Early Psychological Interventions Do Not Reduce PTSD Risk

Early therapy sessions to people exposed to a traumatic event in an attempt to prevent posttraumatic stress disorder (PTSD), may actually be doing more harm than good, claims a new study.

Researchers at the University Hospital of Wales (Cardiff, United Kingdom) conducted a meta-analysis that included eight randomized controlled studies of multiple-session early psychological intervention or treatment designed to prevent symptoms of PTSD. The therapies included integrated cognitive behavioral and family therapy, individual counseling, interpersonal counseling, group counseling, adapted debriefing, up to six sessions of cognitive behavioral therapy (CBT), and counseling and collaborative care. The outcome variable measured was prevention of PTSD, defined as repeated experiencing of the trauma; avoidance of reminders and symptoms of numbing; and symptoms of heightened arousal.

The researchers found the studies do not support routine use of any psychological intervention in asymptomatic subjects, and that some people do worse with multiple-session interventions than with no intervention; a trend towards more self-reported PTSD symptoms in people who underwent multiple-session interventions at 3 to 6 months was found when compared to no intervention at all. However, this was not an entirely consistent finding across other outcomes. The researchers cautioned that the analysis includes data from studies using a number of different types of intervention, and it may be that certain interventions are harmful but others are not; for example, the group that received adapted debriefing intervention tended to do worse across a range of outcomes, as did the group that had counseling following an interpersonal psychotherapy model. The study was published on July 8, 2009, in the Cochrane Database of Systematic Reviews.

"There was no evidence of any intervention being effective at preventing PTSD for participants who had been exposed to a traumatic event regardless of any symptomatology,” said lead author Neil Roberts, D.Clin.Psy, a consultant clinical psychologist at the traumatic stress service at the University Hospital of Wales. "The clear practice implication of this is that, at present, multiple-session interventions aimed at all individuals exposed to traumatic events should not be used.”

PTSD is an anxiety disorder that can develop after exposure to one or more traumatic events that threatened or caused great physical harm, effectively overwhelming psychological defenses. In some cases, it can also be from profound psychological and emotional trauma, apart from any actual physical harm. Often, however, incidents involving both things are found to be the cause. PTSD has been recognized in the past as, shell shock, battle fatigue, traumatic war neurosis, or posttraumatic stress syndrome. Diagnostic symptoms include re-experience, such as flashbacks and nightmares; avoidance of stimuli associated with the trauma; and increased arousal, such as difficulty falling or staying asleep, anger, and hypervigilance. Per definition, the symptoms last more than six months and cause significant impairment in social, occupational, or other important areas of functioning.

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University Hospital of Wales