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Early intervention found successful at reducing PTSD

Prolonged exposure therapy in the emergency department initiated within hours of a traumatic experience successfully reduced posttraumatic stress disorder symptoms and depression symptoms 1 and 3 months after the traumatic event, according to recent study results. Researchers said early intervention is safe and feasible.

“It is clear that what happens in the immediate aftermath of trauma can make things better or possibly make things worse,” study researcher Barbara Olasov Rothbaum, PhD, told Healio.com. “We don’t yet know how to identify who needs what or whether they will be fine with their own natural recovery.  In the meantime, we urge caution, careful and ongoing assessment, and that clinicians should use their clinical skills to determine the best course of action for any individual patient.”

Rothbaum, of the department of psychiatry and behavioral sciences at Emory University School of Medicine, and colleagues randomly assigned 137 patients aged 18 to 65 years to receive early intervention therapy or an assessment-only control group. All participants presented to a public hospital emergency department (ED) within 72 hours of experiencing a trauma and met criterion A of the DSM-IV.

Early intervention, a modified prolonged-exposure treatment distinct from debriefing because it is based on individual and not group delivery, includes breathing relaxation, in vivo exposure, attention to cognitions and self-care. The intervention also involves “multiple repetition of the trauma narrative to allow for fear extinction within and between sessions for homework,” the researchers wrote.

Participants took part in three hour-long sessions distributed 1 week apart. Therapists, trained in prolonged exposure, had either a master’s or a doctoral degree in psychology or social work. Masked assessors administered the Update Trauma Interview, the PTSD Symptom Scale-Interview Version (PSS-I), the Posttraumatic Stress Diagnostic Scale and the Additional Treatment Inventory 4 and 12 weeks after enrollment in the ED. The Beck Depression Inventory, Second Edition, was used to assess depressive symptoms at the 4-week follow-up.

Participants in the early intervention group reported significantly lower PSS-I scores at the 4-week follow-up (95% CI, 15.51-22.68) compared with the control group (95% CI, 21.22-27.87). The researchers found similar results for the 12-week follow-up, with the early intervention group (95% CI, 11.60-19.34) scoring significantly lower than the control group (95% CI, 16.79-23.87). The early intervention group also reported significantly lower depressive symptoms at week 4 compared with the control group (P<.05). Early intervention was the most effective at reducing PTSD in rape victims at week 4 (P=.004) and week 12 (P=.05).

Exposure therapy has received more empirical support than any other treatment for PTSD, but has never been implemented within hours of the traumatic event, according to the researchers.

The researchers added that it is important to test the early intervention method in the field, with both civilians and military personnel.

Disclosure: The researchers report no relevant financial disclosures.