Special Collection - Evidence Aid - Free access to reviews
Cochrane & Evidence Aid: resources for post-traumatic stress disorder following natural disasters
As people recover from yet another example of nature's fury, those involved in disaster planning will need to consider the psychological consequences of the series of traumatic incidents associated with the typhoon.
One such psychological consequence is post-traumatic stress disorder (PTSD), and this special collection brings together the summary conclusions of the evidence from Cochrane systematic reviews on the effects of interventions aimed at preventing and treating PTSD, with links to the full reviews (see below). These Cochrane Reviews have been prepared by the authors and editors of the Cochrane Depression, Anxiety and Neurosis Group.
PTSD develops in people who were exposed to traumatic events that involved an actual or perceived threat of death or serious injury to them, their loved ones or significant others. The symptoms develop usually within the first one to three months after the event. Sufferers from PTSD characteristically re-experience aspects of the traumatic event in the form of vivid experiences that the event is recurring (flashbacks), distressing and intrusive images of the event, or nightmares. Reminders of the traumatic event (people, situations or circumstances resembling or associated with the event) often arouse intense distress or physiological reactions. Attempts to avoid such reminders are another characteristic feature of PTSD. Many people develop symptoms of hyperarousal: being excessively vigilant, easily startled, irritable, or having difficulty concentrating and in sleeping. Many PTSD sufferers describe feeling detached from others, unable to experience feelings and losing interest in previously important activities. PTSD may be associated with depression, anxiety, or panic and may lead some to use harmful amounts of alcohol or other addictive substances.
Most survivors of catastrophic events will initially develop symptoms of PTSD of varying intensity, but the vast majority will recover within the following year, or years, without treatment, or with informal support from families and friends. However, up to a third may continue to have distressing symptoms many years after the event.
This Special Collection was developed in collaboration with Evidence Aid (evidenceaid.org).
Treatment of early acute traumatic stress syndrome
Individual trauma-focused cognitive behavioural interventions were effective, in the short-term, for individuals with acute traumatic stress symptoms compared to both waiting list and supportive counselling interventions; however, caution should be taken in interpreting these results because the quality of trials was variable, sample sizes were small and there was unexplained heterogeneity. The results of this review are in line with calls that have been made for a stepped- or stratified-care system whereby those with the most symptoms are offered more complex interventions.
The amelioration of psychological distress following traumatic events is a major concern. Systematic reviews suggest that interventions targeted at all of those exposed to such events are not effective at preventing PTSD. Recently other forms of intervention have been developed with the aim of treating acute traumatic stress problems. This review evaluates randomised trials of psychological treatments and interventions commenced within three months of a traumatic event aimed at treating acute traumatic stress reactions.
No randomised controlled trials evaluating sports or games to alleviate the symptoms of PTSD were identified. More research is therefore required before a fair assessment can be made of the effectiveness of these interventions for PTSD.
It has been suggested that participation in sports and games may alleviate symptoms of PTSD. This review assesses the effectiveness of sports and games in alleviating or diminishing the symptoms of PTSD, when compared to usual care or other interventions.
This review suggests that there is no difference between psychological therapies and relative controls on the immediate effects on post-traumatic symptoms, distress, or quality of life. However, at six-month follow-up, some specific psychological interventions showed moderate benefits in the reduction of PTSD and distress.
Torture is widespread, with potentially broad and long-lasting impact across physical, psychological, social, and other areas of life. It's complex and diverse effects interact with ethnicity, gender, and refugee experience. This review assesses beneficial and adverse effects of psychological, social, and welfare interventions for torture survivors and compares these effects with those reported by active and inactive controls. The studies included in this review looked at psychological interventions and were mostly very low-quality. None of the studies looked at social or welfare interventions.
There is evidence only from individual small and low-quality trials with minimal data suggesting that police officers benefit from psychosocial interventions, in terms of physical symptoms and psychological symptoms such as anxiety, depression, sleep problems, cynicism, anger, PTSD, marital problems and distress. No data on adverse effects were available.
