Exposure Therapy Effective To Prevent Post-Traumatic Stress Disorder
The progression from acute stress disorder to post-traumatic stress
disorder may be prevented by exposure-based therapy, in which trauma
survivors are guided to relive a troubling event. These reults were
published in an article released on June 2, 2008 in the Archives
of General Psychiatry, one of the JAMA/Archives journals.
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.
generic synthroid online buy 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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Written by Anna Sophia McKenney
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