A Critical Analysis of Approaches to Targeted PTSD Prevention

Although efforts to prevent posttraumatic stress disorder (PTSD) have met with relatively limited success, theoretically driven preventive approaches with promising efficacy are emerging. The current article critically reviews investigations of PTSD prevention programs that target persons at risk for being exposed to a traumatic event or who have been exposed to a traumatic event. This review uniquely extends prior reviews in this area by using theories of PTSD to suggest future directions in the area of PTSD prevention. The authors first discuss the primary mechanisms of action believed to account for the failure for PTSD symptoms to remit among a substantial minority of traumatic event-exposed individuals. Second, empirical progress in PTSD prevention efforts is reviewed. Third, the authors consider how existing prevention programs target these mechanisms of action. Finally, the authors consider directions for future research in the area of targeted PTSD prevention.

[1]  S. Galea,et al.  Psychological sequelae of the September 11 terrorist attacks in New York City. , 2002, The New England journal of medicine.

[2]  B. Roozendaal,et al.  The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder in survivors , 2001, Biological Psychiatry.

[3]  D. Clark,et al.  A cognitive model of posttraumatic stress disorder. , 2000, Behaviour research and therapy.

[4]  J. Gross Antecedent- and response-focused emotion regulation: divergent consequences for experience, expression, and physiology. , 1998, Journal of personality and social psychology.

[5]  M. Zvolensky,et al.  Exploring Basic Processes Underlying Acceptance and Mindfulness , 2005 .

[6]  D. Sloan,et al.  Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology. , 2005, Behaviour research and therapy.

[7]  R. Pitman,et al.  Post-traumatic stress disorder, hormones, and memory , 1989, Biological Psychiatry.

[8]  T. Keane,et al.  A behavioral formulation of posttraumatic stress disorder in Vietnam veterans. , 1984 .

[9]  D. Clark,et al.  Thought suppression produces a rebound effect with analogue post-traumatic intrusions. , 1998, Behaviour research and therapy.

[10]  R. Bryant,et al.  The additive benefit of hypnosis and cognitive-behavioral therapy in treating acute stress disorder. , 2005, Journal of consulting and clinical psychology.

[11]  P. Ouimette,et al.  Trauma and substance abuse: Causes, consequences, and treatment of comorbid disorders. , 2003 .

[12]  Ayelet Meron Ruscio,et al.  Internet-based intervention for mental health and substance use problems in disaster-affected populations: a pilot feasibility study. , 2006, Behavior therapy.

[13]  Matt J. Gray,et al.  Behavioral Interventions for Recent Trauma , 2005, Behavior modification.

[14]  M. Haller,et al.  The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder and health-related quality of life in survivors. , 1999, Critical care medicine.

[15]  B. Steele,et al.  Improving the rates of quitting smoking for veterans with posttraumatic stress disorder. , 2005, The American journal of psychiatry.

[16]  G. Eifert,et al.  Response intensity in content-specific fear conditioning comparing 20% versus 13% CO2-enriched air as unconditioned stimuli. , 1998, Journal of abnormal psychology.

[17]  A. Harvey,et al.  Treatment of acute stress disorder: a comparison of cognitive-behavioral therapy and supportive counseling. , 1998, Journal of consulting and clinical psychology.

[18]  B. Rothbaum,et al.  Behavioral/cognitive conceptualizations of post-traumatic stress disorder , 1989 .

[19]  R. Davidson,et al.  Alterations in Brain and Immune Function Produced by Mindfulness Meditation , 2003, Psychosomatic medicine.

[20]  Mary B. Williams,et al.  Violence hits home: Comprehensive treatment approaches to domestic violence. , 1990 .

[21]  F. H. Kanfer,et al.  Self-monitoring, self-evaluation, and self-reinforcement in children's learning: A test of a multistage self-regulation model , 1977 .

[22]  P. Knapp,et al.  [Cognitive therapy for posttraumatic stress disorder]. , 2003, Revista brasileira de psiquiatria.

[23]  P. Conrod,et al.  Psychosocial models of functional associations between posttraumatic stress disorder and substance use disorder. , 2003 .

