Materiały źródłowe

• #1 Prevention of Post-Traumatic Stress Disorder After Trauma: Current Evidence and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4723637/

  Post-traumatic stress disorder (PTSD) is a frequent, tenacious, and disabling consequence of traumatic events. The disorders identifiable onset and early symptoms provide opportunities for early detection and prevention. […] Controlled studies have shown that theory-driven preventive interventions, such as cognitive behavioral therapy (CBT), or stress hormone-targeted pharmacological interventions, are efficacious in selected samples of survivors. However, the effectiveness of early clinical interventions remains unknown, and results obtained in aggregates (large groups) overlook individual heterogeneity in PTSD pathogenesis. We review current evidence of PTSD prevention and outline the need to improve the disorders early detection and intervention in individual-specific paths to chronic PTSD.

• #1 Prevention – Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK201092/

  Prevention of posttraumatic stress disorder (PTSD) in active-duty and veteran populations is important to support their overall health and well-being, to preserve personnel resources, and to maximize force readiness. This chapter examines prevention of and prophylaxis for PTSD in active-duty and veteran populations. […] Prevention is broadly defined as measures taken to avoid the occurrence of disease or interventions that are applied before the onset of a clinically diagnosable disorder with the aim of reducing the number of new cases of that disorder. […] Prevention of PTSD in active-duty personnel is provided via programs aimed at preparing service members for combat and other deployment-related stressors. […] Other prevention efforts seek to detect and treat disorder in its early stages (for example, treat those who meet the criteria for acute stress disorder [ASD]) often before it presents clinically as chronic PTSD.

• #1 PTSD (Post-Traumatic Stress Disorder): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/9545-post-traumatic-stress-disorder-ptsd

  You cant necessarily prevent a traumatic event. But some studies show that certain steps may help you prevent PTSD afterward. These are called protective factors and include: […] Seeking support from others after the event, such as friends and family. This helps establish a sense of security. […] Joining a support group after a traumatic event. […] Learning to feel positive about your actions in the face of danger. […] Having a healthy coping strategy after the traumatic event. […] Being able to act and respond effectively despite feeling fear. […] Helping other people, especially if its a traumatic event that affected several people, like a natural disaster.

• #1 Post-traumatic Stress Disorder in Children | Children’s Mental Health | CDC

  https://www.cdc.gov/children-mental-health/about/post-traumatic-stress-disorder-in-children.html

  When children develop long-term symptoms from stress due to a traumatic event, which are upsetting or interfere with their relationships and activities, they may have post-traumatic stress disorder (PTSD). […] It is important to emphasize that not all children and adolescents exposed to traumatic events will develop PTSD. […] Preventing risks for trauma, like maltreatment, violence, or injuries, or lessening the impact of unavoidable disasters on children, can help protect a child from PTSD.

• #1 Posttraumatic stress disorder: from diagnosis to prevention | Military Medical Research | Full Text

  https://mmrjournal.biomedcentral.com/articles/10.1186/s40779-018-0179-0

  Posttraumatic stress disorder (PTSD) is a chronic impairment disorder that occurs after exposure to traumatic events. […] Prevention and treatment methods for PTSD vary from psychological interventions to pharmacological medications. […] Future investigations are needed to determine which guideline or inspection method is the best for early diagnosis and which strategies might prevent the development of PTSD. […] Current approaches to PTSD prevention span a variety of psychological and pharmacological categories, which can be divided into three subgroups: primary prevention (before the traumatic event, including prevention of the event itself), secondary prevention (between the traumatic event and the development of PTSD), and tertiary prevention (after the first symptoms of PTSD become apparent).

• #1 Prevention – Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK201092/

  Several studies have demonstrated that early interventions for ASD result in significant reductions of ASD symptoms and the prevention of the onset of PTSD in the majority of individuals treated. […] Prophylactic interventions can be implemented immediately after a trauma (within 48 hours) or during the acute period (within weeks) to prevent full onset of PTSD symptoms, although the efficacy of this approach is unknown. […] The latter type of PTSD prevention includes interventions in patients who have subthreshold PTSD symptoms, ASD, and ancillary problems; it provides treatment for clinical PTSD and recurrence prevention through rehabilitation programs. […] Prevention is considered here in three phases: Interventions that are applied to an entire population before a traumatic event and regardless of the potential for exposure.

• #1 Adult Prevention and Early Treatment for PTSD | International Society for Traumatic Stress Studies

  https://istss.org/clinical-resources/trauma-treatment/adult-prevention-and-early-treatment-for-ptsd/

  Adult Prevention and Early Treatment for PTSD […] In the field of prevention and early intervention for PTSD, who receives an intervention and when is just as important as the intervention itself. ISTSS published its most recent Posttraumatic Stress Disorder Prevention and Treatment Guidelines in 2018 to assist clinicians who provide prevention and treatment interventions for children and adults with or at risk of developing PTSD and Complex PTSD. […] These guidelines are organized based on the Institute of Medicine’s classification of prevention, with the addition of early treatment, to provide further clinical insight into who should receive early preventative interventions and early treatment and when they should be administered. […] Universal interventions target everyone exposed to a traumatic event to intervene before PTSD develops. […] Selective/Indicated interventions target people with higher initial symptoms to prevent the development of PTSD. […] Early treatment targets people who experience clinically significant PTSD symptoms or have developed early PTSD (within 3 months of traumatic event).

• #1

  https://www.who.int/news-room/fact-sheets/detail/post-traumatic-stress-disorder

  Feeling supported by family, friends or other people following the potentially traumatic event can reduce the risk of developing PTSD. […] Receiving social support following potentially traumatic events can reduce the risk for PTSD. […] There are many effective treatments for PTSD. […] The psychological interventions with the most evidence for effective treatment of PTSD are those based on cognitive behavioural therapy with a trauma focus and eye movement desensitization and reprocessing (EMDR). […] Self-care can have an important role in supporting treatment for PTSD.

• #1 Post-traumatic stress disorder (PTSD) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967

  Getting timely help and support may prevent usual stress reactions from getting worse and leading to PTSD. […] This may mean turning to family and friends who will listen and offer comfort. […] It also may mean seeking out a mental health professional for a brief course of therapy. […] Some people also may find it helpful to turn to their faith communities. […] Support from others also may prevent you from turning to unhealthy coping methods, such as misusing alcohol or drugs.

• #1 Preventing PTSD

  https://worksafe.tas.gov.au/topics/Health-and-Safety/health-and-wellbeing/wellbeing-a-z/mental-health/PTSD-Post-Traumatic-Stress-Disorder/preventing-ptsd

  Not everyone who experiences a potentially traumatic event will develop PTSD. […] Protective factors at the individual level that may prevent PTSD from developing or reduce how severe it is include: being in continuous contact with and getting support from important people in your life, identifying as a survivor as opposed to a victim, engaging in activities that promote positive emotions, finding positive meaning in the trauma, helping others in their healing process, holding the belief that you can manage your feelings and cope. […] Protective factors at the workplace level that may prevent someone from developing PTSD or reduce how severe it is include: psychologically safe working environment where psychosocial risks are identified and adequately controlled. This includes having controls in place for roles that may be directly or indirectly exposed to potentially traumatic events such as occupational violence or dealing with objectionable material, effective supervisors and understanding colleagues. A functional and supportive team environment protects people against psychological harms, workplace-based early intervention pathways that are clear and accessible to everyone in the workplace.

• #1 Interventions for the Prevention of Post-traumatic Stress Disorder in Adults After Exposure to Psychological Trauma | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/ptsd-adults-trauma-interventions/research-protocol

  Interventions for the Prevention of Post-traumatic Stress Disorder in Adults After Exposure to Psychological Trauma […] Specific psychological interventions that have been studied for the prevention of adult PTSD are described below and include the following: psychological debriefing interventions, including critical incident stress debriefing (CISD) and critical incident stress management (CISM); psychological first aid (PFA); trauma-focused cognitive-behavioral therapy (CBT); cognitive restructuring therapy; cognitive processing therapy; exposure-based therapies; coping skills therapy (including stress inoculation therapy); psychoeducation; normalization; and eye movement desensitization and reprocessing (EMDR). These therapies are designed to prevent the onset of PTSD and development of trauma-related stress symptoms soon after exposure to a traumatic event.

