Early Intervention May Prevent the Development of Posttraumatic Stress Disorder: A Randomized Pilot Civilian Study with Modified Prolonged Exposure

Abstract

Background Posttraumatic stress disorder is a major public health concern with long term sequelae. There are no accepted interventions delivered in the immediate aftermath of trauma. This study tested an early intervention aimed at modifying the memory to prevent the development of PTSD prior to memory consolidation. Methods Patients (N=137) were randomly assigned to receive 3 sessions of an early intervention beginning in the emergency department (ED) compared to an assessment only control group. Posttraumatic stress reactions (PTSR) were assessed at 4 and 12 weeks post-injury and depression at baseline and week 4. The intervention consisted of modified prolonged exposure including imaginal exposure to the trauma memory, processing of traumatic material, and in vivo and imaginal exposure homework. Results Patients were assessed an average of 11.79 hours post-trauma. Intervention participants reported significantly lower PTSR than the assessment group at 4 weeks post-injury, p < 0.01, and at 12 weeks post-injury, p < 0.05, and significantly lower depressive symptoms at Week 4 than the assessment group, p < 0.05. In a subgroup analysis the intervention was the most effective at reducing PTSD in rape victims at Week 4 (p=.004) and Week 12 (p=.05). Conclusions These findings suggest that the modified prolonged exposure intervention initiated within hours of the trauma in the ED is successful at reducing PTSR and depression symptoms one and three months after trauma exposure and is safe and feasible. This is the first behavioral intervention delivered immediately post-trauma that has been shown to be effective at reducing PTSR.

Development and testing of TraumaGameplay: an iterative experimental approach using the trauma film paradigm

“…Although evidence-based interventions for PTSD are available (Bisson et al, 2007), studies examining interventions to prevent PTSD’s onset have not been encouraging, and the majority of these studies have shown that they are ineffective or may even increase PTSD symptoms (e.g. psychological debriefing; Rose, Bisson, Churchill, & Wessely, 2002; Sijbrandij, Olff, Reitsma, Carlier, & Gersons, 2006; but see Rothbaum et al, 2012). Currently, interventions that can be offered to trauma survivors in the immediate aftermath are lacking and there is a high unmet need for effective early interventions that can relieve initial trauma symptoms and reduce PTSD rates (Kearns, Ressler, Zatzick, & Rothbaum, 2012; Qi, Gevonden, & Shalev, 2016).…”

Tetris and Word games lead to fewer intrusive memories when applied several days after analogue trauma

“…PTSD is one of the few psychiatric disorders with a clear onset event (the trauma), and thus prevention strategies would be relatively applicable. However, to date effective preventive interventions are lacking, although some studies have found trauma focused Cognitive Behavioural Therapy (CBT) to be effective (Roberts, Kitchiner, Kenardy, & Bisson, 2010; Rothbaum et al, 2012; Sijbrandij et al, 2007). …”

Early interventions for the prevention of PTSD in adults: a systematic literature review

“…Results were divided according to the type of intervention (pharmacological or psychological). From the 29 articles reviewed, 16 reported significant effects of interventions for the prevention of PTSD or symptoms related to the disorder [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] . Of these, 22 studies used psychological interventions and 7 used pharmacological interventions (Table 2).…”

“…Four of the six studies that used CBT or related techniques reported results compatible with reduced occurrence of PTSD or PTSDrelated symptoms in groups who underwent interventions in relation to control groups 9,[17][18][19] . In the study by Mouthaan et al 24 , which did not report reductions in the occurrence of PTSD, the authors discuss the fact that one-fifth of the volunteers failed to adhere to the intervention program.…”

“…From the 29 articles reviewed, four had no uniform samples in terms of the type of trauma experienced, that is, these studies assessed more than one type of trauma 17,18,22,28 . There is evidence in the literature of correlations between the type of trauma experienced and gender-related vulnerability 37 .…”