[24]  R. Liberman,et al.  Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research , 1998 .

[25]  Suzanne Witterholt,et al.  Treating the Trauma of Rape: Cognitive-Behavioral Therapy for PTSD , 1999 .

[26]  J. Wald,et al.  Interoceptive Exposure Therapy Combined with Trauma‐related Exposure Therapy for Post‐traumatic Stress Disorder: a Case Report , 2005, Cognitive behaviour therapy.

[27]  T. Mellman,et al.  Hypnotic medication in the aftermath of trauma. , 2002, The Journal of clinical psychiatry.

[28]  Simon Wessely,et al.  A Systematic Review of Single-Session Psychological Interventions (‘Debriefing’) following Trauma , 2003, Psychotherapy and Psychosomatics.

[29]  R. Lubow Latent inhibition. , 1973, Psychological bulletin.

[30]  S. Mineka,et al.  Immunization against the observational conditioning of snake fear in rhesus monkeys. , 1986, Journal of abnormal psychology.

[31]  R. Acierno,et al.  An acute post-rape intervention to prevent substance use and abuse. , 2003, Addictive behaviors.

[32]  R. Janoff-Bulman Shattered Assumptions: Towards a New Psychology of Trauma , 1992 .

[33]  M. Pollack,et al.  Internal cue exposure and the treatment of substance use disorders: lessons from the treatment of panic disorder. , 2004, Journal of anxiety disorders.

[34]  P. Schnurr,et al.  Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. , 2006, Journal of consulting and clinical psychology.

[35]  Larry Cahill,et al.  Sex‐Related Influences on the Neurobiology of Emotionally Influenced Memory , 2003, Annals of the New York Academy of Sciences.

[36]  L. G. De la Casa,et al.  Latent inhibition in human affective learning. , 2002, Emotion.

[37]  J. Bisson,et al.  Randomised controlled trial of psychological debriefing for victims of acute burn trauma , 1997, British Journal of Psychiatry.

[38]  M. Zvolensky,et al.  Evaluating differential predictions of emotional reactivity during repeated 20% carbon dioxide-enriched air challenge , 2001 .

[39]  Steven Taylor,et al.  Anxiety Sensitivity and Its Implications for Understanding and Treating PTSD , 2003, Journal of Cognitive Psychotherapy.

[40]  R. McNally,et al.  Does Early Psychological Intervention Promote Recovery From Posttraumatic Stress? , 2003, Psychological science in the public interest : a journal of the American Psychological Society.

[41]  D H Barlow,et al.  The influence of an illusion of control on panic attacks induced via inhalation of 5.5% carbon dioxide-enriched air. , 1989, Archives of general psychiatry.

[42]  A. Harvey,et al.  Integration of psychological and biological approaches to trauma memory: implications for pharmacological prevention of PTSD. , 2004, Journal of traumatic stress.

[43]  R. Yehuda,et al.  Enhanced cortisol suppression following dexamethasone administration in domestic violence survivors. , 2005, The American journal of psychiatry.

[44]  R. Acierno,et al.  Prevention of post-rape psychopathology: preliminary findings of a controlled acute rape treatment study. , 1999, Journal of anxiety disorders.

[45]  C. Brewin,et al.  Fear, Helplessness, and Horror in Posttraumatic Stress Disorder: Investigating DSM-IV Criterion A2 in Victims of Violent Crime , 2000, Journal of traumatic stress.

[46]  R. Bryant,et al.  Cognitive behaviour therapy of acute stress disorder: a four-year follow-up. , 2003, Behaviour research and therapy.

[47]  R. Baumeister,et al.  Self-control as limited resource: regulatory depletion patterns. , 1998, Journal of personality and social psychology.

[48]  D. Barlow,et al.  The etiology of posttraumatic stress disorder. , 1990 .

[49]  P. Schnurr,et al.  Randomized trial of cognitive-behavioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse. , 2005, Journal of consulting and clinical psychology.

[50]  S. Southwick,et al.  Psychobiologic mechanisms of posttraumatic stress disorder. , 1993, Archives of general psychiatry.

