Cognitive-behavioural therapy modestly reduces post-traumatic stress symptoms resulting from physical injury

摘要

Bisson's early cognitive-behavioural intervention study is an important step in delineating the necessary amount and timing of effective interventions following trauma. Whereas earlier RCTs of cognitive behavioural interventions studied individuals diagnosed with ASD, and were initiated within one month of the traumatic incident,' this study reduced the intervention length, started treatment at a later post-trauma phase (5-10 weeks), and did not require a diagnosis of ASD for inclusion. As Bisson states, because the findings in this study are not as robust as in previous studies, it may be that four 1 hour sessions are not sufficient to prevent chronic adjustment difficulties following trauma. His intervention did not significantly reduce anxious or depressive symptoms, further clarifying possible additional treatment components that may be necessary to improve outcome. Taking a phased and modular approach to the post-trauma situation might be the most effective response to the needs of individuals, with the important caveat of taking into account the resources available.In regards to resources, particularly in the area of disasters and mass violence, there is a strong need for efficient, effective early interventions. Recent controversy regarding the lack of effectiveness of one time interventions in preventing post-trauma psychological distress means that this type of research is critical for drawing the boundaries of effective care. Possible next steps to Bisson's intervention would be implementation in mass violence settings, traumatically bereaved populations, and different timeframes following trauma. His positive findings point to a need for larger scale training of therapists in these types of interventions, so that resources in the community will be available as needed. Also critical is finding the appropriate timing for the intervention. Recent expert consensus recommendations for interventions following mass violence suggest that structured cognitive-behavioural interventions not be implemented until secondary stressors in the environment are under sufficient control to allow the individual to focus on the intervention (usually not sooner than three weeks after incident).2 Bisson's use of this intervention suggests that it can have an impact within the 5-10 week window. In conducting such high quality randomised controlled early intervention trials, Bisson continues to be a key player in moving the field forward.