NEW YORK (Reuters Health) – Patients who experience a traumatic event are less likely to develop chronic symptoms of post-traumatic stress disorder (PTSD) if they receive trauma-focused cognitive therapies, an Israeli team reports in the October 3 online issue of the Archives of General Psychiatry.

Treatment with a serotonin reuptake inhibitor, however, is not helpful in this setting, the researchers found.

In the background to their paper, Dr. Arieh Y. Shalev and colleagues at Hadassah University Hospital in Jerusalem note that chronic PTSD is disabling and hard to treat, but the ability of cognitive therapy and pharmacotherapy to prevent the condition has not been established. In particular, the effect of the timing of intervention in relation to the traumatic event has not been explored in controlled studies.

The team therefore conducted a study of survivors of traumatic events to compare early and delayed interventions for preventing chronic PTSD. Eligible subjects were interviewed a mean of 9.6 days after the event, and those who met PTSD symptom criteria were offered treatment. Out of 756 patients interviewed, 242 were randomized to prolonged exposure therapy, or cognitive therapy, or escitalopram versus placebo, or assignment to a waiting list for 12 weeks.

Prolonged exposure therapy consisted of 12 weekly sessions involving imagined exposure to traumatic memories and actual exposure to avoided situations, along with education and training in breathing control. Cognitive therapy involved the same number of sessions, during which negative automatic thoughts were identified and challenged.

The pharmacologic study was double-blinded, with the dose escalated from one 10-mg tablet to two after two weeks.

At 5 months’ follow-up, the prevalence of PTSD determined by the Clinician-Administered PTSD Scale (CAPS) was 21.4% in the prolonged exposure group and 18.2% in the cognitive therapy group, significantly less than in the wait-listed arm (58.2%), the SSRI group (61.9%) and the placebo group (55.6%).

Waiting list participants with PTSD after 12 weeks received prolonged exposure therapy, and this delayed intervention had a similar effect as in the earlier intervention group.

At 9 months, the prevalence of PTSD in the prolonged exposure group, the cognitive therapy group and waiting list group was 21.2%, 22.8%, and 22.9%, respectively, while the prevalence in the SSRI and placebo groups remained higher at 42.1% and 47.1%, respectively.

The latter result “joins several other disappointing findings in studies on the pharmacological prevention of PTSD,” Dr. Shalev and colleagues comment. However, they point out that a potential preventive effect can not be ruled out because of the small size of the SSRI and placebo subgroups, as well as the relatively low 20-mg dose of escitalopram.

On the positive side, they conclude that prolonged exposure therapy and cognitive therapy have significant preventive effects. Furthermore, “Our finding suggests that delaying the intervention does not increase the risk of chronic PTSD,” the authors state.

“Thus,” they add, “a delayed intervention is an acceptable option when early clinical interventions cannot be provided (eg, during wars, disasters, or continuous hostilities).”

Reference:
Prevention of Posttraumatic Stress Disorder by Early Treatment
Arch Gen Psychiatry 2011;