[51]  F H Norris,et al.  Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups. , 1992, Journal of consulting and clinical psychology.

[52]  W. Katon,et al.  Cost-effectiveness and cost offset of a collaborative care intervention for primary care patients with panic disorder. , 2002, Archives of general psychiatry.

[53]  H. Resnick,et al.  Description of an Early Intervention to Prevent Substance Abuse and Psychopathology in Recent Rape Victims , 2005, Behavior modification.

[54]  S. Mineka,et al.  Fear conditioned with escapable and inescapable shock: Effects of a feedback stimulus. , 1984 .

[55]  Y. Gidron,et al.  Translating Research Findings to PTSD Prevention: Results of a Randomized–Controlled Pilot Study , 2001, Journal of traumatic stress.

[56]  G. Davey Dental phobias and anxieties: evidence for conditioning processes in the acquisition and modulation of a learned fear. , 1989, Behaviour research and therapy.

[57]  Chris R Brewin,et al.  Psychological theories of posttraumatic stress disorder. , 2003, Clinical psychology review.

[58]  M. Dadds,et al.  Early intervention and prevention of anxiety disorders in children: results at 2-year follow-up. , 1999, Journal of consulting and clinical psychology.

[59]  R. Bradley,et al.  A multidimensional meta-analysis of psychotherapy for PTSD. , 2005, The American journal of psychiatry.

[60]  D. Weiss,et al.  Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. , 2003, Psychological bulletin.

[61]  Steven Taylor,et al.  Comparative efficacy, speed, and adverse effects of three PTSD treatments: exposure therapy, EMDR, and relaxation training. , 2003, Journal of consulting and clinical psychology.

[62]  C. Brewin,et al.  Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. , 2000, Journal of consulting and clinical psychology.

[63]  B. Rothbaum,et al.  Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder. , 2001, The Journal of clinical psychiatry.

[64]  M. Dadds,et al.  A Universal Prevention Trial of Anxiety and Depressive Symptomatology in Childhood: Preliminary Data from an Australian Study , 2001, Behaviour Change.

[65]  S. Southwick,et al.  Low Urinary Cortisol Excretion in Patients with Posttraumatic Stress Disorder , 1990, The Journal of nervous and mental disease.

[66]  C. Turner,et al.  Prevention of anxiety symptoms in primary school children: preliminary results from a universal school-based trial. , 2001, The British journal of clinical psychology.

[67]  Matt J. Gray,et al.  Early intervention for trauma: Current status and future directions. , 2006 .

[68]  D. Hedeker,et al.  Assessing a smoking cessation intervention involving groups, incentives, and self-help manuals , 1995 .

[69]  W. O’Donohue Learning and Behavior Therapy , 1997 .

[70]  George S. Everly,et al.  Critical Incident Stress Debriefing (CISD) and the Prevention of Work-Related Traumatic Stress among High Risk Occupational Groups , 1995 .

[71]  Peter J. Lang,et al.  A Bio‐Informational Theory of Emotional Imagery , 1979 .

[72]  M. Tsuang,et al.  A twin registry study of the relationship between posttraumatic stress disorder and nicotine dependence in men. , 2005, Archives of general psychiatry.

[73]  A. Ehlers,et al.  Psychological debriefing for road traffic accident victims , 2000, British Journal of Psychiatry.

[74]  E. Keogh,et al.  Does Anxiety Sensitivity Predict Post-Traumatic Stress Symptoms Following Childbirth? A Preliminary Report , 2002 .

[75]  J T Mitchell,et al.  When disaster strikes...the critical incident stress debriefing process. , 1983, JEMS : a journal of emergency medical services.

[76]  R. Kessler,et al.  Posttraumatic stress disorder in the National Comorbidity Survey. , 1995, Archives of general psychiatry.

[77]  A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. , 2002 .

[78]  W. Katon,et al.  Predicting posttraumatic distress in hospitalized trauma survivors with acute injuries. , 2002, The American journal of psychiatry.

