Early psychological interventions to treat acute traumatic stress symptoms

Roberts, Neil P., Kitchiner, Neil J., Kenardy, Justin and Bisson, Jonathan I. (2010) Early psychological interventions to treat acute traumatic stress symptoms. Cochrane Database of Systematic Reviews, 2010 4: CD007944-1-CD007944-72. doi:10.1002/14651858.CD007944.pub2

Author Roberts, Neil P.
Kitchiner, Neil J.
Kenardy, Justin
Bisson, Jonathan I.
Title Early psychological interventions to treat acute traumatic stress symptoms
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2010
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD007944.pub2
Volume 2010
Issue 4
Start page CD007944-1
End page CD007944-72
Total pages 75
Editor Cochrane Depression, Anxiety and Neurosis Group
Place of publication Oxford, England, U.K.
Publisher John Wiley & Sons
Collection year 2011
Language eng
Subject 110319 Psychiatry (incl. Psychotherapy)
1701 Psychology
Formatted abstract
Background  The amelioration of psychological distress following traumatic events is a major concern. Systematic reviews suggest that interventions targeted at all of those exposed to such events are not effective at preventing post traumatic stress disorder (PTSD). Recently other forms of intervention have been developed with the aim of treating acute traumatic stress problems.

Objectives  To perform a systematic review of randomised controlled trials of all psychological treatments and interventions commenced within three months of a traumatic event aimed at treating acute traumatic stress reactions. The review followed the guidelines of the Cochrane Collaboration.

Search strategy  Systematic searches were performed of of CCDAN Registers up to August 2008. Editions of key journals were searched by hand over a period of two years; personal communication was undertaken with key experts in the field; online discussion fora were searched.

Selection criteria  Randomised controlled trials of any psychological intervention or treatment designed to reduce acute traumatic stress symptoms, with the exception of single session interventions.

Data collection and analysis  Data were entered and analysed for summary effects using Review Manager 5.0 software. Standardised mean differences were calculated for continuous variable outcome data. Relative risks were calculated for dichotomous outcome data. When statistical heterogeneity was present a random effects model was applied.

Main results  Fifteen studies (two with long term follow-up studies) were identified examining a range of interventions.
   In terms of main findings, twelve studies evaluated brief trauma focused cognitive behavioural interventions (TF-CBT). TF-CBT was more effective than a waiting list intervention (6 studies, 471 participants; SMD -0.64, 95% CI -1.06, -0.23) and supportive counselling (4 studies, 198 participants; SMD -0.67, 95% CI -1.12, -0.23). Effects against supportive counselling were still present at 6 month follow-up (4 studies, 170 participants; SMD -0.64, 95% CI -1.02, -0.25). There was no evidence of the effectiveness of a structured writing intervention when compared against minimal intervention (2 studies, 149 participants; SMD -0.15, 95% CI -0.48, 0.17).

Authors' conclusions  There was evidence that individual TF-CBT was effective for individuals with acute traumatic stress symptoms compared to both waiting list and supportive counselling interventions. The quality of trials included was variable and sample sizes were often small. There was considerable clinical heterogeneity in the included studies and unexplained statistical heterogeneity observed in some comparisons. This suggests the need for caution in interpreting the results of this review. Additional high quality trials with longer follow up periods are required to further test TF-CBT and other forms of psychological intervention.
Copyright © 2010 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.
Keyword Randomized controlled-trial
Cognitive-behavioral therapy
Eye-movement desensitization
Rape victims
Prolonged exposure
Violent crime
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Publication status and date: Edited (no change to conclusions), published in Issue 4, 2010. Review content assessed as up-to-date: 31 July 2008. Citation: Roberts NP, Kitchiner NJ, Kenardy J, Bisson JI. Early psychological interventions to treat acute traumatic stress symptoms. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD007944. DOI: 10.1002/14651858.CD007944.pub2.

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2011 Collection
School of Medicine Publications
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Created: Sun, 04 Apr 2010, 00:06:30 EST