Psychological treatment of post-traumatic stress disorder (PTSD)

Bisson, JI; Andrew, Martin

doi:10.1002/14651858.cd003388

Cited by 179 publications

(226 citation statements)

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“…However, using the ASD diagnosis as a means to reduce the risk of PTSD remains a challenge due to limitations of screening, the lack of capacity to provide care, and the inconclusive evidence on the effectiveness of treatment [11]. In addition, it has been shown that therapies to minimize PTSD other than cognitive behavior therapy, such as behavioral activation, cognitive restructuring, counseling, relaxation therapy, stepped collaborative care, or structured writing interventions are largely ineffective [26]. While there remains a need to abstain from providing a clinical diagnosis of PTSD in absence of capacity to provide care, this reservation is not sufficient grounds to avoid routine screening for acute stress as it would detract from the capacity to understand broader contexts associated with recovery and how best to anticipate and respond to patient needs prior to and after discharge.…”

Section: Discussionmentioning

confidence: 99%

Routine versus ad hoc screening for acute stress following injury: who would benefit and what are the opportunities for prevention

Bell

Sobolev

Anderson

et al. 2014

J Trauma Manage Outcomes

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BackgroundScreening for acute stress is not part of routine trauma care owing in part to high variability of acute stress symptoms in identifying later onset of posttraumatic stress disorder (PTSD). The objective of this pilot study was to assess the sensitivity, specificity, and power to predict onset of PTSD symptoms at 1 and 4 months using a routine screening program in comparison to current ad hoc referral practice.MethodsProspective cross-sectional observational study of a sample of hospitalized trauma patients over a four-month period from a level-I hospital in Canada. Baseline assessments of acute stress (ASD) and subsyndromal ASD (SASD) were measured using the Stanford Acute Stress Reaction Questionnaire (SASRQ). In-hospital psychiatric consultations were identified from patient discharge summaries. PTSD symptoms were measured using the PTSD Checklist-Specific (PCL-S). Post-discharge health status and health services utilization surveys were also collected.ResultsRoutine screening using the ASD (0.43) and SASD (0.64) diagnoses were more sensitive to PTSD symptoms at one month in comparison to ad hoc referral (0.14) and also at four months (0.17, 0.33 versus 0.17). Ad hoc referral had greater positive predictive power in identifying PTSD caseness at 1 month (0.50) in comparison to the ASD (0.46) and SASD (0.43) diagnoses and also at 4 months (0.67 versus 0.25 and 0.29).ConclusionsAd hoc psychiatric referral process for acute stress is a more conservative approach than employing routine screening for identifying persons who are at risk of psychological morbidity following injury. Despite known limitations of available measures, routine patient screening would increase identification of trauma survivors at risk of mental health sequelae and better position trauma centers to respond to the circumstances that affect mental health during recovery.

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Section: Discussionmentioning

confidence: 99%

Routine versus ad hoc screening for acute stress following injury: who would benefit and what are the opportunities for prevention

Bell

Sobolev

Anderson

et al. 2014

J Trauma Manage Outcomes

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“…Clinical experience has shown that patients with subthreshold PTSD may profit from psychological coaching. Such coaching focuses on improvement of coping capacities, is widely used and results in reduced symptom severity and associated fear 9. Full PTSD requires so-called trauma focused therapies to reduce the degree of mental and physical impairment 22.…”

Section: Discussionmentioning

confidence: 99%

Post-traumatic stress in Crohn's disease and its association with disease activity