[79]  R A Bryant,et al.  Avoidant coping style and post-traumatic stress following motor vehicle accidents. , 1995, Behaviour research and therapy.

[80]  R. Young,et al.  The D2 dopamine receptor (DRD2) gene is associated with co-morbid depression, anxiety and social dysfunction in untreated veterans with post-traumatic stress disorder , 2006, European Psychiatry.

[81]  M. Zvolensky,et al.  Panic attacks, panic disorder, and agoraphobia: Associations with substance use, abuse, and dependence , 2006, Current psychiatry reports.

[82]  L. Roemer,et al.  A PRELIMINARY STUDY OF THE EFFECTS OF DIRECTED SUPPRESSION OF RAPE-RELATED MATERIAL AMONG RAPE SURVIVORS USING UNOBTRUSIVE MEASURES , 2004, Behavioural and Cognitive Psychotherapy.

[83]  R. Bryant,et al.  Treating acute stress disorder: an evaluation of cognitive behavior therapy and supportive counseling techniques. , 1999, The American journal of psychiatry.

[84]  P. Schnurr,et al.  Anxiety Sensitivity as a Moderator of the Relation Between Trauma Exposure Frequency and Posttraumatic Stress Symptomatology , 2006, Journal of Cognitive Psychotherapy.

[85]  C. Spitzer,et al.  [Dissociative disorders]. , 2005, Der Nervenarzt.

[86]  M. Zvolensky,et al.  Preference between onset predictable and unpredictable administrations of 20% carbon-dioxide-enriched air: implications for better understanding the etiology and treatment of panic disorder. , 2000, Journal of experimental psychology. Applied.

[87]  Matt J. Gray,et al.  A longitudinal analysis of PTSD symptom course: delayed-onset PTSD in Somalia peacekeepers. , 2004, Journal of consulting and clinical psychology.

[88]  A. Caspi,et al.  Influence of Life Stress on Depression: Moderation by a Polymorphism in the 5-HTT Gene , 2003, Science.

[89]  A. Harvey,et al.  Predictors of acute stress following mild traumatic brain injury. , 1998, Brain injury.

[90]  Steven Taylor,et al.  COGNITIVE FACTORS IN TRAUMATIC STRESS REACTIONS: PREDICTING PTSD SYMPTOMS FROM ANXIETY SENSITIVITY AND BELIEFS ABOUT HARMFUL EVENTS , 2000, Behavioural and Cognitive Psychotherapy.

[91]  M. Horowitz Stress response syndromes , 1976 .

[92]  M. Kozak,et al.  Emotional processing of fear: exposure to corrective information. , 1986, Psychological bulletin.

[93]  M. Zvolensky,et al.  Anxiety sensitivity-physical concerns as a moderator of the emotional consequences of emotion suppression during biological challenge: an experimental test using individual growth curve analysis. , 2006, Behaviour research and therapy.

[94]  Olga V. Demler,et al.  Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. , 2005, Archives of general psychiatry.

[95]  J. Krystal,et al.  Brain-Derived Neurotrophic Factor–5-HTTLPR Gene Interactions and Environmental Modifiers of Depression in Children , 2006, Biological Psychiatry.

[96]  B. McEwen Protective and damaging effects of stress mediators. , 1998, The New England journal of medicine.

[97]  Charles R. Figley Stress Response Syndromes, 2nd ed , 1987 .

[98]  G S Everly,et al.  Critical incident stress debriefing (CISD): a meta-analysis. , 1999, International journal of emergency mental health.

[99]  A. Ehlers,et al.  Early psychological interventions for adult survivors of trauma: a review , 2003, Biological Psychiatry.

[100]  S. Mineka,et al.  Psychological preparedness for trauma as a protective factor in survivors of torture , 1997, Psychological Medicine.

[101]  J. Bisson Single-session early psychological interventions following traumatic events. , 2003, Clinical psychology review.

[102]  O. D. Leon Neurobiological and clinical consequences of stress , 1997 .

[103]  M. Friedman Future pharmacotherapy for post-traumatic stress disorder: prevention and treatment. , 2002, The Psychiatric clinics of North America.

