Quick therapy may reduce post-traumatic stress when delivered immediately

July, 2012

A pilot study supports the value of brief cognitive therapy for victims of traumatic events, when delivered as soon as possible after the event. The benefit appears greatest for sexual assault victims.

A new study has found that, when delivered quickly, a modified form of prolonged exposure therapy reduces post-traumatic stress reactions and depression.

The study involved 137 patients being treated in the emergency room of a major trauma center in Atlanta. The patients were chosen from survivors of traumatic events such as rape, car or industrial accidents, and shooting or knife attacks. Participants were randomly assigned to either receive three sessions of therapy beginning in the emergency department (an average of 12 hours after the event), or assessment only. Stress reactions were assessed at 4 and 12 weeks, and depression at baseline and 4 weeks.

Those receiving the therapy reported significantly lower post-traumatic stress at 4 weeks and 12 weeks, and significantly lower depression at 4 weeks. Analysis of subgroups revealed that the therapy was most effective in rape victims. In the cases of transport accidents and physical (non-sexual) assault, the difference between therapy and assessment-only was only barely significant (for transport at 4 weeks) or non-significant. In both subgroups, the effect was decidedly less at 12 weeks than at 4 weeks.

The therapy, carried out by trained therapists, involved participants describing the trauma they had experienced while the therapist recorded the description. The bulk of the hour-long session was taken up with reliving and processing the experience. There were three sessions spaced a week apart. The patients were instructed to listen to their recordings every day, and 85% were compliant. The therapists also explained normal reactions to trauma, helped the patients look at obtrusive thoughts of guilt or responsibility, and taught them a brief breathing or relaxation technique and self care.

While this study doesn’t itself compare the effects of immediate vs delayed therapy, the assumption that delivering the therapy so soon after the trauma is a crucial factor in its success is in line with other research (mainly to do with fear-conditioning in rodent and human laboratory studies). Moreover, while brief cognitive-behavioral therapy has previously been shown to be effective with people diagnosed with acute stress disorder, such therapy is normally begun some 2-4 weeks after trauma, and a study of female assault survivors found that although such therapy did indeed accelerate recovery compared with supportive counseling, after 9 months, PTSD severity was similar in both groups.

Another, severe, limitation of this study is that the therapy involved multiple items. We cannot assume that it was the repeated re-experiencing of the event that is critical.

However, this study is only a pilot study, and its findings are instructive rather than decisive. But at the least it does support the idea that immediate therapy is likely to help victims of trauma recover more quickly.

One final, important, note: It should not, of course, be assumed that simply having the victim describe the events — say to police officers — is in itself therapeutic. Done badly, that experience may itself be traumatic.

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