• #1 Interventions for the Prevention of Post-traumatic Stress Disorder in Adults After Exposure to Psychological Trauma | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/ptsd-adults-trauma-interventions/research-protocol

  Psychological debriefing interventions aim to educate victims about normal reactions to trauma and to encourage them to share their experiences and emotional responses to the event. Debriefing is typically offered in a single session within hours or days after the event to everyone exposed to the event. Although several variations of these single-session interventions have been tested, the most common form of psychological debriefing is CISD. […] CISD is a secondary prevention intervention originally developed for use with individuals indirectly exposed to traumatic events because of their occupation, such as firefighters or emergency medical personnel. CISD is administered in a single 3- to 4-hour session by a team composed of individuals familiar with the organization (e.g., officers within a police department) and mental health professionals. In addition to helping normalize the responses of individuals to stress and encouraging them to talk about their experiences and reactions, the team teaches coping skills and offers additional resources for those who may need it. By design, the CISD approach is flexible and loosely structured. CISD was not designed to prevent PTSD; nonetheless, it has been applied directly to victims of trauma despite evidence that it may be ineffective for that purpose and actually may have harmful effects.

• #1 Post-traumatic stress disorder – Wikipedia

  https://en.wikipedia.org/wiki/Post-traumatic_stress_disorder

  Prevention may be possible when counselling is targeted at those with early symptoms, but is not effective when provided to all trauma-exposed individuals regardless of whether symptoms are present. […] The World Health Organization recommends against the use of benzodiazepines and antidepressants in for acute stress (symptoms lasting less than one month). […] Trauma focused intervention delivered within days or weeks of the potentially traumatic event has been found to decrease PTSD symptoms. […] Risk-targeted interventions are those that attempt to mitigate specific formative information or events. […] Psychological debriefing is unhelpful, is potentially harmful and does not reduce the future risk of developing PTSD. […] Early intervention is aimed at preventing new-onset or relapsed mental disorders and further distress later in the healing process.

• #1 Interventions for the Prevention of Posttraumatic Stress Disorder (PTSD) in Adults After Exposure to Psychological Trauma – Sheps Center

  https://www.shepscenter.unc.edu/2018/05/24/interventions-for-the-prevention-of-posttraumatic-stress-disorder-ptsd-in-adults-after-exposure-to-psychological-trauma/

  Interventions for the Prevention of Posttraumatic Stress Disorder (PTSD) in Adults After Exposure to Psychological Trauma. […] To assess efficacy, comparative effectiveness, and harms of psychological, pharmacological, and emerging interventions to prevent posttraumatic stress disorder (PTSD) in adults. […] For most interventions studied, we did not find reliable evidence to support efficacy for the prevention of PTSD or for the reduction of PTSD-related symptom severity. […] First, debriefing does not reduce either the incidence or the severity of PTSD or related psychological symptoms in civilian victims of crime, assault, or accident trauma (low SOE). […] Second, our meta-analyses of three trials showed that, in subjects with acute stress disorder, brief trauma-focused cognitive behavioral therapy (CBT) was more effective than supportive counseling (SC) in reducing the severity of PTSD (moderate SOE).

• #1 Interventions for the Prevention of Post-traumatic Stress Disorder in Adults After Exposure to Psychological Trauma | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/ptsd-adults-trauma-interventions/research-protocol

  CISM incorporates additional methods such as pre-incident training for people with high-risk occupations, one-on-one individual crisis support, demobilizing (i.e., information about coping and stress to large groups of emergency workers as they rotate off duty), and defusing (small-group interventions during which participants are asked to explore and discuss the incident and their emotional reactions to it). CISM also has a family support component whereby family members of the emergency personnel are debriefed. Lastly, there are additional procedures for referring people for psychological services. […] PFA is a systematic set of helping actions aimed at reducing initial post-trauma distress and supporting short- and long-term adaptive functioning. PFA is designed as an initial component of a comprehensive disaster/trauma response, and it is constructed around eight core actions: (1) contact and engagement, (2) safety and comfort, (3) stabilization, (4) information gathering, (5) practical assistance, (6) connection with social supports, (7) information on coping support, and (8) linkage with collaborative services. PFA is intended for use by disaster mental health responders, counselors, and others who may provide immediate support for trauma survivors.

• #1 Posttraumatic Stress Disorder Treatment & Management: Approach Considerations, Long-Term Monitoring, Consultations

  https://emedicine.medscape.com/article/288154-treatment

  Secondary prevention consists of interventions designed to decrease the rate of posttraumatic stress disorder (PTSD) in individuals exposed to traumatic events. […] While no definitive studies exist, it is commonly believed that Psychological First Aid (PFA) may decrease rates of PTSD following a natural disaster or mass casualty situation. […] High levels of emotional support and help with basic needs for shelter, food, clothing, and economic issues likely decrease the risk of PTSD. […] Trauma-focused CBT and eye movement desensitization and reprocessing (EMDR) have been shown to be most effective in treating patients with PTSD. […] In 2013, the World Health Organization (WHO) issued new clinical protocols and guidelines for addressing the mental health consequences of PTSD, acute stress, and bereavement.

• #1

  https://link.springer.com/article/10.1007/s11920-015-0655-0

  Trauma-focused CBT can involve different strategies with distinct aims. […] Trials of exposure-based CBT have generally demonstrated moderately positive results in reducing PTSD or other symptoms in the long term. […] CBT is currently the mainstay of early prevention of PTSD. […] Several considerations, however, make its systematic implementation a major challenge. […] A meta-analysis of early interventions has indicated that CBT is only efficient in participants with diagnosable PTSD at treatment onset. […] CBT is consequently best positioned as a clinical intervention for identified and ascertained acute PTSD cases. […] Various pharmacological agents have been examined in the prevention of post-traumatic symptoms. […] A Cochrane review in 2014 concluded that in general, there is moderate quality evidence for the efficacy of hydrocortisone, and no evidence for propranolol, escitalopram, temazepam, and gabapentin.

• #1 Prevention of Post-Traumatic Stress Disorder After Trauma: Current Evidence and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4723637/

  Trials of exposure-based CBT have generally demonstrated moderately positive results in reducing PTSD or other symptoms in the long term. […] CBT is currently the mainstay of early prevention of PTSD. […] A meta-analysis of early interventions has indicated that CBT is only efficient in participants with diagnosable PTSD at treatment onset, and results from the Jerusalem Trauma Outreach and Prevention Study (J-TOPS) have similarly shown that survivors with sub-threshold PTSD symptoms equally recover with or without CBT. […] CBT is consequently best positioned as a clinical intervention for identified and ascertained acute PTSD cases. […] Various pharmacological agents have been examined in the prevention of post-traumatic symptoms. […] A Cochrane review in 2014 concluded that in general, there is moderate quality evidence for the efficacy of hydrocortisone, and no evidence for propranolol, escitalopram, temazepam, and gabapentin.

• #1 Adult Prevention and Early Treatment for PTSD | International Society for Traumatic Stress Studies

  https://istss.org/clinical-resources/trauma-treatment/adult-prevention-and-early-treatment-for-ptsd/

  Current evidence suggests it is important to target interventions to the population at risk with higher symptoms for greatest treatment efficacy, given that these people are most likely to develop PTSD. […] Research suggests that selective/indicated interventions focusing on social support, skill building, cognitive restructuring, and therapeutic exposure may be most effective for those who are at risk for PTSD or demonstrating early symptoms, but do not yet meet criteria for a trauma-related disorder. […] There is a strong body of literature suggesting the efficacy of CBT with a trauma focus (which typically involves components of CBT and imaginal and graded in vivo exposure), cognitive therapy, and EMDR for those experiencing clinically significant PTSD symptoms or those who have developed early PTSD (within three months of trauma exposure).

• #1 Interventions for the Prevention of Post-traumatic Stress Disorder in Adults After Exposure to Psychological Trauma | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/ptsd-adults-trauma-interventions/research-protocol

  The implications of these various theories provide a rationale for a myriad of early intervention strategies, but they are only one part of the puzzle. Variability of types of trauma, contexts in which they occur, and individual differences of those exposed to traumatic events are likely to prohibit a one-size-fits-all model for preventive intervention. […] Various neurobiological pathways have been implicated in the development of PTSD. Accordingly, pharmacotherapy has been tried as a preventive intervention for PTSD. Several drugs have been studied for PTSD prevention including propranolol, morphine, glucocorticoids, and selective serotonin-reuptake inhibitors (SSRIs). […] Propranolol, a beta-adrenergic antagonist that crosses the blood-brain barrier, has been evaluated in several studies for its ability to prevent PTSD. So far results have failed to show any clear benefit of propranolol, when compared with placebo, in reducing physiological reactivity during traumatic imagery, severity of PTSD symptoms, or the rate of the PTSD diagnostic outcome. In addition, significant controversy exists about the use of propranolol for PTSD prevention because of its ability to attenuate the emotional response and memory of a traumatic event.

