Does Early Psychological Intervention Promote Recovery From Posttraumatic Stress? - PubMed (original) (raw)
Does Early Psychological Intervention Promote Recovery From Posttraumatic Stress?
Richard J McNally et al. Psychol Sci Public Interest. 2003 Nov.
Abstract
In the wake of the terrorist attacks at the World Trade Center, more than 9,000 counselors went to New York City to offer aid to rescue workers, families, and direct victims of the violence of September 11, 2001. These mental health professionals assumed that many New Yorkers were at high risk for developing posttraumatic stress disorder (PTSD), and they hoped that their interventions would mitigate psychological distress and prevent the emergence of this syndrome. Typically developing in response to horrific, life-threatening events, such as combat, rape, and earthquakes, PTSD is characterized by reexperiencing symptoms (e.g., intrusive recollections of the trauma, nightmares), emotional numbing and avoidance of reminders of the trauma, and hyperarousal (e.g., exaggerated startle, difficulty sleeping). People vary widely in their vulnerability for developing PTSD in the wake of trauma. For example, higher cognitive ability and strong social support buffer people against PTSD, whereas a family or personal history of emotional disorder heightens risk, as does negative appraisal of one's stress reactions (e.g., as a sign of personal weakness) and dissociation during the trauma (e.g., feeling unreal or experiencing time slowing down). However, the vast majority of trauma survivors recover from initial posttrauma reactions without professional help. Accordingly, the efficacy of interventions designed to mitigate acute distress and prevent long-term psychopathology, such as PTSD, needs to be evaluated against the effects of natural recovery. The need for controlled evaluations of early interventions has only recently been widely acknowledged. Psychological debriefing-the most widely used method-has undergone increasing empirical scrutiny, and the results have been disappointing. Although the majority of debriefed survivors describe the experience as helpful, there is no convincing evidence that debriefing reduces the incidence of PTSD, and some controlled studies suggest that it may impede natural recovery from trauma. Most studies show that individuals who receive debriefing fare no better than those who do not receive debriefing. Methodological limitations have complicated interpretation of the data, and an intense controversy has developed regarding how best to help people in the immediate wake of trauma. Recent published recommendations suggest that individuals providing crisis intervention in the immediate aftermath of the event should carefully assess trauma survivors' needs and offer support as necessary, without forcing survivors to disclose their personal thoughts and feelings about the event. Providing information about the trauma and its consequences is also important. However, research evaluating the efficacy of such "psychological first aid" is needed. Some researchers have developed early interventions to treat individuals who are already showing marked stress symptoms, and have tested methods of identifying those at risk for chronic PTSD. The single most important indicator of subsequent risk for chronic PTSD appears to be the severity or number of posttrauma symptoms from about 1 to 2 weeks after the event onward (provided that the event is over and that there is no ongoing threat). Cognitive-behavioral treatments differ from crisis intervention (e.g., debriefing) in that they are delivered weeks or months after the trauma, and therefore constitute a form of psychotherapy, not immediate emotional first aid. Several controlled trials suggest that certain cognitive-behavioral therapy methods may reduce the incidence of PTSD among people exposed to traumatic events. These methods are more effective than either supportive counseling or no intervention. In this monograph, we review risk factors for PTSD, research on psychological debriefing, recent recommendations for crisis intervention and the identification of individuals at risk of chronic PTSD, and research on early interventions based on cognitive-behavioral therapy. We close by placing the controversy regarding early aid for trauma survivors in its social, political, and economic context.
© 2003 Association for Psychological Science.
Similar articles
- Immediate and early behavioral interventions for the prevention of acute and posttraumatic stress disorder.
Agorastos A, Marmar CR, Otte C. Agorastos A, et al. Curr Opin Psychiatry. 2011 Nov;24(6):526-32. doi: 10.1097/YCO.0b013e32834cdde2. Curr Opin Psychiatry. 2011. PMID: 21941180 Review. - [Post-traumatic stress disorder (PTSD): the syndrome with multiple faces].
Waddington A, Ampelas JF, Mauriac F, Bronchard M, Zeltner L, Mallat V. Waddington A, et al. Encephale. 2003 Jan-Feb;29(1):20-7. Encephale. 2003. PMID: 12640323 French. - The physician's role in managing acute stress disorder.
Kavan MG, Elsasser GN, Barone EJ. Kavan MG, et al. Am Fam Physician. 2012 Oct 1;86(7):643-9. Am Fam Physician. 2012. PMID: 23062092 - Post-traumatic stress disorder in victims of civilian trauma and criminal violence.
Davis GC, Breslau N. Davis GC, et al. Psychiatr Clin North Am. 1994 Jun;17(2):289-99. Psychiatr Clin North Am. 1994. PMID: 7937360 Review.
Cited by
- Psychological Clinical Science: Meeting the Challenge of Public Mental Health.
McNally RJ. McNally RJ. Clin Psychol Eur. 2024 Apr 26;6(Spec Issue):e12067. doi: 10.32872/cpe.12067. eCollection 2024 Apr. Clin Psychol Eur. 2024. PMID: 39118647 Free PMC article. - Screening Second Victims for Emotional Distress: Assessment of the Clinimetric Properties of the WITHSTAND-PSY Questionnaire.
Busch IM, Mazzi MA, Berti L, Wu AW, Cosci F, Marinelli V, Moretti F, Rimondini M. Busch IM, et al. Psychother Psychosom. 2023;92(6):399-409. doi: 10.1159/000535006. Epub 2023 Dec 20. Psychother Psychosom. 2023. PMID: 38118426 Free PMC article. - Evaluation of the Implementation of the NFFF Stress First Aid Intervention in Career Fire Departments: A Cluster Randomized Controlled Trial.
Jahnke SA, Watson P, Leto F, Jitnarin N, Kaipust CM, Hollerbach BS, Haddock CK, Poston WSC, Gist R. Jahnke SA, et al. Int J Environ Res Public Health. 2023 Nov 16;20(22):7067. doi: 10.3390/ijerph20227067. Int J Environ Res Public Health. 2023. PMID: 37998298 Free PMC article. Clinical Trial. - Family-authored ICU diaries to reduce fear in patients experiencing a cardiac arrest (FAID fear): A pilot randomized controlled trial.
Cornelius T, Mendieta M, Cumella RM, Lopez Veneros D, Tincher IM, Agarwal S, Kronish I. Cornelius T, et al. PLoS One. 2023 Jul 27;18(7):e0288436. doi: 10.1371/journal.pone.0288436. eCollection 2023. PLoS One. 2023. PMID: 37498834 Free PMC article. Clinical Trial. - Workplace mental health screening: a systematic review and meta-analysis.
Strudwick J, Gayed A, Deady M, Haffar S, Mobbs S, Malik A, Akhtar A, Braund T, Bryant RA, Harvey SB. Strudwick J, et al. Occup Environ Med. 2023 Aug;80(8):469-484. doi: 10.1136/oemed-2022-108608. Epub 2023 Jun 15. Occup Environ Med. 2023. PMID: 37321849 Free PMC article.
LinkOut - more resources
Full Text Sources