Exposure therapy may help prevent post-traumatic stress disorder
Exposure-based therapy, in which
recent trauma survivors are instructed to relive the troubling event,
may be effective in preventing the progression from acute stress
disorder to post-traumatic stress disorder, according to a report in
the June issue of Archives of General Psychiatry, one of the
JAMA/Archives journals.
Individuals who develop acute stress
disorder during or soon after a traumatic event are likely to
subsequently develop post-traumatic stress disorder (PTSD), according
to background information in the article. PTSD is associated with other
mental and physical illnesses, a reduced quality of life and increased
health care costs. Both exposure therapy and cognitive restructuring,
which focuses on changing maladaptive thoughts and responses to a
traumatic event, have been used as early interventions to prevent PTSD
in those with acute stress disorder. However, there is evidence that
some clinicians do not use exposure therapy because it causes distress
for recent trauma survivors.
Richard A. Bryant, Ph.D., of the
University of New South Wales, Sydney, Australia, and colleagues
conducted a randomized controlled trial involving 90 patients who
developed acute stress disorder following a non-sexual assault or motor
vehicle crash between March 2002 and June 2006. Thirty participants
each were randomly assigned to five weekly 90-minute sessions of
exposure therapy or cognitive restructuring, while the remaining 30
were put on a waitlist for treatment. All the patients were assessed at
the beginning of the study, after six weeks and six months following
treatment.
Sixty-three participants completed the study. After
completing treatment, fewer patients in the exposure therapy group (10,
or 33 percent) met criteria for PTSD than patients in the cognitive
restructuring group (19, or 63 percent) or the wait-list group (23, or
77 percent). At the six-month follow-up, fewer patients in the exposure
therapy group (11, or 37 percent) met criteria for PTSD than patients
in the cognitive restructuring group (19, or 63 percent), and 14
patients (47 percent) in the exposure group vs. four patients (13
percent) in the cognitive restructuring group achieved full remission.
"Despite
some concerns that patients may not be able to manage the distress
elicited by prolonged exposure, there was no difference in drop-out
rates for the prolonged exposure and cognitive restructuring groups (17
percent vs. 23 percent)," the authors write. In addition, distress
ratings were more significantly reduced in the exposure therapy group
than the cognitive restructuring group after three sessions.
Exposure
therapy may be more effective than cognitive restructuring because it
eases the anxiety associated with the traumatic memory and corrects the
belief that the memory must be avoided, in addition to encouraging
self-control by managing the exposure exercise, the authors note. "The
current findings suggest that direct activation of trauma memories is
particularly useful for prevention of PTSD symptoms in patients with
acute stress disorder," they conclude. "Exposure should be used in
early intervention for people who are at high risk for developing
PTSD."
Source
Arch Gen Psychiatry. 2008;65[6]:659-667.