• #1 Interventions for the Prevention of Post-traumatic Stress Disorder in Adults After Exposure to Psychological Trauma | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/ptsd-adults-trauma-interventions/research-protocol

  The opiate analgesic, morphine, has shown promise in preventing PTSD in persons experiencing physical injury from a traumatic event. In 155 adults hospitalized after traumatic injury, those prescribed higher doses of morphine had lower incidence of PTSD at 3-month followup. In 696 combat-injured U.S. military personnel serving in Iraq, the use of morphine during early trauma care was associated with significantly lower risk of a subsequent PTSD diagnosis. These studies highlight and support the importance of pain control in physically injured persons, but the potential role of opiates in prevention of PTSD after severe psychological trauma in the absence of painful physical injury remains unclear. […] A substantial body of research has suggested that alterations in the hypothalamic-pituitary-adrenal (HPA) axis are associated with PTSD. Much of the research suggests increased sensitivity of the HPA negative feedback loop between the release of corticotropin-releasing factor (CRF) from the hypothalamus and release of cortisol from the adrenal cortex, resulting in high levels of CRF and low levels of cortisol among people with PTSD. This has led to the hypothesis that exogenous administration of cortisol shortly after trauma may prevent PTSD by preventing development of HPA axis dysregulation.

• #1 Interventions for the Prevention of Post-traumatic Stress Disorder in Adults After Exposure to Psychological Trauma | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/ptsd-adults-trauma-interventions/research-protocol

  Several naturalistic studies have found that patients who were administered glucocorticoids either during or immediately after the trauma were significantly less likely to develop PTSD than those who were not. […] SSRI antidepressants are currently the drugs most widely used to treat PTSD. SSRIs have been shown to be modestly effective for civilian trauma-related PTSD, but no more effective than placebo for PTSD in military veterans. As with beta-blockers such as propranolol, SSRIs may diminish the more severe clinical sequelae after a stress exposure, possibly through nonspecific effects on other monoamines, through neuroprotective effects in the brain, or through increases in neurotrophic factors that can block the down-regulation of brain-derived neurotrophic factors. […] One of the primary outcomes in the PTSD-prevention intervention literature is lack of trauma-related symptom development, which includes both clinician-rated and self-reported measures. In addition, we will consider other health outcomes such as symptom reduction; prevention/reduction of comorbid medical or psychiatric conditions (e.g., depressive symptoms, anxiety symptoms); improved quality of life; or ability to return to work or return to active duty. If we cannot find data on a particular health outcome of interest, we will include surrogate outcomes if evidence of a causal relationship between surrogate and health outcomes is available.

• #1 Posttraumatic Stress Disorder: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/0300/posttraumatic-stress-disorder.html

  Posttraumatic stress disorder (PTSD) is common, with a lifetime prevalence of approximately 6%. […] Although intervention after trauma is an opportunity to prevent PTSD, there is no consensus on how to prevent PTSD for patients with traumatic exposures. A single session debriefing is not effective at preventing PTSD development. […] However, early psychological treatments may be helpful. A Cochrane review found low-certainty evidence that multiple early interventions reduced the likelihood of PTSD diagnosis at three to six months after trauma (number needed to treat = 12; 95% CI, 8 to 67), but these interventions may not be effective at one year. […] Many medications have been proposed to reduce the likelihood of PTSD after trauma, but most show no evidence of benefit. A 2022 Cochrane review found that hydrocortisone, propranolol, and gabapentin do not prevent PTSD development after a traumatic exposure.

• #1 Pharmacological prevention and early treatment of post-traumatic stress disorder and acute stress disorder: a systematic review and meta-analysis | Translational Psychiatry

  https://www.nature.com/articles/s41398-019-0673-5

  Post-traumatic stress disorder (PTSD) is a common mental disorder associated with significant distress and reduced functioning. Its occurrence after a severe traumatic event and association with characteristic neurobiological changes make PTSD a good candidate for pharmacological prevention and early treatment. […] The primary aim for this systematic review and meta-analysis was to assess whether pharmacological interventions when compared to placebo, or other pharmacological/psychosocial interventions resulted in a clinically significant reduction or prevention of symptoms, improved functioning or quality of life, presence of disorder, or adverse effects. […] Hydrocortisone shows the most promise, of pharmacotherapies subjected to RCTs, as an emerging intervention in the prevention of PTSD within three months after trauma and should be a target for further investigation.

• #1 Pharmacological prevention and early treatment of post-traumatic stress disorder and acute stress disorder: a systematic review and meta-analysis | Translational Psychiatry

  https://www.nature.com/articles/s41398-019-0673-5

  The limited evidence for hydrocortisone and its adverse effects mean it cannot be recommended for routine use, but, it could be considered as a preventative intervention for people with severe physical illness or injury, shortly after a traumatic event, as long as there are no contraindications. […] More research is needed using larger, high quality RCTs to establish the most efficacious use of hydrocortisone in different populations and optimal dosing, dosing window and route. […] There is currently a lack of evidence to suggest that other pharmacological agents are likely to be effective.

• #1 Posttraumatic Stress Disorder Treatment & Management: Approach Considerations, Long-Term Monitoring, Consultations

  https://emedicine.medscape.com/article/288154-treatment

  Benzodiazepine use for the reduction of acute traumatic stress symptoms or sleep problems in the first month after a potentially traumatic event is not recommended. […] Recommendations for pharmacological treatment vary depending on the source. […] The United Kingdoms National Institute for Health and Care Excellence (NICE) and the World Health Organization (WHO) do not recommend any medications as first-line treatment for PTSD. […] Benzodiazepine use for the reduction of acute traumatic stress symptoms or sleep problems after a potentially traumatic event is not recommended. […] Although benzodiazepines may be popular with patients and lead to a transient decrease in anxiety symptoms, research indicates that they not only are not effective, but may prolong the course of PTSD.

• #1 Prevention – Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK201092/

  Prevention efforts in the DoD are directed to all service personnel who face the risk of exposure to traumatic events during deployment. […] The DoD Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) have a Resilience and Prevention Directorate that assists the services and the DoD in optimizing resilience, psychologic health, and readiness for service members and their families. […] The focus on stress resilience training before deployment reflects a quantum shift in military culture and can now be seen to emanate from the highest levels of command in the military. […] The DoD has a number of programs to promote psychologic resilience in service members and their families, but most have not been evaluated. […] The VA does not have the responsibility for predeployment programs but, like the DoD, it does attempt to prevent chronic PTSD by working with veterans who have symptoms.

• #1 Prevention – Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK201092/

  The VA has also developed a program on MST. […] The VA provides a guide for returning service members on what to expect after deployment and return to civilian life, including how to deal with children, spouses, family and friends, finances, and emotions. […] While there are a variety of DoD and VA programs that target PTSD prevention, it is important to note that, at present, none of them has evidence for their effectiveness in preventing or reducing PTSD or stress in service members or their families.

• #1 Early psychological interventions for prevention and treatment of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in post-partum women: A systematic review and meta-analysis | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258170

  Early psychological interventions for prevention and treatment of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in post-partum women: A systematic review and meta-analysis […] Pre-term or full-term childbirth can be experienced as physically or psychologically traumatic. Cumulative and trans-generational effects of traumatic stress on both psychological and physical health indicate the ethical requirement to investigate appropriate preventative treatment for stress symptoms in women following a routine traumatic experience such as childbirth. […] The objective of this review was to investigate the effectiveness of early psychological interventions in reducing or preventing post-traumatic stress symptoms and post-traumatic stress disorder in post-partum women within twelve weeks of a traumatic birth.

• #1 Early psychological interventions for prevention and treatment of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in post-partum women: A systematic review and meta-analysis | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258170

  There are a broad range of interventions targeting post-traumatic stress disorder following childbirth including psychotherapeutic therapy, grief counselling, expressive writing, midwifery counselling and debriefing. Traditionally, midwifery led psychological debriefing is offered to women in the days and weeks following the birth of their baby. It has been described as an opportunity for the mother to describe her experience, express her emotions and feelings in relation to the negative event and fill in the gaps. Evidence of the effectiveness of trauma focused debriefing is controversial with systematic literature reviews concluding that there are no midwifery interventions aimed at reducing PTSD that can be recommended to clinical practice following childbirth. NICE and the International Society for Stress Studies conclude that there is insufficient evidence to recommend psychological debriefing for the prevention of PTSD. Providing an ineffective treatment may be regarded as harmful, as reliving traumatic experiences can retraumatise an individual and deter them from appropriate treatment interventions.

