assessment and treatment of posttraumatic stress disorder (PTSD). Instead, a more proactive early intervention is suggested for potentially traumatic events that have the potential to lead to high psychic distress, PTSD, or complicated grief reactions for a significant number of those affected. This involves providing strategies tailored to the needs of these individuals and families and not providing conventional individual therapeutic interventions. Early intervention is wise as recent research has demonstrated that early misconceptions and negative appraisals about one's own reactions to a trauma can be significant in the development and maintenance of posttraumatic reactions and early intervention may help in forming adequate appraisals, thus counteracting misunderstandings and misperceptions. Adopting a “watchful waiting” approach with individuals and families has the potential to hinder and impede their longer-term coping responses. Recent advances, especially in the field of memory research, have implications for early interventions. We present recent findings, which make the case for early interventions following exposure to traumatic events.
    Full-text · Article · May 2012 · Journal of Loss and Trauma

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