Cámara

Gander

Begré

et al. 2010

Frontline Gastroenterol

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ObjectiveViolence, accidents and natural disasters are known to cause post-traumatic stress, which is typically accompanied by fear, suffering and impaired quality of life. Similar to chronic diseases, such events preoccupy the patient over longer periods. We hypothesised that post-traumatic stress could also be caused by Crohn's disease (CD), and that CD specific post-traumatic stress could be associated with an increased risk of disease exacerbation.MethodsA cohort of CD patients was observed over 18 months in various types of locations providing gastroenterological treatment in Switzerland. The cohort included 597 consecutively recruited adults. At inclusion, CD specific post-traumatic stress was assessed using the Post-traumatic Diagnostic Scale (range 0–51 points). During follow-up, clinical aggravation was assessed by combining important outcome measures. Patients with post-traumatic stress levels suggestive of a post-traumatic stress disorder (≥ 15 points) were compared with patients with lower post-traumatic stress levels as well as with patients without post-traumatic stress. Also, the continuous relation between post-traumatic stress severity and risk of disease exacerbation was assessed.ResultsThe 88 (19.1%) patients scoring ≥15 points had 4.3 times higher odds of exacerbation (95% CI 2.6 to 7.2) than the 372 (80.9%) patients scoring <15 points, and 13.0 times higher odds (95% CI 3.6 to 46.2) than the 45 (9.8%) patients scoring 0 points. The odds of exacerbation increased by 2.2 (95% CI 1.6 to 2.8) per standard deviation of post-traumatic stress.ConclusionsCD specific post-traumatic stress is frequent and seems to be associated with exacerbation of CD. Thus gastroenterologists may want to ask about symptoms of post-traumatic stress and, where relevant, offer appropriate management according to current knowledge.

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“…To the best of our knowledge, no study had evaluated the effects of Eye Movement Desensitization and Reprocessing (EMDR®) on subjective sleep complaints and objective sleep pattern in PTSD patients. We chose to employ EMDR given the evidence that this treatment, together with trauma focused CBT, is effective in reducing clinician assessed PTSD symptoms (Van Etten and Taylor, 1998; Bisson and Andrew, 2007; Bisson et al, 2007; Rhudy et al, 2010). This psychotherapy involves alternated bilateral sensorial stimulation at the same time that the traumatic event is being processed (Shapiro, 1996).…”

Section: Introductionmentioning

confidence: 99%

Improvement of mood and sleep alterations in posttraumatic stress disorder patients by eye movement desensitization and reprocessing

Raboni

Alonso

Tufik

et al. 2014

Front. Behav. Neurosci.

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Posttraumatic stress disorder (PTSD) patients exhibit depressive and anxiety symptoms, in addition to nightmares, which interfere with sleep continuity. Pharmacologic treatment of these sleep problems improves PTSD symptoms, but very few studies have used psychotherapeutic interventions to treat PTSD and examined their effects on sleep quality. Therefore, in the present study, we sought to investigate the effects of Eye Movement Desensitization Reprocessing therapy on indices of mood, anxiety, subjective, and objective sleep. The sample was composed of 11 healthy controls and 13 PTSD patients that were victims of assault and/or kidnapping. All participants were assessed before, and 1 day after, the end of treatment for depressive and anxiety profile, general well-being and subjective sleep by filling out specific questionnaires. In addition, objective sleep patterns were evaluated by polysomnographic recording. Healthy volunteers were submitted to the therapy for three weekly sessions, whereas PTSD patients underwent five sessions, on average. Before treatment, PTSD patients exhibited high levels of anxiety and depression, poor quality of life and poor sleep, assessed both subjectively and objectively; the latter was reflected by increased time of waking after sleep onset. After completion of treatment, patients exhibited improvement in depression and anxiety symptoms, and in quality of life; with indices that were no longer different from control volunteers. Moreover, these patients showed more consolidated sleep, with reduction of time spent awake after sleep onset. In conclusion, Eye Movement Desensitization and Reprocessing was an effective treatment of PTSD patients and improved the associated sleep and psychological symptoms.

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Psychological treatment of post-traumatic stress disorder (PTSD)

Cited by 179 publications

References 0 publications

Routine versus ad hoc screening for acute stress following injury: who would benefit and what are the opportunities for prevention

Routine versus ad hoc screening for acute stress following injury: who would benefit and what are the opportunities for prevention

Post-traumatic stress in Crohn's disease and its association with disease activity

Improvement of mood and sleep alterations in posttraumatic stress disorder patients by eye movement desensitization and reprocessing

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