• #1 Early psychological interventions for prevention and treatment of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in post-partum women: A systematic review and meta-analysis | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258170

  Early intervention treatments are administered in the days, weeks and first three months of a traumatic event. This early period following a traumatic event is critically important in the development of clinically significant PTSD symptoms as the traumatic memory remains fragmented. Early psychological intervention may prevent the accumulation of unprocessed traumatic memories, as re-current exposure to trauma may further sensitise underlying and dormant disorders. […] NICE recommend Trauma Focused CBT and prolonged exposure therapies up to four weeks following a traumatic incident, and Eye Movement Desensitisation and Reprocessing (EMDR) if the patient requests it after four weeks of the onset event. The International Society for Traumatic Stress Studies advise on multiple session trauma focused cognitive behavioural therapy and EMDR as the standard recommended early treatment interventions for PTSD symptoms in adults.

• #1 Early psychological interventions for prevention and treatment of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in post-partum women: A systematic review and meta-analysis | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258170

  This review focuses on analysis of early interventions, delivered within 12 weeks for women who have experienced a traumatic birth. […] There is firm evidence in favour of immediate response early psychological interventions administered within 72 hours of a traumatic birth in reducing symptoms of PTSD in women on a case by case basis. Further long-term studies are required in order to address methodological weaknesses before recommendation can be made to clinical practice. Future studies that target clinical diagnosis of PTSD and co morbidities are necessary. Multifinality of risk factors associated with the development of PTSD in post-partum women, such as experiencing the birth as traumatic and having previous experience of traumatic birth in parous women are important when determining appropriate application of early psychological intervention for women in the perinatal period; applying clinical equipoise to womens needs and reducing unnecessary costs.

• #1 A Systematic Review of Interventions for Prevention and Treatment of Post-Traumatic Stress Disorder Following Childbirth | medRxiv

  https://www.medrxiv.org/content/10.1101/2023.08.17.23294230v1

  Postpartum women can develop post-traumatic stress disorder (PTSD) in response to complicated, traumatic childbirth; prevalence of these events remains high in the U.S. Currently, there is no recommended treatment approach in routine peripartum care for preventing maternal childbirth-related PTSD (CB-PTSD) and lessening its severity. […] Here, we provide a systematic review of available clinical trials testing interventions for the prevention and indication of CB-PTSD. […] Trials tested psychological therapies most often delivered as secondary prevention against CB-PTSD onset (n=21); some examined primary (n=3) and tertiary (n=9) therapies. […] Positive treatment effects were found for early interventions employing conventional trauma-focused therapies, psychological counseling, and mother-infant dyadic focused strategies.

• #1 A Systematic Review of Interventions for Prevention and Treatment of Post-Traumatic Stress Disorder Following Childbirth | medRxiv

  https://www.medrxiv.org/content/10.1101/2023.08.17.23294230v1

  An array of early psychological therapies delivered in response to traumatic childbirth, rather than universally, in the first postpartum days and weeks, may potentially buffer CB-PTSD development. […] As additional RCTs generate critical information and guide recommendations for first-line preventive treatments for CB-PTSD, the psychiatric consequences associated with traumatic childbirth could be lessened.

• #1 Post-Traumatic Stress Disorder in Children | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/post-traumatic-stress-disorder-children

  Preventive measures to reduce the incidence or lessen the chance of traumatic experiences in children include, but are not limited to, the following: […] Provide appropriate support and/or counseling for children and adolescents who have experienced or witnessed a traumatic event. […] Encourage prevention programs within your community or local school system.

• #1 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content?ContentTypeID=90&ContentID=P02579

  What can I do to prevent PTSD in my child? These measures may help prevent PTSD in children: […] PTSD can be treated. Early diagnosis and treatment are very important. It can ease symptoms and enhance your child’s normal development. It can also improve your child’s quality of life. […] Teach children that it’s OK to say no to someone who tries to touch their body or make them feel uncomfortable. […] Encourage prevention programs in your community or local school system. […] Decrease the impact of unavoidable disasters, like earthquakes, by practicing disaster response drills in homes and schools.

• #1 Prevention of Post-Traumatic Stress Disorder After Trauma: Current Evidence and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4723637/

  These conditions create unique opportunities for detecting survivors at risk and providing preventive interventions. […] Despite these favorable attributes of PTSD, its systematic prevention is elusive at this point, and the disorders prevalence in the last four decades is remarkably stable, in both military personnel and civilians. […] Current preventive interventions were derived from evidence in chronic PTSD and may not properly engage the disorders pathogenesis. […] Nonetheless, a rapidly growing body of work better informs our understanding of post-traumatic psychopathology, its neurobiological mechanisms, the resulting symptom trajectories, and putative trajectory moderators. This review outlines the better-researched theoretical models of PTSD and related interventions and discusses directions for future research and individual-specific prevention.

• #1

  https://link.springer.com/article/10.1007/s11920-015-0655-0

  Current preventive interventions were derived from evidence in chronic PTSD and may not properly engage the disorders pathogenesis. […] Interventions addressing the first goal include attempts to reduce the stressfulness of the traumatic event (e.g., stress management, need-based assistance), and interventions meant to reduce participants initial responses to the event or its encoding in memory. […] The efficacy of the latter, therefore, hinges on proper risk detection at the early aftermath of trauma exposure. […] Most preventive studies to date are theory-informed. […] The current review will only focus on secondary and tertiary prevention, which target the progression of psychopathology after the traumatic event. […] Interventions targeting elements in that progression (e.g., fear conditioning, emotion processing, initial neuroendocrine response) are associated with each element.

• #1 Prevention of Post-Traumatic Stress Disorder After Trauma: Current Evidence and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4723637/

  The underlying mechanism has not yet been established. […] One way to advance the prevention of PTSD is to better map the variety of paths leading to this condition and map those paths into subsets of trauma exposed individuals. […] Several steps should be taken in future studies. We need to step beyond diagnosis-based screenings and develop more complex accurate methods to predict individual risks of expressing debilitating symptoms and impairment after traumatic events.

• #1 Prevention of post-traumatic stress disorder: Lessons learned from a terminated RCT of prolonged exposure | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251898

  Prevention of post-traumatic stress disorder: Lessons learned from a terminated RCT of prolonged exposure […] The main purpose of the current trial was to test if a brief trauma-focused cognitive-behaviour therapy protocol (prolonged exposure; PE) provided within 72 h after a traumatic event could be effective in decreasing the incidence of post-traumatic stress disorder (PTSD), thus replicating and extending the findings from an earlier trial. […] One way to decrease the prevalence of PTSD is to intervene before the disorder develops. […] The results from studies on early interventions are mixed. […] In their trial, PE was superior to the assessment-only control group in reducing PTSD symptoms 12 weeks after the event, and the intervention seemed to reduce the risk for PTSD development. […] Given the estimated effect sizes in the previous trial by Rothbaum et al., we calculated that 352 participants (176 in both groups) were needed in order to detect a standardised effect size (Cohens d) of 0.3. […] In this study, we took advantage of already established procedures and infrastructure at the hospital. […] Another option for future research to overcome the problems mentioned above would be to recruit, assess, and provide trauma patients with early interventions remotely, for example, by using smartphone or internet-delivered approaches. […] A significant proportion of ED patients (24%) in the current study were excluded due to the time criterion. […] Future research could investigate in more detail whether sleep has a moderating effect on early interventions for trauma. […] To summarise, this prematurely terminated trial generated important scientific and clinical experiences. Based on these experiences, we suggest that future research into the prevention of PTSD might benefit from considering implementation models with remotely delivered, easily accessible intervention and assessment procedures that are independent of regular health organisation routines.