[104]  F. Norris,et al.  60,000 Disaster Victims Speak: Part I. An Empirical Review of the Empirical Literature, 1981—2001 , 2002, Psychiatry.

[105]  M. Gazzaniga,et al.  The new cognitive neurosciences , 2000 .

[106]  P. Coons The dissociative disorders. Rarely considered and underdiagnosed. , 1998, The Psychiatric clinics of North America.

[107]  P. Schnurr,et al.  Trauma in the Lives of Older Men: Findings from the Normative Aging Study , 2002 .

[108]  D. Koretz,et al.  Core Elements of Developmental Epidemiologically Based Prevention Research , 1999, American journal of community psychology.

[109]  O. Kernberg An Integrated Theory of Depression , 2009 .

[110]  T. Dalgleish,et al.  A dual representation theory of posttraumatic stress disorder. , 1996, Psychological review.

[111]  R. Bryant,et al.  Psychosocial Approaches of Acute Stress Reactions , 2005, CNS Spectrums.

[112]  J M Golding,et al.  Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. , 1997, The American journal of psychiatry.

[113]  L. Cahill,et al.  Pilot study of secondary prevention of posttraumatic stress disorder with propranolol , 2002, Biological Psychiatry.

[114]  M. Bouton,et al.  Understanding Trauma: Some Biobehavioral Insights into Persistent Effects of Emotional Trauma , 2007 .

[115]  J. Beck,et al.  The role of thought suppression in posttraumatic stress disorder , 2005 .

[116]  V. Follette,et al.  Experiential Avoidance and High-Risk Sexual Behavior in Survivors of Child Sexual Abuse , 2002 .

[117]  B. Rothbaum,et al.  Uncontrollability and unpredictability in post-traumatic stress disorder: an animal model. , 1992, Psychological bulletin.

[118]  W. Katon,et al.  A randomized effectiveness trial of stepped collaborative care for acutely injured trauma survivors. , 2004, Archives of general psychiatry.

[119]  M. Zvolensky,et al.  The effects of offset control over 20% carbon-dioxide-enriched air on anxious responding. , 1999, Journal of abnormal psychology.

[120]  B. Roozendaal,et al.  Can Posttraumatic Stress Disorder Be Prevented with Glucocorticoids? , 2004, Annals of the New York Academy of Sciences.

[121]  B. McEwen,et al.  Posttraumatic stress disorder, allostatic load, and medical illness. , 2004 .

[122]  P. Schnurr,et al.  Posttraumatic Stress Disorder Symptoms, Physical Health, and Health Care Utilization 50 Years After Repeated Exposure to a Toxic Gas , 2004, Journal of traumatic stress.

[123]  J. H. Kamphuis,et al.  Post-trauma debriefing : the road too frequently travelled , 2022 .

[124]  L. Cahill,et al.  The Neurobiology of Emotionally Influenced Memory Implications for Understanding Traumatic Memory , 1997, Annals of the New York Academy of Sciences.

[125]  J. Gross Emotion regulation: affective, cognitive, and social consequences. , 2002, Psychophysiology.

[126]  Steven Taylor,et al.  Anxiety sensitivity. , 2020, Clinical handbook of fear and anxiety: Maintenance processes and treatment mechanisms..

[127]  H. Resnick,et al.  Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. , 1993, Journal of consulting and clinical psychology.

[128]  S. Mineka,et al.  Unpredictable and uncontrollable events: a new perspective on experimental neurosis. , 1978, Journal of abnormal psychology.

[129]  D. D. de Quervain,et al.  Stress doses of hydrocortisone reduce chronic stress symptoms and improve health-related quality of life in high-risk patients after cardiac surgery: a randomized study. , 2006, The Journal of thoracic and cardiovascular surgery.

[130]  D. Sloan,et al.  The role of emotion in the psychological functioning of adult survivors of childhood sexual abuse , 2002 .

[131]  Larry F. Hodges,et al.  Virtual Reality Exposure Therapy of Combat-Related PTSD: A Case Study Using Psychophysiological Indicators of Outcome , 2003, Journal of Cognitive Psychotherapy.

