Shalev, A.Y., Ankri, Y., Israeli-Shalev, Y., Peleg, T., Adessky, R., & Freedman, S. (2011). Prevention of posttraumatic stress disorder by early treatment. Arch Gen Psychiatry.
A recent and first comparative study of early and delayed cognitive behavior therapy (CBT) interventions for PTSD found that prolonged exposure (PE), cognitive therapy (CT), and delayed PE prevent chronic PTSD in recent survivors. This study published in the Archives of General Psychiatry used equipoise-stratified randomization with trauma survivors who were recruited from Hadassah Hospital in Jerusalem. Adult trauma survivors were initially screened via telephone to ensure that they met DSM-IV criteria for PTSD. Adults (516) who met criteria were randomly assigned to receive treatment in a prolonged exposure (PE) group, a cognitive therapy (CT) group, double blind comparison of treatment with escitalopram (SSRI) or placebo groups, and a control wait-list group. Of the 756 adults who did not meet DSM-IV criteria, 296 of them accepted an invitation to receive clinical assessment. The participants were evaluated following early interventions at 5 months and assessed again at 9 months. PE and CT treatment sessions were recorded and evaluated by CT experts. The Clinician-Administered PTSD Scale (CAPS) was used to measure the presence of PTSD at 5 and 9 months following treatment. Results showed that PE, CT, and delayed PE treatments were effective in lowering the rates and symptoms of PTSD in participants. Furthermore, there was no significant difference between the presence of PTSD in participants who received PE or CT and delayed PE treatment. This suggests that delaying PTSD interventions may not pose a threat to treatment outcomes. There was also no difference in improvement between the groups who received the SSRI versus placebo pills. Since this was the first comparative study of early and delayed PTSD interventions, the researchers recommend replication studies to test for reliability. They also propose that future research focus on more simple CBT techniques to determine how those methods play a role in preventing PTSD. Finally, the lack of improvement from pharmacological treatment with escitalopram necessitates further evaluation and replication with larger samples.