• #1 Post-traumatic Stress Disorder (PTSD) | Causes, Symptoms and Treatment

  https://patient.info/doctor/post-traumatic-stress-disorder-pro

  Post-traumatic stress disorder (PTSD) may develop after exposure to exceptionally threatening or horrifying events. […] Studies have shown that preventative interventions, such as cognitive behavioral therapy (CBT), or stress hormone-targeted pharmacological interventions, are effective in selected samples of survivors. […] A Cochrane review found the evidence for debriefing sessions after childbirth to be equivocal with respect to preventing psychological trauma including PTSD. […] Do not offer psychologically-focused debriefing for the prevention or treatment of PTSD. […] Offer an individual trauma-focused CBT intervention to adults who have acute stress disorder or clinically important symptoms of PTSD and have been exposed to one or more traumatic events within the preceding month. […] Do not offer drug treatments, including benzodiazepines, to prevent PTSD in adults.

• #1

  https://link.springer.com/article/10.1007/s11920-015-0655-0

  The need-based, multi-method model can be seen as an alternative to a single clinical intervention. […] The general picture emerging from this review is that the prevention of PTSD, despite its critical importance, is under-researched and inappropriately explored. […] From a risk assessment perspective, PTSD is likely multi-causal, and as such, individuals with differing vulnerabilities and different exposure and post-exposure circumstances may come to express the PTSD symptom complex through individual-specific pathways and be responsive to individual-specific interventions. […] Once such knowledge becomes available, personalized target-specific early interventions might replace generic treatment protocols, which in practice are effective for some but not for all.

• #2 Posttraumatic stress disorder: from diagnosis to prevention | Military Medical Research | Full Text

  https://mmrjournal.biomedcentral.com/articles/10.1186/s40779-018-0179-0

  Based on current research on the primary prevention of post-trauma pathology, psychological and pharmacological interventions for particular groups or individuals (e.g., military personnel, firefighters, etc.) with a high risk of traumatic event exposure were applicable and acceptable for PTSD sufferers. […] However, efficiency for these training has not been evaluated yet due to a lack of high-level evidence-based studies. […] Evidence has suggested that pharmacological prevention is most effective when started before and early after the traumatic event, and it seems that sympatholytic drugs (alpha and beta-blockers) have the highest potential for primary prevention of PTSD. […] The secondary and tertiary prevention of PTSD has abundant methods, including different forms of debriefing, treatments for Acute Stress Disorder (ASD) or acute PTSD, and targeted intervention strategies.

• #2 Prevention – Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK201092/

  Interventions that are applied to individuals who are known to have been exposed to a traumatic event and thus to be at risk for PTSD and who may or may not be showing symptoms of stress. […] Interventions aimed at individuals who are displaying symptoms of or have received a diagnosis of PTSD with the goals of preventing worsening of the symptoms and improving functioning. […] Studies of OEF, OIF, and Vietnam veterans have also documented post-event social support as a strong predictor of PTSD and other psycho-pathologic conditions. […] The DoD has issued directives and instructions on stress control programs for many years; however, the instructions and programs deal with general combat stress and are not always PTSD-specific. […] The goal of CSC programs is to manage combat stress reactions as close to unit level as possible.

• #2

  https://link.springer.com/article/10.1007/s11920-015-0655-0

  Trauma-focused CBT can involve different strategies with distinct aims. […] Trials of exposure-based CBT have generally demonstrated moderately positive results in reducing PTSD or other symptoms in the long term. […] CBT is currently the mainstay of early prevention of PTSD. […] Several considerations, however, make its systematic implementation a major challenge. […] A meta-analysis of early interventions has indicated that CBT is only efficient in participants with diagnosable PTSD at treatment onset. […] CBT is consequently best positioned as a clinical intervention for identified and ascertained acute PTSD cases. […] Various pharmacological agents have been examined in the prevention of post-traumatic symptoms. […] A Cochrane review in 2014 concluded that in general, there is moderate quality evidence for the efficacy of hydrocortisone, and no evidence for propranolol, escitalopram, temazepam, and gabapentin.

• #2 Interventions for the Prevention of Post-traumatic Stress Disorder in Adults After Exposure to Psychological Trauma | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/ptsd-adults-trauma-interventions/research-protocol

  The implications of these various theories provide a rationale for a myriad of early intervention strategies, but they are only one part of the puzzle. Variability of types of trauma, contexts in which they occur, and individual differences of those exposed to traumatic events are likely to prohibit a one-size-fits-all model for preventive intervention. […] Various neurobiological pathways have been implicated in the development of PTSD. Accordingly, pharmacotherapy has been tried as a preventive intervention for PTSD. Several drugs have been studied for PTSD prevention including propranolol, morphine, glucocorticoids, and selective serotonin-reuptake inhibitors (SSRIs). […] Propranolol, a beta-adrenergic antagonist that crosses the blood-brain barrier, has been evaluated in several studies for its ability to prevent PTSD. So far results have failed to show any clear benefit of propranolol, when compared with placebo, in reducing physiological reactivity during traumatic imagery, severity of PTSD symptoms, or the rate of the PTSD diagnostic outcome. In addition, significant controversy exists about the use of propranolol for PTSD prevention because of its ability to attenuate the emotional response and memory of a traumatic event.

• #2 Prevention of Post-Traumatic Stress Disorder After Trauma: Current Evidence and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4723637/

  Trials of exposure-based CBT have generally demonstrated moderately positive results in reducing PTSD or other symptoms in the long term. […] CBT is currently the mainstay of early prevention of PTSD. […] A meta-analysis of early interventions has indicated that CBT is only efficient in participants with diagnosable PTSD at treatment onset, and results from the Jerusalem Trauma Outreach and Prevention Study (J-TOPS) have similarly shown that survivors with sub-threshold PTSD symptoms equally recover with or without CBT. […] CBT is consequently best positioned as a clinical intervention for identified and ascertained acute PTSD cases. […] Various pharmacological agents have been examined in the prevention of post-traumatic symptoms. […] A Cochrane review in 2014 concluded that in general, there is moderate quality evidence for the efficacy of hydrocortisone, and no evidence for propranolol, escitalopram, temazepam, and gabapentin.

• #2 Interventions for the Prevention of Post-traumatic Stress Disorder in Adults After Exposure to Psychological Trauma | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/ptsd-adults-trauma-interventions/research-protocol

  The opiate analgesic, morphine, has shown promise in preventing PTSD in persons experiencing physical injury from a traumatic event. In 155 adults hospitalized after traumatic injury, those prescribed higher doses of morphine had lower incidence of PTSD at 3-month followup. In 696 combat-injured U.S. military personnel serving in Iraq, the use of morphine during early trauma care was associated with significantly lower risk of a subsequent PTSD diagnosis. These studies highlight and support the importance of pain control in physically injured persons, but the potential role of opiates in prevention of PTSD after severe psychological trauma in the absence of painful physical injury remains unclear. […] A substantial body of research has suggested that alterations in the hypothalamic-pituitary-adrenal (HPA) axis are associated with PTSD. Much of the research suggests increased sensitivity of the HPA negative feedback loop between the release of corticotropin-releasing factor (CRF) from the hypothalamus and release of cortisol from the adrenal cortex, resulting in high levels of CRF and low levels of cortisol among people with PTSD. This has led to the hypothesis that exogenous administration of cortisol shortly after trauma may prevent PTSD by preventing development of HPA axis dysregulation.

• #2 Interventions for the Prevention of Post-traumatic Stress Disorder in Adults After Exposure to Psychological Trauma | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/ptsd-adults-trauma-interventions/research-protocol

  Several naturalistic studies have found that patients who were administered glucocorticoids either during or immediately after the trauma were significantly less likely to develop PTSD than those who were not. […] SSRI antidepressants are currently the drugs most widely used to treat PTSD. SSRIs have been shown to be modestly effective for civilian trauma-related PTSD, but no more effective than placebo for PTSD in military veterans. As with beta-blockers such as propranolol, SSRIs may diminish the more severe clinical sequelae after a stress exposure, possibly through nonspecific effects on other monoamines, through neuroprotective effects in the brain, or through increases in neurotrophic factors that can block the down-regulation of brain-derived neurotrophic factors. […] One of the primary outcomes in the PTSD-prevention intervention literature is lack of trauma-related symptom development, which includes both clinician-rated and self-reported measures. In addition, we will consider other health outcomes such as symptom reduction; prevention/reduction of comorbid medical or psychiatric conditions (e.g., depressive symptoms, anxiety symptoms); improved quality of life; or ability to return to work or return to active duty. If we cannot find data on a particular health outcome of interest, we will include surrogate outcomes if evidence of a causal relationship between surrogate and health outcomes is available.

