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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    • "Trials of exposure-based CBT have generally demonstrated moderately positive results in reducing PTSD or other symptoms in the long term (Table 1).conducted a study using modified Prolonged Exposure (PE) in rape, assault, and motor vehicle accidents survivors around 12 h after trauma, and found lower PTSD symptoms in the intervention group at 4 and 12 weeks after trauma, mainly for sexual assault victims. The same cohort also showed that PE might mitigate symptoms of PTSD in genetically predisposed individuals[35, 36•].Bryant et al. (2008)found 5 weeks of exposure-based CBT to be effective in reducing PTSD in participants who met acute stress disorder diagnostic criteria[37].Bisson et al. (2004)found a reduction of PTSD symptoms at 13 months—but not 3 months after the traumatic events[38], while a small study with 3 weeks of PE did not find significant symptom improvement in the PE group compared to supportive counseling[39]. CBT without in-session exposure has shown effectiveness in some but not all studies.Sijbrandij et al. (2007)compared CBT to waitlist control subjects with acute PTSD and found that CBT accelerated recovery, but makes no long-term difference[40].Shalev et al. (2012), found that cognitive therapy fared as well as prolonged exposure 9 months[41•]after trauma exposure . "
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