Early trauma-focused cognitive-behavioural therapy to prevent chronic post-traumatic stress disorder and related symptoms: a systematic review and meta-analysis
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BACKGROUND: Early trauma-focused cognitive-behavioural therapy (TFCBT) holds promise as a preventive intervention for people at risk of developing chronic post-traumatic stress disorder (PTSD). The aim of this review was to provide an updated evaluation of the effectiveness of early TFCBT on the prevention of PTSD in high risk populations. METHODS: We performed a systematic literature search in international electronic databases (MEDLINE, EMBASE, PsycINFO, CENTRAL, CINAHL, ISI and PILOTS) and included randomised controlled trials comparing TFCBT delivered within 3 months of trauma, to alternative interventions. All included studies were critically appraised using a standardised checklist. Two independent reviewers selected studies for inclusion and assessed study quality. Data extraction was performed by one reviewer and controlled by another. Where appropriate, we entered study results into meta-analyses. RESULTS: Seven articles reporting the results of five RCTs were included. All compared TFCBT to supportive counselling (SC). The study population was patients with acute stress disorder (ASD) in four trials, and with a PTSD diagnosis disregarding the duration criterion in the fifth trial. The overall relative risk (RR) for a PTSD diagnosis was 0.56 (95% CI 0.42 to 0.76), 1.09 (95% CI 0.46 to 2.61) and 0.73 (95% CI 0.51 to 1.04) at 3-6 months, 9 months and 3-4 years post treatment, respectively. A subgroup analysis of the four ASD studies only resulted in RR = 0.36 (95% CI 0.17 to 0.78) for PTSD at 3-6 months. Anxiety and depression scores were generally lower in the TFCBT groups than in the SC groups. CONCLUSION: There is evidence for the effectiveness of TFCBT compared to SC in preventing chronic PTSD in patients with an initial ASD diagnosis. As this evidence originates from one research team replications are necessary to assess generalisability. The evidence about the effectiveness of TFCBT in traumatised populations without an ASD diagnosis is insufficient.
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Three reviews synthesised and compared results from studies that had used risk screening tools and studies that had not used risk screening tools to identify participants for inclusion.
“Three of these reviews synthesised and compared results from studies that had used risk screening tools and studies that had not used risk screening tools to identify participants for inclusion.42 73 77”
From Impact of healthcare interventions on distress following acute musculoskeletal/orthopaedic injury: A scoping review of systematic reviews (2024) · cites this paper as [42]
The Methods (Data synthesis) describe pooling trial results, and the Discussion compares a subgroup of trials requiring an acute stress disorder diagnosis with a trial using a PTSD diagnosis for inclusion. The paper does not describe this as a comparison between studies that used risk-screening tools and studies that did not. (LLM, conf=0.78)
Experimental — accuracy not yet measuredFive reviews had inclusion criteria requiring studies to have included participants on the basis of identified risk or analysed these studies separately from studies that did not have such inclusion criteria.
“Five reviews had inclusion criteria requiring studies to have included participants on the basis of identified risk or analysed these studies separately from studies that did not have such inclusion criteria.41 42 73 77 78”
From Impact of healthcare interventions on distress following acute musculoskeletal/orthopaedic injury: A scoping review of systematic reviews (2024) · cites this paper as [42]
In five reviews of psychological interventions, higher levels of risk were a criterion for study inclusion.
“In five reviews of psychological interventions, higher levels of risk were a criterion for study inclusion.41 42 73 77 78”
From Impact of healthcare interventions on distress following acute musculoskeletal/orthopaedic injury: A scoping review of systematic reviews (2024) · cites this paper as [42]
Meta-analytic studies support the utility of early targeted intervention to limit later PTSD.
“Meta-analytic studies have supported the utility of early targeted intervention to limit later PTSD 133,134 .”
From Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges (2019) · cites this paper as [133]
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- Authors
- Kornør, H., Winje, D., Ekeberg, Ø., Weisæth, L., Kirkehei, I., Johansen, K., & Steiro, A.
- Affiliations
- Nasjonalt Kunnskapssenter for Helsetjenesten (NO)
- University of Bergen (NO)
- University of Oslo (NO)
- Norwegian Centre for Violence and Traumatic Stress Studies (NO)
- Corresponding author
- Kornør, Hege
- Venue
- BMC Psychiatry
- Published
- 2008-09-19
- Volume
- 8
- Issue
- 1
- Pages
- 81-81
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC2559832
- OpenAlex
- W2153338539
- Cited by
- 106
- References
- 20
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 9 · 2020: 5 · 2019: 7 · 2018: 4 · 2017: 7 · 2016: 6 · 2015: 7 · 2014: 8 · 2013: 7 · 2012: 10
- FWCI
- 1.26
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- BIBSYS Brage (BIBSYS (Norway)) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- trauma-focused cognitive behavioral therapy, post-traumatic stress disorder prevention, acute stress disorder, supportive counseling, chronic PTSD, anxiety, depression, vulnerable populations
- MeSH terms
- Anxiety Disorders, Chronic Disease, Depressive Disorder, Humans, Stress Disorders, Post-Traumatic, Time Factors, Cognitive Behavioral Therapy
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