• #2 Posttraumatic Stress Disorder Treatment & Management: Approach Considerations, Long-Term Monitoring, Consultations

  https://emedicine.medscape.com/article/288154-treatment

  Benzodiazepine use for the reduction of acute traumatic stress symptoms or sleep problems in the first month after a potentially traumatic event is not recommended. […] Recommendations for pharmacological treatment vary depending on the source. […] The United Kingdoms National Institute for Health and Care Excellence (NICE) and the World Health Organization (WHO) do not recommend any medications as first-line treatment for PTSD. […] Benzodiazepine use for the reduction of acute traumatic stress symptoms or sleep problems after a potentially traumatic event is not recommended. […] Although benzodiazepines may be popular with patients and lead to a transient decrease in anxiety symptoms, research indicates that they not only are not effective, but may prolong the course of PTSD.

• #2 Post-traumatic stress disorder – Wikipedia

  https://en.wikipedia.org/wiki/Post-traumatic_stress_disorder

  Prevention may be possible when counselling is targeted at those with early symptoms, but is not effective when provided to all trauma-exposed individuals regardless of whether symptoms are present. […] The World Health Organization recommends against the use of benzodiazepines and antidepressants in for acute stress (symptoms lasting less than one month). […] Trauma focused intervention delivered within days or weeks of the potentially traumatic event has been found to decrease PTSD symptoms. […] Risk-targeted interventions are those that attempt to mitigate specific formative information or events. […] Psychological debriefing is unhelpful, is potentially harmful and does not reduce the future risk of developing PTSD. […] Early intervention is aimed at preventing new-onset or relapsed mental disorders and further distress later in the healing process.

• #2 Prevention – Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK201092/

  Prevention of posttraumatic stress disorder (PTSD) in active-duty and veteran populations is important to support their overall health and well-being, to preserve personnel resources, and to maximize force readiness. This chapter examines prevention of and prophylaxis for PTSD in active-duty and veteran populations. […] Prevention is broadly defined as measures taken to avoid the occurrence of disease or interventions that are applied before the onset of a clinically diagnosable disorder with the aim of reducing the number of new cases of that disorder. […] Prevention of PTSD in active-duty personnel is provided via programs aimed at preparing service members for combat and other deployment-related stressors. […] Other prevention efforts seek to detect and treat disorder in its early stages (for example, treat those who meet the criteria for acute stress disorder [ASD]) often before it presents clinically as chronic PTSD.

• #2 Prevention – Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK201092/

  Prevention efforts in the DoD are directed to all service personnel who face the risk of exposure to traumatic events during deployment. […] The DoD Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) have a Resilience and Prevention Directorate that assists the services and the DoD in optimizing resilience, psychologic health, and readiness for service members and their families. […] The focus on stress resilience training before deployment reflects a quantum shift in military culture and can now be seen to emanate from the highest levels of command in the military. […] The DoD has a number of programs to promote psychologic resilience in service members and their families, but most have not been evaluated. […] The VA does not have the responsibility for predeployment programs but, like the DoD, it does attempt to prevent chronic PTSD by working with veterans who have symptoms.

• #2 Prevention – Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK201092/

  The VA has also developed a program on MST. […] The VA provides a guide for returning service members on what to expect after deployment and return to civilian life, including how to deal with children, spouses, family and friends, finances, and emotions. […] While there are a variety of DoD and VA programs that target PTSD prevention, it is important to note that, at present, none of them has evidence for their effectiveness in preventing or reducing PTSD or stress in service members or their families.

• #2 Early psychological interventions for prevention and treatment of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in post-partum women: A systematic review and meta-analysis | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258170

  There are a broad range of interventions targeting post-traumatic stress disorder following childbirth including psychotherapeutic therapy, grief counselling, expressive writing, midwifery counselling and debriefing. Traditionally, midwifery led psychological debriefing is offered to women in the days and weeks following the birth of their baby. It has been described as an opportunity for the mother to describe her experience, express her emotions and feelings in relation to the negative event and fill in the gaps. Evidence of the effectiveness of trauma focused debriefing is controversial with systematic literature reviews concluding that there are no midwifery interventions aimed at reducing PTSD that can be recommended to clinical practice following childbirth. NICE and the International Society for Stress Studies conclude that there is insufficient evidence to recommend psychological debriefing for the prevention of PTSD. Providing an ineffective treatment may be regarded as harmful, as reliving traumatic experiences can retraumatise an individual and deter them from appropriate treatment interventions.

• #2 Early psychological interventions for prevention and treatment of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in post-partum women: A systematic review and meta-analysis | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258170

  Early intervention treatments are administered in the days, weeks and first three months of a traumatic event. This early period following a traumatic event is critically important in the development of clinically significant PTSD symptoms as the traumatic memory remains fragmented. Early psychological intervention may prevent the accumulation of unprocessed traumatic memories, as re-current exposure to trauma may further sensitise underlying and dormant disorders. […] NICE recommend Trauma Focused CBT and prolonged exposure therapies up to four weeks following a traumatic incident, and Eye Movement Desensitisation and Reprocessing (EMDR) if the patient requests it after four weeks of the onset event. The International Society for Traumatic Stress Studies advise on multiple session trauma focused cognitive behavioural therapy and EMDR as the standard recommended early treatment interventions for PTSD symptoms in adults.

• #2 A Systematic Review of Interventions for Prevention and Treatment of Post-Traumatic Stress Disorder Following Childbirth | medRxiv

  https://www.medrxiv.org/content/10.1101/2023.08.17.23294230v1

  Postpartum women can develop post-traumatic stress disorder (PTSD) in response to complicated, traumatic childbirth; prevalence of these events remains high in the U.S. Currently, there is no recommended treatment approach in routine peripartum care for preventing maternal childbirth-related PTSD (CB-PTSD) and lessening its severity. […] Here, we provide a systematic review of available clinical trials testing interventions for the prevention and indication of CB-PTSD. […] Trials tested psychological therapies most often delivered as secondary prevention against CB-PTSD onset (n=21); some examined primary (n=3) and tertiary (n=9) therapies. […] Positive treatment effects were found for early interventions employing conventional trauma-focused therapies, psychological counseling, and mother-infant dyadic focused strategies.

• #2 Post-traumatic Stress Disorder in Children | Children’s Mental Health | CDC

  https://www.cdc.gov/children-mental-health/about/post-traumatic-stress-disorder-in-children.html

  When children develop long-term symptoms from stress due to a traumatic event, which are upsetting or interfere with their relationships and activities, they may have post-traumatic stress disorder (PTSD). […] It is important to emphasize that not all children and adolescents exposed to traumatic events will develop PTSD. […] Preventing risks for trauma, like maltreatment, violence, or injuries, or lessening the impact of unavoidable disasters on children, can help protect a child from PTSD.

• #2 Prevention of Post-Traumatic Stress Disorder After Trauma: Current Evidence and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4723637/

  These conditions create unique opportunities for detecting survivors at risk and providing preventive interventions. […] Despite these favorable attributes of PTSD, its systematic prevention is elusive at this point, and the disorders prevalence in the last four decades is remarkably stable, in both military personnel and civilians. […] Current preventive interventions were derived from evidence in chronic PTSD and may not properly engage the disorders pathogenesis. […] Nonetheless, a rapidly growing body of work better informs our understanding of post-traumatic psychopathology, its neurobiological mechanisms, the resulting symptom trajectories, and putative trajectory moderators. This review outlines the better-researched theoretical models of PTSD and related interventions and discusses directions for future research and individual-specific prevention.

• #2 Prevention of Post-Traumatic Stress Disorder After Trauma: Current Evidence and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4723637/

  The underlying mechanism has not yet been established. […] One way to advance the prevention of PTSD is to better map the variety of paths leading to this condition and map those paths into subsets of trauma exposed individuals. […] Several steps should be taken in future studies. We need to step beyond diagnosis-based screenings and develop more complex accurate methods to predict individual risks of expressing debilitating symptoms and impairment after traumatic events.

• #2 Posttraumatic Stress Disorder Treatment & Management: Approach Considerations, Long-Term Monitoring, Consultations

  https://emedicine.medscape.com/article/288154-treatment

  Secondary prevention consists of interventions designed to decrease the rate of posttraumatic stress disorder (PTSD) in individuals exposed to traumatic events. […] While no definitive studies exist, it is commonly believed that Psychological First Aid (PFA) may decrease rates of PTSD following a natural disaster or mass casualty situation. […] High levels of emotional support and help with basic needs for shelter, food, clothing, and economic issues likely decrease the risk of PTSD. […] Trauma-focused CBT and eye movement desensitization and reprocessing (EMDR) have been shown to be most effective in treating patients with PTSD. […] In 2013, the World Health Organization (WHO) issued new clinical protocols and guidelines for addressing the mental health consequences of PTSD, acute stress, and bereavement.

