Can early psychological treatment prevent post-traumatic stress disorder?
Early psychological help can prevent post-traumatic stress disorder (PTSD) in people who have been deeply traumatized. Psychological debriefing – where a trained professional guides those affected, helpers or witnesses through a talk about the traumatic experience a short while afterwards – doesn't prevent PTSD, though.
Traumatized people need attention and support immediately after the traumatic event. The exact type of help will depend on the specific situation and the needs of the people affected. For many, empathy and support from friends, family or coworkers is enough to help them cope with what they have experienced. But some people need professional psychological help.
Post-traumatic stress disorder is only diagnosed if the typical symptoms have lasted for more than four weeks. Psychological treatment usually isn’t started until after that. And some people aren’t ready for psychological treatment until a bit of time has passed.
Professional psychological support is sometimes offered shortly after a traumatic event has occurred – for instance, by professional associations, railway companies or police psychologists. The primary goal is to prevent post-traumatic stress disorder. Scientific studies have looked at an approach called “psychological debriefing” and treatments based on cognitive behavioral therapy.
When talking about debriefing as a psychological intervention, it means speaking about a traumatic experience shortly after it has occurred. These talks are guided by a psychologist or counselor and usually follow a certain procedure. Those affected by the trauma are asked how they perceived the event, what they think about it, and how they feel. Ways of dealing with what has happened are also discussed.
Psychological debriefing was first specially developed for people in certain professions, like police officers and rescue workers, who have to deal with dramatic events on a regular basis. These professional helpers then share what they have experienced in a group a few days afterwards and are offered appropriate psychological support. Debriefing is also used in people who are immediately involved in the event or in people who witnessed it, for instance following a crime or accident. Experts now doubt that debriefing helps, though.
What do studies say about the benefits of psychological debriefing?
Studies have found that debriefing doesn’t lower the risk of developing post-traumatic stress disorder. The studies looked at debriefing interventions in adults, teenagers and children. Despite the debriefing, in most of the studies the later occurrence of post-traumatic stress disorder was just as high as in people who didn’t have this intervention – and in one study it was even higher. In most of the studies, PTSD was equally common in people who had and hadn’t had the debriefing intervention. In one study it was even more common following debriefing. Those involved, such as rescue workers, often found the group talk helpful at first.
There is some evidence that debriefing could even have a negative effect on some people who have been traumatized. For instance, the timing of the debriefing may be inappropriate because they aren’t yet ready to speak about what they have experienced. Some experts also worry that these kinds of talks may trigger the PTSD symptoms, and that they could prevent self-healing powers.
Support and compassion from others are important following a horrific event – but there is currently no evidence to support the use of group debriefing for all victims, helpers or witnesses after the event. Instead, an effort should be made to see what kind of help people might need. Many people first need time to figure out their thoughts and feelings, and will then signal when and how much they want to speak about what they’ve experienced.
Brief cognitive behavioral therapy
Talking with a therapist about what you experienced and how it has affected you may already be a good idea within the first few weeks of the traumatic event. These types of early talks may be suitable for severely traumatized people who really need support – and if doctors are concerned that the symptoms won’t go away without therapy. They may also be a good idea for people who have experienced repeated traumatic events or who have developed severe symptoms early on and have been diagnosed with an acute stress reaction (“nervous breakdown”). These people may be very confused, desperate, very scared and sometimes aggressive as a result of what they have experienced. They may also have physical symptoms and some might be haunted by nightmares.
Several studies have looked into the effectiveness of brief interventions based on cognitive behavioral therapy (CBT). The cognitive behavioral therapy focuses on reinterpreting and reevaluating distressing experiences and feelings. These talks typically involved about 10 to 15 hours of therapy.
Research on the benefits of brief cognitive behavioral therapy
Early psychological therapy can help some people who have been traumatized. Those who were found to benefit most in studies were people who had severe symptoms of an acute stress reaction. The treatment prevented them from developing post-traumatic stress disorder. It involved several sessions with a therapist in the first few weeks after the event. They talked about the traumatic experience and possible coping strategies.
These studies also looked into various support programs that are based on cognitive behavioral therapy and are offered to traumatized children early on – for example, children who experienced domestic abuse, were sexually abused or had been exposed to war. The research suggests that these programs had a positive effect on family life, and were able to prevent behavioral problems and post-traumatic stress disorder.
Flynn AB, Fothergill KE, Wilcox HC, Coleclough E, Horwitz R, Ruble A et al. Primary Care Interventions to Prevent or Treat Traumatic Stress in Childhood: A Systematic Review. Acad Pediatr 2015; 15(5): 480-492.
Frommberger U, Nyberg E, Angenendt J, Lieb K, Berger M. Posttraumatische Belastungsstörungen. In: Berger M (Ed). Psychische Erkrankungen - Klinik und Therapie. München: Urban und Fischer; 2015.
Gartlehner G, Forneris CA, Brownley KA, Gaynes BN, Sonis J, Coker-Schwimmer E et al. Interventions for the Prevention of Posttraumatic Stress Disorder (PTSD) in Adults After Exposure to Psychological Trauma. April 2013. (AHRQ Comparative Effectiveness Reviews; Volume 109).
Gillies D, Maiocchi L, Bhandari AP, Taylor F, Gray C, O'Brien L. Psychological therapies for children and adolescents exposed to trauma. Cochrane Database Syst Rev 2016; (10): CD012371.
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