Psychosocial interventions are widely used for the prevention of psychological disorders in law enforcement officers. This review assesses the effectiveness and comparative effectiveness of psychosocial interventions for the prevention of psychological disorders in law enforcement officers.
Although the evidence of each comparison of psychological treatments was very low, this evidence showed that individual trauma-focused cognitive behavioural therapy/exposure therapy (TFCBT) and eye movement desensitisation and reprocessing (EMDR) did better than waitlist/usual care in reducing clinician-assessed PTSD symptom; individual TFCBT, EMDR and non-TFCBT are equally effective immediately post-treatment in the treatment of PTSD; there was some evidence that TFCBT and EMDR are superior to non-TFCBT between one to four moths following treatment; and also that individual TFCBT, EMDR and non-TFCBT are more effective than other therapies.
Post-traumatic stress disorder (PTSD) is a distressing condition, which is often treated with psychological therapies. Earlier versions of this review, and other meta-analyses, have found these to be effective, with trauma-focused treatments being more effective than non-trauma-focused treatments. This review assessed the effects of psychological therapies for the treatment of adults with chronic post-traumatic stress disorder (PTSD).
Medication treatments can be effective in treating PTSD, acting to reduce its core symptoms, as well as associated depression and disability. The findings of this review support the status of selective serotonin reuptake inhibitors as first-line agents in the pharmacotherapy of PTSD, as well as their value in long-term treatment. However, there remain important gaps in the evidence base, and a continued need for more effective agents in the management of PTSD.
Evidence that PTSD is characterised by specific psychobiological dysfunctions has contributed to a growing interest in the use of medication in its treatment. This review assesses the effects of medication for PTSD.
Combined psychological and pharmacological interventions
There is not enough evidence available to support or refute the effectiveness of combined psychological therapy and pharmacotherapy compared to either of these interventions alone.
Symptoms of PTSD include re-experiencing the event, avoidance and arousal, as well as distress and impairment resulting from these symptoms. Guidelines suggest that a combination of both psychological therapy and pharmacotherapy may enhance treatment response, especially in those with more severe PTSD or in those who have not responded to either intervention alone. This review assesses whether the combination of psychological therapy and pharmacotherapy provides a more effective treatment for PTSD than either of these interventions delivered separately.
There is no evidence that single-session individual psychological debriefing is a useful treatment for the prevention of PTSD after traumatic incidents. Compulsory debriefing of victims of trauma should cease.
Over the past few decades, early psychological interventions, such as psychological 'debriefing', have been increasingly used following psychological trauma. While this intervention has become popular and its use has spread to several settings, empirical evidence for its efficacy is noticeably lacking. This review assesses the effectiveness of brief psychological debriefing for the management of psychological distress after trauma, and the prevention of PTSD.
Multiple-session interventions aimed at all individuals exposed to traumatic events should not be used.
The prevention of long-term psychological distress following traumatic events is a major concern. Systematic reviews have suggested that individual psychological debriefing is not an effective intervention at preventing PTSD. Recently other forms of intervention have been developed with the aim of preventing PTSD. This review examines the efficacy of multiple-session early psychological interventions commenced within three months of a traumatic event aimed at preventing PTSD. This review did not investigate the efficacy of group-based psychological interventions.
Prathap Tharyan, Evidence Aid member and Director of the South Asian Cochrane Centre (introductory text); Mike Clarke, Chair of Research Methodology, Queen's University in Belfast (comments and edits); and Rachel Churchill, Co-ordinating Editor of the Cochrane Depression, Anxiety and Neurosis Group (comments and edits).
Julie Dermansky/Science Photo Library
Cochrane Editorial Unit (firstname.lastname@example.org)
28 March 2011; updated 8 May 2013 (one updated review) and 13 January 2014 (one new review)