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Cited by 145Posttraumatic Stress Disorder ResearchPsychotherapy Techniques and ApplicationsPsychoanalysis and Psychopathology Research

Treatment of Acute Stress Disorder: A Randomized Controlled Trial

Bryant, Richard A., Mastrodomenico, Julie, Felmingham, Kim L., Hopwood, Sally, Kenny, Lucy, Kandris, Eva, Cahill, Catherine, Creamer, Mark·2008·Archives of General Psychiatry
DOI 10.1001/archpsyc.65.6.659
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Abstract

CONTEXT: Recent trauma survivors with acute stress disorder (ASD) are likely to subsequently develop chronic posttraumatic stress disorder (PTSD). Cognitive behavioral therapy for ASD may prevent PTSD, but trauma survivors may not tolerate exposure-based therapy in the acute phase. There is a need to compare nonexposure therapy techniques with prolonged exposure for ASD. OBJECTIVE: To determine the efficacy of exposure therapy or trauma-focused cognitive restructuring in preventing chronic PTSD relative to a wait-list control group. DESIGN, SETTING, AND PARTICIPANTS: A randomized controlled trial of civilians who experienced trauma and who met the diagnostic criteria for ASD (N = 90) seen at an outpatient clinic between March 1, 2002, and June 30, 2006. INTERVENTION: Patients were randomly assigned to receive 5 weekly 90-minute sessions of either imaginal and in vivo exposure (n = 30) or cognitive restructuring (n = 30), or assessment at baseline and after 6 weeks (wait-list group; n = 30). MAIN OUTCOME MEASURES: Measures of PTSD at the 6-month follow-up visit by clinical interview and self-report assessments of PTSD, depression, anxiety, and trauma-related cognition. RESULTS: Intent-to-treat analyses indicated that at posttreatment, fewer patients in the exposure group had PTSD than those in the cognitive restructuring or wait-list groups (33% vs 63% vs 77%; P = .002). At follow-up, patients who underwent exposure therapy were more likely to not meet diagnostic criteria for PTSD than those who underwent cognitive restructuring (37% vs 63%; odds ratio, 2.10; 95% confidence interval, 1.12-3.94; P = .05) and to achieve full remission (47% vs 13%; odds ratio, 2.78; 95% confidence interval, 1.14-6.83; P = .005). On assessments of PTSD, depression, and anxiety, exposure resulted in markedly larger effect sizes at posttreatment and follow-up than cognitive restructuring. CONCLUSIONS: Exposure-based therapy leads to greater reduction in subsequent PTSD symptoms in patients with ASD when compared with cognitive restructuring. Exposure should be used in early intervention for people who are at high risk for developing PTSD.

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  • Most prior interventions targeting psychological outcomes were not informed by psychological insights and proven psychotherapeutic approaches delivered by trained mental health professionals.

    “This may be because most prior interventions, while targeting psychological outcomes, were not informed by psychological insights and proven psychotherapeutic approaches to promote adjustment to stress, grief, and trauma (21-24) delivered by trained mental health professionals.”

    From EMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU (2024) · cites this paper as [21]

  • Surrogates who are anxious and/or emotionally dependent on the patient are at heightened risk of PTSD, Prolonged Grief Disorder, and other adverse longer-term psychological outcomes.

    “it targets surrogates who are anxious and/or emotionally dependent on the patient, thus placing them at heightened risk of PTSD, Prolonged Grief Disorder, and other adverse longer-term psychological outcomes (21, 22, 48, 61)”

    From EMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU (2024) · cites this paper as [21]

  • Abridged versions of TF-CBT (usually 5-6 sessions) for early intervention in people at high risk for PTSD were typically more efficacious than control conditions.

    “These programs evaluated abridged versions of TF-CBT (usually 5-6 sessions), and typically found that they were more efficacious than control conditions 128-132 .”

    From Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges (2019) · cites this paper as [129]

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Authors
Bryant, R. A., Mastrodomenico, J., Felmingham, K. L., Hopwood, S., Kenny, L., Kandris, E., Cahill, C., & Creamer, M.
Affiliations
UNSW Sydney (AU)
ORCID
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
2008-06-02
Volume
65
Issue
6
Pages
659
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archpsyc.65.6.659
OpenAlex
W2064468202
Cited by
145
References
54
Citations by year
2026: 4 · 2024: 5 · 2023: 4 · 2022: 5 · 2021: 6 · 2020: 4 · 2019: 7 · 2018: 5 · 2017: 5 · 2016: 6 · 2015: 11 · 2014: 8 · 2013: 13 · 2012: 16
FWCI
17.06
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • eCite Digital Repository (University of Tasmania) (submittedVersion)
Funders
  • Medical Research Council
  • National Health and Medical Research Council (300304)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
acute stress disorder, prolonged exposure therapy, imaginal exposure, in vivo exposure, trauma survivors, early intervention, depression, anxiety
MeSH terms
Accidents, Traffic, Adaptation, Psychological, Adult, Chronic Disease, Desensitization, Psychologic, Female, Humans, Male, Middle Aged, Personality Assessment, Risk Factors, Stress Disorders, Post-Traumatic, Violence, Cognitive Behavioral Therapy, Patient Satisfaction, Stress Disorders, Traumatic, Acute

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