Few effective, evidence-based interventions to prevent posttraumatic stress disorder, review finds

Despite this high rate of exposure, little is known about the effectiveness of treatments aimed at preventing and relieving posttraumatic stress symptoms that adults may experience after such events, according to researchers at the RTI-UNC Evidence-based Practice Center.

The article, published online today by the American Journal of Preventive Medicine, summarizes the results of a systematic review of clinical interventions for adults exposed to at least one traumatic event such as war, a natural or human-made disaster, motor vehicle accidents, community violence, sexual assault or domestic violence. The U.S. Agency for Healthcare Research and Quality funded the review.

After reviewing 2,563 abstracts, the investigators found 19 studies that met the criteria for inclusion in the review. Only two psychotherapeutic treatments showed possible benefits for adults exposed to trauma. Cognitive behavioral therapy (CBT) in particular was found to be more effective than another type of therapy called supportive counseling for individuals exposed to a traumatic event and who meet the diagnostic criteria for another trauma-related syndrome, Acute Stress Disorder. In addition, a type of therapy called collaborative care (care management, evidence-based pharmacologic interventions, and components of CBT) showed promise to reduce severity of symptoms based on one study.

"Unfortunately, because this body of evidence is so small, the generalizability of these findings is not known," said Catherine A. Forneris, PhD, ABPP, professor in the Department of Psychiatry in the UNC School of Medicine. "Much more research is needed before we can make definitive conclusions.

Gerald Gartlehner, MD, MPH, of RTI International and Danube University, agrees, "Clinicians and patients should know have to be aware that while there are many treatments offered for the prevention of PTSD, many lack sufficient scientific evidence. not based on scientific evidence. Without sound studies, there is great uncertainty whether traumatized people actually receive the best care."

The authors recommend immediate attention from funding agencies, clinicians, researchers, policymakers, and other public health authorities to support further, well-designed research that can broaden the evidence base. They suggest that future studies expand their examination of the impact of trauma interventions to a wider range of outcomes such as risk-taking behaviors and suicidality and focus on longer-term indicators of development and functioning.