Exposure Therapy Effective To Prevent Post-Traumatic Stress Disorder
Acute stress disorder, sometimes called shock, involves the development of a strong stress response after a traumatic event. Symptoms are brought on when the sympathetic nervous system reacts, in the familiar fight or flight response. If this threat is perceived as unusually serious, a more intense and prolonged physiological response can results. The presence of shock after a traumatic event is linked to the subsequent development of post-traumatic stress disorder (PTSD), an anxiety disorder that involves prolonged reaction to the event or events. PTSD is associated with other mental and physical disorders, as well as a reduced quality of life and increased cost of health care.
Cognitive restructuring, which entails rebuilding the thoughts and responses to a traumatic event to be more accurate and beneficial for the patient, is one common form of therapy to help prevent PTSD in those with acute stress. Exposure therapy is another therapy used to this end in which the patient is re-exposed in some way to the source of the trauma, in the hopes of habituating the patient and thus decreasing the response. There is some evidence that many clinicians do not use the latter form of therapy because it can cause distress for recent survivors of trauma.
To investigate the effects of exposure therapy on acute stress disorder patients, especially as it relates to progression to PTSD, Richard A. Bryant, Ph.D., of the University of New South Wales, Sydney, Australia, and colleagues performed a randomized, controlled trial of patients who developed acute stress disorder following a motor vehicle crash or assault that was not sexual between March 2002 and June 2006. Of the 90 total participants, thirty were randomly assigned to receive treatment using exposure therapy, thirty were assigned to cognitive restructuring, and thirty were put on a wait-list for treatment. Each treatment regimen consisted of five weekly 90-minute sessions of therapy, and assessment as performed at the start of the study, after six weeks, and then six months after treatment.
The study was completed by 63 of the participants. After the completion of treatment, the following proportions of patients met the criteria for PTSD: in the exposure therapy group, 33% (10 patients,); in the cognitive restructuring group 63% (19 patients,) and in the wait-list group 77% (23 patients.) After the six month follow-up, 37% (11 patients) in the exposure therapy group met the criteria for PTSD in contrast with the 63% (19 patients) in the cognitive restructuring group. Additionally, in the exposure group, 47% (14 patients) achieved full remission, while only 13% (4 patients) achieved this in the cognitive group. In all, this indicates relative success on the part of exposure therapy to prevent PTSD.
The authors write that they are optimistic about exposure therapy in the prevention of PTSD, addressing the similar levels of participation in each group: "Despite some concerns that patients may not be able to manage the distress elicited by prolonged exposure, there was no difference in drop-out rates for the prolonged exposure and cognitive restructuring groups (17 percent vs. 23 percent)." Additionally, examination of distress ratings actually showed significant reduction in the exposure therapy group after the third therapy session.
The authors further postulate the reasons that exposure therapy may be more effective than cognitive restructuring: namely because it eases the overall anxiety associated with the memory, and dispels the belief that the memory should be avoided. Additionally, it provides a skill in the self control practiced during the exposure exercise. "The current findings suggest that direct activation of trauma memories is particularly useful for prevention of PTSD symptoms in patients with acute stress disorder," they conclude, fully endorsing the practice. "Exposure should be used in early intervention for people who are at high risk for developing PTSD."
Treatment of Acute Stress Disorder: A Randomized Controlled Trial
Richard A. Bryant; Julie Mastrodomenico; Kim L. Felmingham; Sally Hopwood; Lucy Kenny; Eva Kandris; Catherine Cahill; Mark Creamer
Arch Gen Psychiatry. 2008;65(6):659-667.
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