• #2 New PTSD prevention guidelines released | MDedge Psychiatry

  https://www.mdedge9-ma1.mdedge.com/psychiatry/article/191164/depression/new-ptsd-prevention-guidelines-released

  Hydrocortisone is only drug rated as an intervention with emerging evidence of efficacy. […] New evidence-based guidelines on posttraumatic stress disorder prevention and treatment from the International Society for Traumatic Stress Studies (ISTSS) highlight an uncomfortable truth: Namely, the basis for early formal intervention of any sort is sorely lacking. […] Secondary prevention of PTSD can entail either blocking development of symptoms after exposure to trauma or treating early emergent PTSD symptoms. […] Dr. Bisson emphasized that, although multiple exciting prospects are on the horizon for secondary prevention, those interventions need further work before implementation. […] The ISTSS guidelines, based on the groups meta-analyses of 361 randomized controlled trials, rated most of the diverse psychosocial, psychological, and pharmacologic interventions that have been proposed or are now actually being used in clinical practice as either low effect, interventions with emerging evidence, or insufficient evidence to recommend. […] Those interventions are not backed by sufficient evidence of efficacy to be ready for prime time use in clinical practice. […] Morever, the potential for iatrogenic harm is very real. […] So primum non nocere first do no harm should be a principle we adhere to.

• #2 Interventions for the Prevention of Posttraumatic Stress Disorder (PTSD) in Adults After Exposure to Psychological Trauma – Sheps Center

  https://www.shepscenter.unc.edu/2018/05/24/interventions-for-the-prevention-of-posttraumatic-stress-disorder-ptsd-in-adults-after-exposure-to-psychological-trauma/

  Interventions for the Prevention of Posttraumatic Stress Disorder (PTSD) in Adults After Exposure to Psychological Trauma. […] To assess efficacy, comparative effectiveness, and harms of psychological, pharmacological, and emerging interventions to prevent posttraumatic stress disorder (PTSD) in adults. […] For most interventions studied, we did not find reliable evidence to support efficacy for the prevention of PTSD or for the reduction of PTSD-related symptom severity. […] First, debriefing does not reduce either the incidence or the severity of PTSD or related psychological symptoms in civilian victims of crime, assault, or accident trauma (low SOE). […] Second, our meta-analyses of three trials showed that, in subjects with acute stress disorder, brief trauma-focused cognitive behavioral therapy (CBT) was more effective than supportive counseling (SC) in reducing the severity of PTSD (moderate SOE).

• #3 Prevention – Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK201092/

  Interventions that are applied to individuals who are known to have been exposed to a traumatic event and thus to be at risk for PTSD and who may or may not be showing symptoms of stress. […] Interventions aimed at individuals who are displaying symptoms of or have received a diagnosis of PTSD with the goals of preventing worsening of the symptoms and improving functioning. […] Studies of OEF, OIF, and Vietnam veterans have also documented post-event social support as a strong predictor of PTSD and other psycho-pathologic conditions. […] The DoD has issued directives and instructions on stress control programs for many years; however, the instructions and programs deal with general combat stress and are not always PTSD-specific. […] The goal of CSC programs is to manage combat stress reactions as close to unit level as possible.

• #3

  https://link.springer.com/article/10.1007/s11920-015-0655-0

  Trauma-focused CBT can involve different strategies with distinct aims. […] Trials of exposure-based CBT have generally demonstrated moderately positive results in reducing PTSD or other symptoms in the long term. […] CBT is currently the mainstay of early prevention of PTSD. […] Several considerations, however, make its systematic implementation a major challenge. […] A meta-analysis of early interventions has indicated that CBT is only efficient in participants with diagnosable PTSD at treatment onset. […] CBT is consequently best positioned as a clinical intervention for identified and ascertained acute PTSD cases. […] Various pharmacological agents have been examined in the prevention of post-traumatic symptoms. […] A Cochrane review in 2014 concluded that in general, there is moderate quality evidence for the efficacy of hydrocortisone, and no evidence for propranolol, escitalopram, temazepam, and gabapentin.

• #3 Interventions for the Prevention of Post-traumatic Stress Disorder in Adults After Exposure to Psychological Trauma | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/ptsd-adults-trauma-interventions/research-protocol

  The implications of these various theories provide a rationale for a myriad of early intervention strategies, but they are only one part of the puzzle. Variability of types of trauma, contexts in which they occur, and individual differences of those exposed to traumatic events are likely to prohibit a one-size-fits-all model for preventive intervention. […] Various neurobiological pathways have been implicated in the development of PTSD. Accordingly, pharmacotherapy has been tried as a preventive intervention for PTSD. Several drugs have been studied for PTSD prevention including propranolol, morphine, glucocorticoids, and selective serotonin-reuptake inhibitors (SSRIs). […] Propranolol, a beta-adrenergic antagonist that crosses the blood-brain barrier, has been evaluated in several studies for its ability to prevent PTSD. So far results have failed to show any clear benefit of propranolol, when compared with placebo, in reducing physiological reactivity during traumatic imagery, severity of PTSD symptoms, or the rate of the PTSD diagnostic outcome. In addition, significant controversy exists about the use of propranolol for PTSD prevention because of its ability to attenuate the emotional response and memory of a traumatic event.

• #3 Interventions for the Prevention of Post-traumatic Stress Disorder in Adults After Exposure to Psychological Trauma | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/ptsd-adults-trauma-interventions/research-protocol

  The opiate analgesic, morphine, has shown promise in preventing PTSD in persons experiencing physical injury from a traumatic event. In 155 adults hospitalized after traumatic injury, those prescribed higher doses of morphine had lower incidence of PTSD at 3-month followup. In 696 combat-injured U.S. military personnel serving in Iraq, the use of morphine during early trauma care was associated with significantly lower risk of a subsequent PTSD diagnosis. These studies highlight and support the importance of pain control in physically injured persons, but the potential role of opiates in prevention of PTSD after severe psychological trauma in the absence of painful physical injury remains unclear. […] A substantial body of research has suggested that alterations in the hypothalamic-pituitary-adrenal (HPA) axis are associated with PTSD. Much of the research suggests increased sensitivity of the HPA negative feedback loop between the release of corticotropin-releasing factor (CRF) from the hypothalamus and release of cortisol from the adrenal cortex, resulting in high levels of CRF and low levels of cortisol among people with PTSD. This has led to the hypothesis that exogenous administration of cortisol shortly after trauma may prevent PTSD by preventing development of HPA axis dysregulation.

• #3 Interventions for the Prevention of Post-traumatic Stress Disorder in Adults After Exposure to Psychological Trauma | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/ptsd-adults-trauma-interventions/research-protocol

  Several naturalistic studies have found that patients who were administered glucocorticoids either during or immediately after the trauma were significantly less likely to develop PTSD than those who were not. […] SSRI antidepressants are currently the drugs most widely used to treat PTSD. SSRIs have been shown to be modestly effective for civilian trauma-related PTSD, but no more effective than placebo for PTSD in military veterans. As with beta-blockers such as propranolol, SSRIs may diminish the more severe clinical sequelae after a stress exposure, possibly through nonspecific effects on other monoamines, through neuroprotective effects in the brain, or through increases in neurotrophic factors that can block the down-regulation of brain-derived neurotrophic factors. […] One of the primary outcomes in the PTSD-prevention intervention literature is lack of trauma-related symptom development, which includes both clinician-rated and self-reported measures. In addition, we will consider other health outcomes such as symptom reduction; prevention/reduction of comorbid medical or psychiatric conditions (e.g., depressive symptoms, anxiety symptoms); improved quality of life; or ability to return to work or return to active duty. If we cannot find data on a particular health outcome of interest, we will include surrogate outcomes if evidence of a causal relationship between surrogate and health outcomes is available.

• #3 Posttraumatic Stress Disorder Treatment & Management: Approach Considerations, Long-Term Monitoring, Consultations

  https://emedicine.medscape.com/article/288154-treatment

  Benzodiazepine use for the reduction of acute traumatic stress symptoms or sleep problems in the first month after a potentially traumatic event is not recommended. […] Recommendations for pharmacological treatment vary depending on the source. […] The United Kingdoms National Institute for Health and Care Excellence (NICE) and the World Health Organization (WHO) do not recommend any medications as first-line treatment for PTSD. […] Benzodiazepine use for the reduction of acute traumatic stress symptoms or sleep problems after a potentially traumatic event is not recommended. […] Although benzodiazepines may be popular with patients and lead to a transient decrease in anxiety symptoms, research indicates that they not only are not effective, but may prolong the course of PTSD.

