Intervention versus intervention

Characteristics Table for the ReferenceIDs included in the clinical question: Early psychological intervention vs other early psychological intervention

Characteristics of Included Studies
MethodsParticipantsOutcomesInterventionsNotes
BRYANT1998
Study Type: RCT

Blindness:
Duration (days): Mean 35
Followup: 6 months post-trauma
N= 24
Age: Mean 32 Range 18–60
Sex: 10 males 14 females
Diagnosis:
Acute stress disorder by Acute Stress Disorder Interview
Exclusions: Suicidal ideation, psychosis, organic mental disorder, substance abuse, brain injury.
Notes: MVA or industrial accidents referred to the PTSD unit, Westmead, Sydney. Average trauma-assessment interval 10 days
Data Used
 Composite International Diagnostic Interview
 State-Trait Anxiety Inventory
 BDI
 IES
Group 1 N= 12
CBT - Five 1.5 hour sessions first intervention within 2 weeks of trauma. All treatment conducted by a Clinical Psychologist. Treatment included education, imaginal exposure, cognitive restructuring and graded in vivo exposure.
Group 2 N= 12
 Supportive Counselling - 5 sessions first intervention within 2 weeks of trauma. Treatment included education, problem solving skills & unconditional support.
High Risk
BRYANT1999
Study Type: RCT

Blindness:
Duration (days): Mean 35
Followup: 6 months

Info on Screening Process: 15 ps excluded for meeting various exclusion criteria
N= 45
Age: Mean 34
Sex:
Diagnosis:
 100% Acute stress disorder by Acute Stress Disorder Interview
Exclusions: Suicidal ideation, psychosis, organic mental disorder, substance abuse, brain injury.
Notes: Survivors of motor vehicle accidents or non-sexual assault referred to the PTSD unit of Westmead Hospital, Sydney. Approx 10 days between event and assessment.
Data Used
 State-Trait Anxiety Inventory
 BDI
 IES
CAPS-2
Acute Stress Disorder Interview
Group 1 N= 19
 Prolonged exposure - Five 1.5 hour weekly sessions within 2 weeks of trauma. All treatment delivered by a Clinical Psychologist. Treatment included prolonged imaginal exposure followed by cognitive restructuring, and included addtionally supportive counselling.
Group 2 N= 18
 Prolonged Exposure & Anxiety Management - Five 1.5 hour weekly sessions within 2 wks of trauma. Included education & relaxation training in 1st session, then prolonged imaginal exposure for 50 mins for following 4 sessions followed by cognitive restructuring of fears identified during exposure.
Group 3 N= 19
 Supportive Counselling - Five 1.5 hour weekly sessions within 2 weeks of trauma. Treatment included education, problem-solving & unconditional support.
High Risk
BRYANT2003
Study Type: RCT

Blindness:
Duration (days):
Followup: n/a
N= 41
Age:
Sex:
Diagnosis:
PTSD by CAPS2
Exclusions: Suicidal ideation, psychosis, organic mental disorder, substance abuse, brain injury
Notes: MVA & non-sexual assault survivors referred to the PTSD Unit at Westmead Hospital, traumatic event no more than two weeks prior to recruitment. 80 ps entered 1998 study, 41 participants available for this follow-up.
Data Used
 State-Trait Anxiety Inventory
 BDI
 IES
PTSD checklist
Group 1 N= 50
CBT - Five 1.5 hour weekly sessions conducted by a clinicial psychologist. Four year assessments conducted by doctoral-level clinical psychologists.
Group 2 N= 30
 Supportive Counselling - Five 1.5 hour weekly sessions conducted by a clinicial psychologist. Four year assessments conducted by doctoral-level clinical psychologists. Time of first intervention not given
High risk. FOLLOW-UP of Bryant1998
BRYANTA
Study Type: RCT

Blindness:
Duration (days): Mean 35
Followup: 6 months
N= 24
Age: Mean 31 Range 18–60
Sex: 8 males 16 females
Diagnosis:
 100% Acute stress disorder by Acute Stress Disorder Interview

Notes: Treatment delivered within two weeks of trauma. Ps survivors of non-sexual assault or MVAs referred to the PTSD Unit at Westmead Hospital.
Data Used
CAPS-2
 Beck Anxiety Inventory
 BDI
 IES
Group 1 N= 12
CBT - Five weekly 1.5 hour sessions conducted by a clinical psychologist. Treatment included education, relaxation training, imaginal exposure, cognitive restructuring & graded in vivo exposure to avoided situations
Group 2 N= 12
 Supportive Counselling - Five weekly 1.5 hour sessions conducted by a clinical psychologist. Treatment included education, problem-solving skills & unconditional support.
High Risk
BRYANTB
Study Type: RCT

