As the people of Japan 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 earthquakes, the tsunami, and threats of nuclear devastation.
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.
In partnership with Wiley-Blackwell and Evidence Aid, free one-click access to the whole contents of The Cochrane Library to everyone in Japan was made available on the day of the earthquake. A Japanese version of this collection has also been prepared by Kyoto University School of Public Health.
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. [Download PDF]
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. [Download PDF]
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. [Download PDF]
Some types of psychological treatment (individual trauma-focused cognitive behavioural therapy/exposure therapy [TFCBT], eye movement desensitisation and reprocessing [EMDR], stress management, and group TFCBT) were effective in the treatment of PTSD, and individual TFCBT and EMDR appeared to be superior to stress management at two to five months. Insufficient evidence was available to determine whether psychological treatment is harmful, but there was greater drop-out in active treatment groups. Caution is needed in interpreting these results because of considerable unexplained heterogeneity, and the potential impact of publication bias.
Psychological interventions are widely used in the treatment of PTSD, and this review assesses the evidence on their effects from randomised trials. [Download PDF]
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. [Download PDF]
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. [Download PDF]
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. [Download PDF]
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. [Download PDF]
Acknowledgements: 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).
Image credit: Julie Dermansky/Science Photo Library, C007/7823
Date published: 28 March 2011
Contact: Cochrane Editorial Unit (firstname.lastname@example.org)