Multiple session early psychological interventions for the prevention of post-traumatic stress disorder

Jul 7 2009

Psychological interventions intended to prevent the development of post-traumatic stress disorder (PTSD) in the early stages after a traumatic experience have not been shown to be effective, Cochrane Researchers have concluded. This systematic review focused on multiple-session treatments for everyone involved, irrespective of the presence of symptoms. Two previous reviews found single session interventions to be ineffective.

"It is important to note that these interventions were for everyone involved in a traumatic event rather than just those who had symptoms, which may account for the results. We found no benefit associated with any of the multiple session interventions studied, and there was some evidence that multiple session interventions may result in worse outcome than no intervention for some individuals," says lead researcher Neil Roberts of the Traumatic Stress Service at the University Hospital of Wales in Cardiff, UK. "Our recommendation is, therefore, that these interventions should not be used as a blanket approach for everyone involved in traumatic events."

PTSD is a condition that affects people who undergo extremely stressful experiences, such as earthquakes, violent crimes and military combat. They may suffer long-lasting psychological difficulties as a result. Experts have been trying to develop effective treatments to prevent PTSD from developing for 25 years, but there is little evidence that those used routinely offer any benefit.

The review encompassed people of all risk levels. Researchers looked at data from eleven studies involving a total of 941 people exposed to traumatic events. These studies offered interventions, which included cognitive behavioural therapy and individual and group counselling, to people whether or not they were experiencing symptoms of PTSD. None of these was effective at preventing PTSD. Patients given the treatments were more likely to report symptoms of PTSD after three to six months than patients who were not.

The reviewers are keen to emphasise that this review should not be read as suggesting that psychological intervention has no role in treating PTSD. "The current study was looking at the ability of psychological interventions to prevent onset of symptoms, and deliberately excluded targeted interventions where therapy was only offered to people who were already displaying symptoms of PTSD," says Roberts. "We are currently evaluating the success of similar interventions when given as treatment to people who have already developed early symptoms."

"We urgently need more research on the most effective ways of giving psychological help to people who suffer traumatic events," says Roberts. "Coupled with the results of earlier reviews, our research indicates that there is currently no effective option for early stage prevention of post traumatic stress disorder."

Full bibliographic information: Roberts NP, Kitchiner NJ, Kenardy J, Bisson J. Multiple session early psychological interventions for the prevention of post-traumatic stress disorder. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006869. DOI: 10.1002/14651858.CD006869.pub2.