Early trauma-focused cognitive-behavioural therapy to prevent chronic post-traumatic stress disorder and related symptoms: A systematic review and meta-analysis

Abstract

Background: Early trauma-focused cognitive-behavioural therapy (TFCBT) holds promise as a preventive intervention for people at risk of developing chronic post-traumatic stress disorder (PTSD). The aim of this review was to provide an updated evaluation of the effectiveness of early TFCBT on the prevention of PTSD in high risk populations.

Preventative Psychosocial Interventions Following Traumatic Physical Injury: Who, What, When?

“…While Kornør et al [1] report significant effects across these studies at 3-6 month follow-up, such effects were not found at 9 months, or 3-4 years post-treatment. Although trends supported the relative efficacy of TFCBT, the results were inconclusive.…”

“…Both the Kornør et al [1] and De Silva et al [4] systematic reviews highlight the lack of fully reported and rigorously designed intervention studies, and so the findings of each of these reviews are necessarily tentative. It seems unclear who is most likely, if anyone, to benefit from preventative (as opposed to curative) psychosocial interventions for people who have received traumatic physical injuries; what sort of interventions might be most successful, and when is the optimum time to intervene to prevent disability, including mental health problems.…”

“…Kornør et al [1] sought to evaluate the effectiveness of trauma-focused cognitive behaviour therapy (TFCBT) in preventing chronic Post-Traumatic Stress Disorder (PTSD), anxiety and depression. They included randomised controlled trials (RCTs) published in peer reviewed journals; people with diagnosed symptoms of Acute Stress Disorder (ASD) or symptoms of PTSD; those who had received TFCBT initiated within three months of the identified traumatic event; a non-pharmacological comparison intervention; and where outcomes were measured at followup of a minimum of one month after treatment.…”

Apoyo psicológico en desastres: Propuesta de un modelo de atención basado en revisiones sistemáticas y metaanálisis

“…Los pacientes más graves, refractarios a los tratamientos basados en la evidencia, podrán ser sometidos a tratamientos de rescate en los Centros de Especialidad en TEPT. El objetivo es reservar la psicoterapia y farmacoterapia sólo para los pacientes con trastornos psiquiátricos formales, ya que es el único grupo que ha demostrado beneficiarse de estos tratamiento 25,27 . Para el resto de los afectados, incluyendo a aquellos con distrés subclínico, se recomienda limitar la atención a los llamados Primeros Auxilios Psicológicos 57 .…”

“…En vista de que no hay evidencia de que la psicoterapia o la farmacoterapia beneficie a todos los afectados por un desastre 25,27 , la atención a la población ubicada en los Centros de Afluencia de Público debería limitarse a brindar seguridad y confort, monitorizar el estado emocional, facilitar el retorno a las rutinas y orientar en el uso de los recursos disponibles, lo que se conoce como Primeros Auxilios Psicológicos 57 (Tabla 2). Éstos recomiendan no forzar a los afectados a hablar de sus sentimientos, ya que las intervenciones psicoterapéuticas que lo hacen, incluyendo el debreafing, no han demostrado reducir el desarrollo de trastornos psiquiátricos posteriores y peor aún podrían aumentarlos 43,[47][48][49]56 .…”