Questioning Blanket Support For Trauma Victims
Say a deadly campus shooting occurs. It might seem sensible to offer everyone on campus psychological support to prevent psychological repercussions, including posttraumatic stress disorder (PTSD).
However, a new review from Wales and Australia suggests the opposite: Researchers found no evidence to support offering interventions to everyone involved in a traumatic event. In fact, they found that some forms of blanket intervention might foster worse outcomes than no intervention whatsoever.
“Some experts argue everyone should be offered help. Others argue that only those considered at particular risk of developing a psychological disorder should be treated. This study attempted to examine whether any psychological intervention offered over more than one session was effective in preventing PTSD,” said lead author Dr. Neil Roberts, a psychologist and honorary senior research fellow with the University Hospital of Wales in Cardiff.
“The results found no evidence to support the use of an intervention offered to everyone,” he said. “There was some evidence that multiple session interventions may result in worse outcomes than no intervention for some individuals, although I don’t want to overplay the risk of harm. The effects for most interventions we studied were neutral; that is, treatment and control participants did equally well.”
The stakes are high. In some people, severe PTSD precipitates family breakdown, job loss and substance abuse.
Roberts’ team evaluated findings from 11 studies that tested diverse psychological interventions aimed at preventing PTSD after one-time traumatic events. Together the studies comprised 941 adult participants.
Participants included mothers who had experienced traumatic births, people in serious traffic accidents, persons involved in armed robberies involving violence and parents of children newly diagnosed with cancer.
Interventions fell into six categories including cognitive behavioral therapy (CBT), individual counseling, group therapy and adapted debriefing. The authors noted that counseling was the most often used intervention and that the evidence provided no support for its use to prevent PTSD. They said that no individual study showed a significant difference in favor of any treatment intervention in comparison to the control.
The new review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence based conclusions about medical practice after considering both the content and quality of existing trials on a topic.
Only one study reported adverse effects due to treatment. In that case, researchers found that individuals with a psychiatric history did worse at six-month follow up if they had received a counseling intervention than similar individuals who received none.
“Our study builds on the findings of previous research showing that a popular intervention —psychological debriefing — delivered in the first few days after trauma was not effective in preventing PTSD. Although many mental health professionals have stopped using debriefing as a result of this research, uncertainty has remained about best practices,” Roberts said.
His team found no evidence to support offering any type of intervention to everybody present at a traumatic incident. However, the review did show that interventions aimed at people showing early signs of PTSD was effective at preventing chronic PTSD. Roger Pitman, M.D., a professor of psychiatry at Harvard Medical School, considered the findings noteworthy.
“The results of this Cochrane review appear to establish limits for outreach efforts to trauma victims,” Pitman said. “Whereas it makes sense to inform them of the availability of therapy should they desire it, encouraging them to make use of it may be imprudent, unless there’s clear evidence of psychiatric symptoms.”
Meaghan O’Donnell, Ph.D., a clinical psychologist and senior research fellow with the Australian Centre for Posttraumatic Mental Health at the University of Melbourne, also deemed the review’s findings important.
“After a traumatic event, most people will experience high levels of distress. This review shows us that despite this distress, most people will not need intervention from a mental health professional,” O’Donnell said. “It also tells us that by identifying those people facing high risk for developing later PTSD, early cognitive behavioral therapy is very useful in preventing chronic PTSD.”
The review called for further research to evaluate the best ways to provide psychological help soon after a traumatic event. Both O’Donnell and Pitman concur: “Early intervention is dependent on effective screening instruments to help target treatments, and we need more research to establish screening instruments that will identify high-risk trauma survivors,” O’Donnell said. “Furthermore, we need to find out whether other psychiatric or psychological interventions are as useful as cognitive behavioral therapy in preventing chronic PTSD.”
These findings might reassure trauma survivors. This research clearly showed mental health professionals what not to do — offer counseling to everyone, and provides guidelines about best practices to prevent chronic PTSD — provide CBT for those with serious early PTSD symptoms. This information could help trauma survivors on their road to recovery.