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PTSD Symptoms Benefited by Early Intervention CBT

NewStudy-Graphic-72x72_edited-3 A recent meta-analysis published in the American Journal of Psychiatry found trauma-focused Cognitive Behavioral Therapy (CBT) delivered within a 3-month period of traumatic events to be effective in the treatment of trauma-induced stress symptoms for patients with PTSD or acute stress disorder.

Research has demonstrated the effectiveness of “multiple-session trauma-focused psychological interventions to treat chronic PTSD,” but little had been done to evaluate the efficacy of early interventions. The present study analyzed randomized controlled trials of early interventions, assessing efficacy, the population receiving the greatest benefit, the best modalities of treatment, and the optimal timing of treatment.

The researchers performed a meta-analysis and systematic review of 25 studies whose interventions were designed to treat or prevent PTSD within 3 months of a traumatic event. The authors found that trauma-focused CBT was significantly more effective for patients than usual care or being on waiting lists in terms of reducing stress symptoms of trauma. The magnitude of the effects varied for this finding; CBT was found to be most effective for individuals diagnosed with acute PTSD or acute stress disorder. Participants who did not meet the diagnostic criteria of a psychological stress disorder gained only minimal benefits from trauma-focused CBT.

The authors concluded that trauma-focused CBT should be offered to patients suffering from acute PTSD or acute stress disorder. They also noted that further investigation could determine whether trauma-focused CBT should become part of initial screening programs for patients who have experienced major traumatic events.

Study authors: N. P. Roberts, N. J. Kitchiner, J. Kenardy, J. I. Bisson

Cognitive Therapy is Helping Veterans

Guest Blogger: John Milwee, Psy.D., Veterans Administration therapist and Beck Institute alumnus

Veterans returning from the conflicts in Afghanistan and Iraq may face many challenges as they begin to reintegrate into their roles as parents, employees, friends, and neighbors. In recent months a great deal of media attention has been focused on those returning Veterans who suffer with symptoms of Post-Traumatic Stress Disorder (PTSD) associated with their combat experience. Alarming statistics are frequently reported that describe the number of these Veterans who, when untreated, commit suicide. Read more

Older Veterans with Post-traumatic Stress Disorder Helped by CBT

NewStudy-Graphic-72x72_edited-3Medscape: According to a pilot study presented at the Anxiety Disorders Association of America 2009 Annual Conference, older veterans suffering from post-traumatic stress disorder (PTSD) and related symptoms of depression and anxiety – which can persist for decades – may benefit from prolonged exposure therapy (a form of cognitive behavioral therapy). Twelve sessions included “in vivo experience, in which patients are exposed to fears out in the world, and imaginary exposure.”

Measures of efficacy included a Clinician-Administered PTSD Scale (CAPS); after treatment, patients showed a significant reduction in mean CAPS score and 75% no longer met PTSD criteria. Patients showed clinical improvement in most PTSD symptoms along with individual symptoms of avoidance and hyperarousal. Additionally, Beck Depression Inventory (BDI) and other measures showed “clinically significant improvement in both depression and anxiety.” The study author noted that after the treatment, the men were able to “do things they hadn’t done in years.”

These findings are particularly promising because they call into question the “dogma” that older adults cannot tolerate or could be harmed by exposure therapy.

According to the study author, “There are lots of people with PTSD who fought in prior wars or who have the condition for other reasons, who have pushed it aside and coped pretty well throughout their lives. Then a spouse dies, they retire or become medically ill, and their PTSD is something they no longer can put aside, and they need help. We need to know how to treat these people.”

The author is planning a randomized clinical trial in 100 older adults with PTSD.

Study author: S. R. Thorp

There’s nothing either good or bad, but thinking makes it so…

Does Shakespeare’s famous maxim apply to head injury?

According to a new study, the answer is yes.

Researchers recently looked at patients with mild head injuries (90% of head injuries in Western countries are classified as “mild”) to see whether perceptions of illness contributed to the development and severity of post-concusional syndrome (PCS). 73 patients with mild head injuries participated in the study. They were monitored for PCS symptoms, post-traumatic stress symptoms, perceptions of illness, depression and anxiety. Scales were completed at the time of injury, and at 3-month follow-up.

The results: patients who believed their injuries would have a serious effect on their quality of life were at greater risk for post-concusional symptoms.

What are the implications for treatment? As the article states: “Recognition of the maladaptive cognitions that contribute to poor outcome of the sort suggested by this study will be helpful in the development of effective cognitive-behavioral interventions.”