• #3 Prevention – Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK201092/

  Prevention efforts in the DoD are directed to all service personnel who face the risk of exposure to traumatic events during deployment. […] The DoD Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) have a Resilience and Prevention Directorate that assists the services and the DoD in optimizing resilience, psychologic health, and readiness for service members and their families. […] The focus on stress resilience training before deployment reflects a quantum shift in military culture and can now be seen to emanate from the highest levels of command in the military. […] The DoD has a number of programs to promote psychologic resilience in service members and their families, but most have not been evaluated. […] The VA does not have the responsibility for predeployment programs but, like the DoD, it does attempt to prevent chronic PTSD by working with veterans who have symptoms.

• #3 Prevention – Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK201092/

  The VA has also developed a program on MST. […] The VA provides a guide for returning service members on what to expect after deployment and return to civilian life, including how to deal with children, spouses, family and friends, finances, and emotions. […] While there are a variety of DoD and VA programs that target PTSD prevention, it is important to note that, at present, none of them has evidence for their effectiveness in preventing or reducing PTSD or stress in service members or their families.

• #3 Interventions for the Prevention of Posttraumatic Stress Disorder (PTSD) in Adults After Exposure to Psychological Trauma – Sheps Center

  https://www.shepscenter.unc.edu/2018/05/24/interventions-for-the-prevention-of-posttraumatic-stress-disorder-ptsd-in-adults-after-exposure-to-psychological-trauma/

  Interventions for the Prevention of Posttraumatic Stress Disorder (PTSD) in Adults After Exposure to Psychological Trauma. […] To assess efficacy, comparative effectiveness, and harms of psychological, pharmacological, and emerging interventions to prevent posttraumatic stress disorder (PTSD) in adults. […] For most interventions studied, we did not find reliable evidence to support efficacy for the prevention of PTSD or for the reduction of PTSD-related symptom severity. […] First, debriefing does not reduce either the incidence or the severity of PTSD or related psychological symptoms in civilian victims of crime, assault, or accident trauma (low SOE). […] Second, our meta-analyses of three trials showed that, in subjects with acute stress disorder, brief trauma-focused cognitive behavioral therapy (CBT) was more effective than supportive counseling (SC) in reducing the severity of PTSD (moderate SOE).

• #4

  https://link.springer.com/article/10.1007/s11920-015-0655-0

  Trauma-focused CBT can involve different strategies with distinct aims. […] Trials of exposure-based CBT have generally demonstrated moderately positive results in reducing PTSD or other symptoms in the long term. […] CBT is currently the mainstay of early prevention of PTSD. […] Several considerations, however, make its systematic implementation a major challenge. […] A meta-analysis of early interventions has indicated that CBT is only efficient in participants with diagnosable PTSD at treatment onset. […] CBT is consequently best positioned as a clinical intervention for identified and ascertained acute PTSD cases. […] Various pharmacological agents have been examined in the prevention of post-traumatic symptoms. […] A Cochrane review in 2014 concluded that in general, there is moderate quality evidence for the efficacy of hydrocortisone, and no evidence for propranolol, escitalopram, temazepam, and gabapentin.

• #4 Prevention – Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK201092/

  Prevention efforts in the DoD are directed to all service personnel who face the risk of exposure to traumatic events during deployment. […] The DoD Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) have a Resilience and Prevention Directorate that assists the services and the DoD in optimizing resilience, psychologic health, and readiness for service members and their families. […] The focus on stress resilience training before deployment reflects a quantum shift in military culture and can now be seen to emanate from the highest levels of command in the military. […] The DoD has a number of programs to promote psychologic resilience in service members and their families, but most have not been evaluated. […] The VA does not have the responsibility for predeployment programs but, like the DoD, it does attempt to prevent chronic PTSD by working with veterans who have symptoms.

• #4 Interventions for the Prevention of Post-traumatic Stress Disorder in Adults After Exposure to Psychological Trauma | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/ptsd-adults-trauma-interventions/research-protocol

  The implications of these various theories provide a rationale for a myriad of early intervention strategies, but they are only one part of the puzzle. Variability of types of trauma, contexts in which they occur, and individual differences of those exposed to traumatic events are likely to prohibit a one-size-fits-all model for preventive intervention. […] Various neurobiological pathways have been implicated in the development of PTSD. Accordingly, pharmacotherapy has been tried as a preventive intervention for PTSD. Several drugs have been studied for PTSD prevention including propranolol, morphine, glucocorticoids, and selective serotonin-reuptake inhibitors (SSRIs). […] Propranolol, a beta-adrenergic antagonist that crosses the blood-brain barrier, has been evaluated in several studies for its ability to prevent PTSD. So far results have failed to show any clear benefit of propranolol, when compared with placebo, in reducing physiological reactivity during traumatic imagery, severity of PTSD symptoms, or the rate of the PTSD diagnostic outcome. In addition, significant controversy exists about the use of propranolol for PTSD prevention because of its ability to attenuate the emotional response and memory of a traumatic event.

• #4 Early psychological interventions for prevention and treatment of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in post-partum women: A systematic review and meta-analysis | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258170

  Early intervention treatments are administered in the days, weeks and first three months of a traumatic event. This early period following a traumatic event is critically important in the development of clinically significant PTSD symptoms as the traumatic memory remains fragmented. Early psychological intervention may prevent the accumulation of unprocessed traumatic memories, as re-current exposure to trauma may further sensitise underlying and dormant disorders. […] NICE recommend Trauma Focused CBT and prolonged exposure therapies up to four weeks following a traumatic incident, and Eye Movement Desensitisation and Reprocessing (EMDR) if the patient requests it after four weeks of the onset event. The International Society for Traumatic Stress Studies advise on multiple session trauma focused cognitive behavioural therapy and EMDR as the standard recommended early treatment interventions for PTSD symptoms in adults.

• #4 Psychiatry.org – What is Posttraumatic Stress Disorder (PTSD)?

  https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

  Posttraumatic stress disorder (PTSD) is a psychiatric condition that may occur in people who have experienced or witnessed a traumatic event or series of traumatic events. […] Psychotherapy, including cognitive behavior therapy can help control symptoms and help prevent them from getting worse and developing into PTSD. […] It is important to note that not everyone who experiences trauma develops PTSD, and not everyone who develops PTSD requires psychiatric treatment. […] The earlier a person gets treatment, the better chance of recovery. […] Psychiatrists and other mental health professionals use various effective and research-proven methods to help people recover from PTSD. Both talk therapy (psychotherapy) and medication provide effective evidence-based treatments for PTSD. […] Medication can help to control the symptoms of PTSD. In addition, the symptom relief that medication provides allows many people to participate more effectively in psychotherapy.

• #5

  https://link.springer.com/article/10.1007/s11920-015-0655-0

  Trauma-focused CBT can involve different strategies with distinct aims. […] Trials of exposure-based CBT have generally demonstrated moderately positive results in reducing PTSD or other symptoms in the long term. […] CBT is currently the mainstay of early prevention of PTSD. […] Several considerations, however, make its systematic implementation a major challenge. […] A meta-analysis of early interventions has indicated that CBT is only efficient in participants with diagnosable PTSD at treatment onset. […] CBT is consequently best positioned as a clinical intervention for identified and ascertained acute PTSD cases. […] Various pharmacological agents have been examined in the prevention of post-traumatic symptoms. […] A Cochrane review in 2014 concluded that in general, there is moderate quality evidence for the efficacy of hydrocortisone, and no evidence for propranolol, escitalopram, temazepam, and gabapentin.

• #5 Prevention – Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK201092/

  Prevention efforts in the DoD are directed to all service personnel who face the risk of exposure to traumatic events during deployment. […] The DoD Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) have a Resilience and Prevention Directorate that assists the services and the DoD in optimizing resilience, psychologic health, and readiness for service members and their families. […] The focus on stress resilience training before deployment reflects a quantum shift in military culture and can now be seen to emanate from the highest levels of command in the military. […] The DoD has a number of programs to promote psychologic resilience in service members and their families, but most have not been evaluated. […] The VA does not have the responsibility for predeployment programs but, like the DoD, it does attempt to prevent chronic PTSD by working with veterans who have symptoms.

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