[132]  O. Bonne,et al.  Treatment of recent trauma survivors with benzodiazepines: a prospective study. , 1996, The Journal of clinical psychiatry.

[133]  R. Baer Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review , 2003 .

[134]  R. Lubow,et al.  Latent inhibition in humans: data, theory, and implications for schizophrenia. , 1995, Psychological bulletin.

[135]  R. Lubow Latent inhibition and behavior pathology: Prophylactic and other possible effects of stimulus preexposure. , 1998 .

[136]  G. Everly,et al.  Critical Incident Stress Management (CISM): A Statistical Review of the Literature , 2004, Psychiatric Quarterly.

[137]  P. Cuijpers Examining the effects of prevention programs on the incidence of new cases of mental disorders: the lack of statistical power. , 2003, The American journal of psychiatry.

[138]  D. Tolin,et al.  Anxiety sensitivity: stability in prospective research. , 2005, Journal of anxiety disorders.

[139]  P. Muris,et al.  Acquisition and maintenance of dental anxiety: the role of conditioning experiences and cognitive factors. , 1995, Behaviour research and therapy.

[140]  Ann Hackmann,et al.  Cognitive therapy for post-traumatic stress disorder: development and evaluation. , 2005, Behaviour research and therapy.

[141]  S. Mineka,et al.  A contemporary learning theory perspective on the etiology of anxiety disorders: it's not what you thought it was. , 2006, The American psychologist.

[142]  G. Everly,et al.  The effectiveness of psychological debriefing with vicarious trauma: a meta‐analysis , 1999 .

[143]  A. Ehlers,et al.  Maintenance of Intrusive Memories in Posttraumatic Stress Disorder: A Cognitive Approach , 1995, Behavioural and Cognitive Psychotherapy.

[144]  M. Zvolensky,et al.  Posttraumatic stress symptoms and smoking to reduce negative affect: an investigation of trauma-exposed daily smokers. , 2007, Addictive behaviors.

[145]  S. Galea,et al.  Increased use of cigarettes, alcohol, and marijuana among Manhattan, New York, residents after the September 11th terrorist attacks. , 2002, American journal of epidemiology.

[146]  S. Glynn,et al.  A test of behavioral family therapy to augment exposure for combat-related posttraumatic stress disorder. , 1999, Journal of consulting and clinical psychology.

[147]  R. Bootzin,et al.  Theoretical Issues in Behavior Therapy , 1985 .

[148]  B. Roozendaal,et al.  Stress doses of hydrocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: a randomized study , 2004, Biological Psychiatry.

[149]  S. Orr,et al.  Psychophysiologic assessment of women with posttraumatic stress disorder resulting from childhood sexual abuse. , 1998, Journal of consulting and clinical psychology.

[150]  P. Schnurr,et al.  Cognitive–Behavioral Couple's Treatment for Posttraumatic Stress Disorder: Initial Findings , 2004, Journal of traumatic stress.

[151]  B F Skinner,et al.  Behavior modification. , 1974, Science.

[152]  R. Bryant Early Interventions Following Psychological Trauma , 2002, CNS Spectrums.

[153]  J. Kenardy,et al.  Internet-Delivered Indicated Prevention For Anxiety Disorders: A Randomized Controlled Trial , 2003, Behavioural and Cognitive Psychotherapy.

[154]  B. Litz,et al.  A Preliminary Investigation of the Role of Strategic Withholding of Emotions in PTSD , 2001 .

[155]  A. Harvey,et al.  The role of valence in attempted thought suppression. , 1998, Behaviour research and therapy.

[156]  P. Blakeney,et al.  Imipramine treatment in pediatric burn patients with symptoms of acute stress disorder: a pilot study. , 1999, Journal of the American Academy of Child and Adolescent Psychiatry.

[157]  Bonnie L. Green,et al.  Trauma and health : physical health consequences of exposure to extreme stress , 2004 .

[158]  Murray B Stein,et al.  An abbreviated PTSD checklist for use as a screening instrument in primary care. , 2005, Behaviour research and therapy.