Brief Counseling Does Not Prevent Later Onset of PTSD
Researchers from University Hospital of Wales in Cardiff, UK, performed a systematic review of counseling interventions designed to prevent the acquisition of posttraumatic stress. Earlier reviews had already established that Critical Incident Stress Debriefing has no effect on preventing PTS. Single session interventions were excluded for this review, which looked at other forms of multiple session early psychological intervention, begun within three months of a traumatic event, aimed at preventing PTS.
Eleven randomized, controlled studies with a total of 941 participants were found to have evaluated brief psychological interventions aimed at preventing PTSD in individuals exposed to a specific traumatic event, examining a heterogeneous range of interventions*. Eight studies were entered into meta-analysis.
There was a trend for increased self-report of PTSD symptoms at 3 to 6 month follow-up in those who received an intervention (k=4, n=292; SMD 0.23; 95% CI 0.00 to 0.46).
Two studies compared a memory structuring intervention against supportive listening. There was no evidence supporting the efficacy of this intervention. The rest were either individual or group counseling sessions or CBT (cognitive behavioral therapy) sessions and one instance of modified debriefing.
The results suggest that none of these psychological interventions can be recommended for routine use following traumatic events and that multiple session interventions, like single session interventions, may have an adverse effect on some individuals.
The clear practice implication of this is that, at present, these multiple session interventions aimed at all individuals exposed to traumatic events are not recommended for use. Further, better designed studies that explore new approaches to early intervention are now required.
* One study (Kazak 2005) evaluated an integrated cognitive behavioural and family therapy intervention for caregivers. Four studies (Brom 1993; Gamble 2005;Holmes 2007; Ryding 1998) evaluated individual counseling interventions. In Holmes 2007 the approach used was specified as an interpersonal counseling model. One study (Ryding 2004) evaluated a group counseling intervention. One study (Marchand 2006) evaluated an adapted debriefing intervention. One study (Andre 1997) evaluated a CBT intervention of up to six sessions. One study (Zatzick 2001) evaluated a counseling and collaborative care intervention to hospitalized inpatients. The maximum number of sessions available to patients in this study was not reported. The mean number of sessions attended by those completing therapy was 5.9. Two studies (Gidron 2001; Gidron 2007) evaluated a two session memory structuring intervention. These two studies used a supportive listening intervention for comparison. In all other studies active interventions were compared against a waiting list or treatment as usual control condition.
Citation: Roberts NP, Kitchiner NJ, Kenardy J, Bisson J. Multiple session early psychological interventions for the prevention of post-traumatic stress disorder. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD006869.