PEARLS No. 207, October 2009, written by Brian R McAvoy - download pdf

Clinical question

How effective are multiple session early psychological interventions for the prevention of post-traumatic stress disorder (PTSD)?

Bottom line

The results suggest no psychological intervention can be recommended for routine use following traumatic events, and multiple session interventions, like single session interventions, may have an adverse effect (increased self-report of PTSD symptoms at 3 to 6 months' follow-up) for some individuals. The clear practice implication of this is that, at present, multiple session interventions aimed at all individuals exposed to traumatic events should not be used.

Caveat

The methodological quality of many of the studies included was poor. Many studies did not provide full details of the method of allocation and some bias was considered possible from the descriptions in 7 studies. Many studies did not provide full details of the method of randomisation, and therefore concealment was unclear or inadequate in 8 studies.

Context

The prevention of long term psychological distress following traumatic events is a major concern. Systematic reviews have suggested individual psychological debriefing is not an effective intervention for preventing PTSD. Recently, other forms of preventive intervention have been developed: counselling, cognitive behavioural therapy, memory structuring interventions, critical incident stress debriefing and collaborative care interventions.

Cochrane Systematic Review

Roberts NP et al. Multiple session early psychological interventions for the prevention of post-traumatic stress disorder. Cochrane Reviews 2009, Issue 3. Article No. CD006869. DOI:10.1002/14651858.CD006869.pub2. This review contains 11 studies involving 941 participants.