Cognitive or Exposure Therapy Helps Prevent Post-Traumatic Stress Syndrome

People who are exposed to trauma are less likely to develop posttraumatic stress syndrome if they undergo therapy with a counselor or trauma-focused exposure therapy, according to a new study from Hadassah University Hospital in Jerusalem. Medication alone did not prevent the condition, and worked less well than doing nothing.

Posttraumatic stress syndrome is a debilitating mental condition that can develop after exposure to extreme trauma. Symptoms can be nightmares, panic attacks, sleep disturbance, repeated flashbacks to the incident, problems in anger management and relationships, and inability to meet everyday responsibilities at home, school or work.

Cognitive therapy is designed to help patients reframe their patterns of thinking in positive ways. In trauma-focused exposure therapy, a patient keeps talking about thoughts, feelings and situations that remind him of the original trauma in order to reduce its power to cause distress. Most people with posttraumatic stress syndrome avoid talking or thinking about the incident or incidents that caused the problem.

Dr. Arieh Shalew and his colleagues located about 200 adult survivors of traumatic events who had qualifying symptoms and signs of posttraumatic stress disorder. They divided the participants into five groups. One received trauma-focused exposure therapy, one received cognitive therapy, one group was the comparison of using the antidepressant Lexapro or a placebo, and the final group was put on a waiting list.

After five months, the research team reassessed the symptoms of the participants. The rates of posttraumatic stress syndrome were 58% for those on the waiting list, 21% for those who had exposure therapy, 18% in the cognitive therapy group, 62% in the Lexapro group, and 56% for those who had the placebo. Nine months later, the rates for each group were 21% exposure therapy, 23% cognitive therapy, 42% antidepressant therapy, and 47% among the placebo group.

“To our knowledge, this is the first comparative study of early and delayed cognitive behavioral interventions for post-traumatic stress syndrome,” the authors wrote. “Our findings suggest that delaying the intervention does not increase the risk of chronic PTSS. A delayed intervention is an acceptable option when early clinical interventions cannot be provided.”

The study was published in the Archives of General Psychiatry.