Early Intervention May Prevent the Development of PTSD: A Randomized Pilot Civilian Study with Modified Prolonged Exposure

• Type of Material: Article
• Authors: Barbara O Rothbaum, Emory University; Megan C. Kearns, Emory University; Matthew Price, Medical University of South Carolina; Emily Malcoun, Emory University; Michael E Davis, Emory University; Kerry Ressler, Emory University; Delia L Lang, Emory University; Debra E Houry, Emory University
• Language: English
• Date: 2012-12-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1016/j.biopsych.2012.06.002
• Title of Journal or Parent Work: Biological Psychiatry
• ISSN: 0006-3223
• Volume: 72
• Issue: 11
• Start Page: 957
• End Page: 963
• Grant/Funding Information: This study was supported by National Institute of Mental Health Grant No. R34 MH083078, “Effects of Early Psychological Intervention to Prevent PTSD”, and the Emory Center for Injury Control, Center for Disease Control Grant No. 5R49CE001494.
• Keywords: Acute Stress Disorder; memory consolidation; early intervention; prolonged exposure; secondary prevention; PTSD
• Research Categories: Health Sciences, Mental Health

Abstract

Background Posttraumatic stress disorder is a major public health concern with long term sequelae. There are no accepted interventions delivered in the immediate aftermath of trauma. This study tested an early intervention aimed at modifying the memory to prevent the development of PTSD prior to memory consolidation. Methods Patients (N=137) were randomly assigned to receive 3 sessions of an early intervention beginning in the emergency department (ED) compared to an assessment only control group. Posttraumatic stress reactions (PTSR) were assessed at 4 and 12 weeks post-injury and depression at baseline and week 4. The intervention consisted of modified prolonged exposure including imaginal exposure to the trauma memory, processing of traumatic material, and in vivo and imaginal exposure homework. Results Patients were assessed an average of 11.79 hours post-trauma. Intervention participants reported significantly lower PTSR than the assessment group at 4 weeks post-injury, p < 0.01, and at 12 weeks post-injury, p < 0.05, and significantly lower depressive symptoms at Week 4 than the assessment group, p < 0.05. In a subgroup analysis the intervention was the most effective at reducing PTSD in rape victims at Week 4 (p=.004) and Week 12 (p=.05). Conclusions These findings suggest that the modified prolonged exposure intervention initiated within hours of the trauma in the ED is successful at reducing PTSR and depression symptoms one and three months after trauma exposure and is safe and feasible. This is the first behavioral intervention delivered immediately post-trauma that has been shown to be effective at reducing PTSR.