Blindness:
Duration (days): Mean 35
Followup: 6 month

Info on Screening Process: 109 screened, 6 declined therapy, 8 suicidal, 8 had history of substance dependence.
N= 87
Age: Range 17–60
Sex: 34 males 53 females
Diagnosis:
 100% Acute stress disorder by DSM-IV
Exclusions: History of psychosis, organic brain syndrome, substance dependance disorder, current suicidal ideation, history of childhood sexual abuse.
Notes: Nonsexual assault/MVA victims referred to the Westmead Hospital PTSD Unit. Average trauma- randomization lapse - 14 days
Data Used
CAPS
 BDI
 Beck Anxiety Inventory
 IES
Group 1 N= 24
CBT - 5 once-weekly 90 minute sessions. All treatment conducted by a masters-level Clinical Psychologist. Treatment included breathing training, imaginal exposure, cognitive retructuring and in vivo exposure.
Group 2 N= 23
CBT & Hypnosis - 5 once-weekly 90 minute sessions. Identical to CBT protocol expept prior to exposure ps listened to a 15 min tape describing a hypnotic induction.
Group 3 N= 22
 Supportive Counselling - 5 once-weekly 90 minute sessions. Treatment included education, problem-solving & unconditional support.
High Risk
CAMPFIELD2001
Study Type: RCT

Blindness: No mention
Duration (days): Mean 2
Followup: 2 and 4 days, 2 weeks after trauma

Notes: Ps exposed to robbery at workplace
N= 77
Age: Range 18–32
Sex: 35 males 42 females
Diagnosis:
 100% PTSD by PDS
Exclusions: PS Receiving treatment or medication.
Notes: Ps referred to National Trauma Clinic, Sydney, following involvement in a critical incident such as assault, robbery & fatality.
Data Used
 Posttraumatic Stress Diagnostic Scale
Group 1 N= 36
 Immediate debriefing - Used 7-stage CISD protocol. Conducted within 10 hours of traumatic event. Qualification of therapist not clear. Individual/small group therapy from 2–5 people.
Group 2 N= 41
 Delayed debriefing - Used 7-phases CISD protocol. Conducted at 48 or more hours after traumatic event. Qualification of therapist not clear.
Immediate for all.
ECHEBURUA1996
Study Type: RCT

Study Description: Randomization process not given
Blindness:
Duration (days):
Followup: 1, 3, 6 & 12 months
Setting: Psychological Counselling Centers for Women

Info on Screening Process: 31 screened, 11 excluded for severe mental disorder or for not meeting diagnostic requirements
N= 20
Age: Mean 22
Sex: all females
Diagnosis:
 100% PTSD by DSM-III-R
Exclusions: Organic/mental disorder
Notes: Victims of sexual aggression from the Psychological Counseling Centres for Women of the Basque Country, Spain.
Data Used
 State-Trait Anxiety Inventory
 BDI
 Scale of Adaptation
 Modified Fear Survey
 Author-devised structured interview
Group 1 N= 10
 Cog. Restructuring/coping skills training - CR - Explaining the normal reaction to rape & modifying negative associations. CS - Progressive muscular relaxation, thought stopping, cog distractions, inc. exposure. 5 one-hr sessions within approx 3 months of last incident of aggression.
Group 2 N= 10
 Progressive Relaxation Training - 5 one- hour sessions first intervention within approx 3 months of last incident of aggression. General education followed by relaxation training. All therapy delivered by clinical psychologist with 5 yrs experience in CBT for victims of sexual aggresssion.
High Risk
EHLERS2003A
Study Type: RCT

Blindness:
Duration (days): Mean 84
Followup: 3 & 9 months after randomization

Info on Screening Process: 205 screened, 88 excluded for not meeting inclusion criteria, 20 self-exclusions. 97 entered self-monitoring phase, 12 improved and thus excluded.
N= 85
Age: Range 18–65
Sex: no information
Diagnosis:
 100% PTSD by DSM-IV
Exclusions: Unconsciousness for more than 15 minutes, memory loss, psychosis, aclohol/substance dependence, borderline personality disorder, depression requiring treatment
Notes: Motor vehicle accident survivors from the John Radcliffe Hospital, Oxford, or the Northampton General Hospital. Self-monitoring phase of intervention began between 2–9 weeks after accident. Mean = 6.23 weeks after.
Data Used
 Sheehan Disability Scale
 Beck Anxiety Inventory
 BDI
CAPS
 Posttraumatic Diagnostic Scale
Group 1 N= 28
 CT - Up to 12 weekly sessions during 3 months and up to 3 montly booster sessions. Initial sessions 90 mins, 60 mins thereafter. Therapy addresses sense of threat through negative appraisals of trauma & disturbed autobiographical memories of event.
Group 2 N= 28
 Self-help booklet - Ps received 64-page booklet following cognitive behavioural principles and met with a clinician for 40 mins to explain the use of the book.
Group 3 N= 29
 Repeated Assessments - Ps met with clinician for 20 mins to explain the rationale & procedure for the RA.
High Risk

From: Appendix 14, Evidence tables for clinical studies

Cover of Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care.
NICE Clinical Guidelines, No. 26.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): Gaskell; 2005.
Copyright © 2005, The Royal College of Psychiatrists & The British Psychological Society.

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