Psychological interventions may have adverse effects in post-traumatic stress disorder

January 01, 0001

Psychological interventions may have adverse effects in post-traumatic stress disorder

Clinical Question:How effective are multiple session early psychological interventions for the prevention of post-traumatic stress disorder (PTSD)?

Bottom line: The results suggest no psychological intervention can be recommended for routine use following traumatic events, and multiple session interventions, like single session interventions, may have an adverse effect (increased self-report of PTSD symptoms at 3 to 6 months' follow-up) for some individuals. The clear practice implication of this is that, at present, multiple session interventions aimed at all individuals exposed to traumatic events should not be used.

Caveat: The methodological quality of many of the studies included was poor. Many studies did not provide full details of the method of allocation and some bias was considered possible from the descriptions in 7 studies. Many studies did not provide full details of the method of randomisation, and therefore concealment was unclear or inadequate in 8 studies

Context: The prevention of long term psychological distress following traumatic events is a major concern. Systematic reviews have suggested individual psychological debriefing is not an effective intervention for preventing PTSD. Recently, other forms of preventive intervention have been developed: counselling, cognitive behavioural therapy, memory structuring interventions, critical incident stress debriefing and collaborative care interventions.

Cochrane Systematic Review: Roberts NP et al. Multiple session early psychological interventions for the prevention of post-traumatic stress disorder. Cochrane Reviews 2009, Issue 3. Article No. CD006869. DOI:10.1002/14651858.CD006869.pub2. This review contains 11 studies involving 941 participants.

Cochrane PEARLS Practical Evidence About Real Life Situations. No. 207, November 2009.
Written by Brian R McAvoy. Published by the Cochrane Primary Care Group

Category: P. Psychological. Keywords: post-traumatic stress disorder, PTSD, psychological interventions, adverse effects
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 30 March 2010

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Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.