Biol Psychiatry

BackgroundPosttraumatic stress disorder is a major public health concern with long term sequelae. There are no accepted interventions delivered in the immediate aftermath of trauma. This study tested an early intervention aimed at modifying the memory to prevent the development of PTSD prior to memory consolidation.MethodsPatients (N=137) were randomly assigned to receive 3 sessions of an early intervention beginning in the emergency department (ED) compared to an assessment only control group. Posttraumatic stress reactions (PTSR) were assessed at 4 and 12 weeks post-injury and depression at baseline and week 4. The intervention consisted of modified prolonged exposure including imaginal exposure to the trauma memory, processing of traumatic material, and in vivo and imaginal exposure homework.ResultsPatients were assessed an average of 11.79 hours post-trauma. Intervention participants reported significantly lower PTSR than the assessment group at 4 weeks post-injury, p < 0.01, and at 12 weeks post-injury, p < 0.05, and significantly lower depressive symptoms at Week 4 than the assessment group, p < 0.05. In a subgroup analysis the intervention was the most effective at reducing PTSD in rape victims at Week 4 (p=.004) and Week 12 (p=.05).ConclusionsThese findings suggest that the modified prolonged exposure intervention initiated within hours of the trauma in the ED is successful at reducing PTSR and depression symptoms one and three months after trauma exposure and is safe and feasible. This is the first behavioral intervention delivered immediately post-trauma that has been shown to be effective at reducing PTSR.5R49CE001494/CE/NCIPC CDC HHS/United StatesR01 MH096764/MH/NIMH NIH HHS/United StatesR34 MH083078/MH/NIMH NIH HHS/United StatesR34 MH083078/MH/NIMH NIH HHS/United StatesT32MH018869/MH/NIMH NIH HHS/United StatesUL1 RR025008/RR/NCRR NIH HHS/United StatesUL1 TR000454/TR/NCATS NIH HHS/United States2013-12-01T00:00:00Z22766415PMC346734