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Preventing PTSD
By Caterina Spinaris
Published: 12/20/2010

Steam Acute Stress Disorder (ASD)1 is diagnosed when people who were exposed to trauma meet certain criteria for a period of two days up to a maximum of four weeks. By definition ASD assesses short-term reactions to traumatic events.

If symptoms persist for more than four weeks after the incident, people need to be assessed to see if they meet criteria for Posttraumatic Stress Disorder (PTSD)1.

Why is the ASD diagnosis noteworthy? It is because those diagnosed with ASD are at high risk for developing PTSD. For example, between 78% and 82% of individuals diagnosed with ASD after a motor vehicle accident were found to suffer from PTSD six months after the accident2, 3. The question then becomes how to effectively treat ASD, so the development of PTSD can be prevented. Such a positive outcome would save many people much suffering.

In one study4 that researched PTSD prevention through ASD treatment, five weekly individual sessions of either cognitive behavior therapy or supportive therapy were offered to people suffering from ASD. The therapy sessions started within two weeks of the traumatic incident. Cognitive behavior therapy involved prolonged imaginal exposure, cognitive therapy and anxiety management. Supportive counseling involved nondirective counseling and general problem solving. It was found that six months later only 17% of the cognitive behavior group, yet 67% of the supportive counseling group met PTSD criteria. That is a dramatic difference in effectiveness of the two approaches. In a follow-up study5 those findings were replicated. Additionally, it was found that prolonged exposure treatment was just as good as prolonged exposure plus anxiety management, and both were significantly better than supportive counseling. Six months after the traumatic incident, 15% of the prolonged exposure group and 23% of the prolonged exposure plus anxiety management group met criteria for PTSD as opposed to 67% of the supportive counseling group. Again, the differences in effectiveness are startling.

These two studies show that chronic PTSD can be prevented through the provision of only five sessions of prolonged exposure types of treatment and cognitive behavior therapy. This is good news for correctional workers who are often routinely exposed to traumatic events, the toxic impact of which adds up over time. According to these studies, correctional workers’ mental health, work performance and overall functioning can be safeguarded by a rather simple treatment intervention.

So let us examine ways to implement this preventative treatment approach in the corrections arena. The benefits will be great to all concerned, from frontline staff to supervisors to administrators to family members to offenders.

Only today I was contacted by a hard-working correctional officer who was exposed to two gruesome incidents at work, and whose work performance and morale ended up being affected negatively as a result. I cannot help but wonder whether these impairments could have been reduced or even avoided altogether had this person received the type of preventative treatment intervention I am advocating for in this article.

REFERENCES
  1. American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th edition). Washington: American Psychiatric Association.
  2. Bryant, R.A. & Harvey, A.G. Relationship of acute stress disorder and posttraumatic stress disorder following mild traumatic brain injury. American Journal of Psychiatry, 1998, 155: 625-629.
  3. Harvey, A.G. & Bryant, R.A. The relationship between acute stress disorder and posttraumatic stress disorder following motor vehicle accidents. Journal of Consulting & Clinical Psychology, 1998, 66: 507-512.
  4. Bryant, R.A, Harvey, A.G., Sackville, T., Dang, S.T., & Basten, C. Treatment of acute stress disorder: A comparison of cognitive behavior therapy and supportive counseling. Journal of Consulting & Clinical Psychology, 1998, 66: 862-866.
  5. Bryant, R.A, Sackville, T., Dang, S.T., Moulds, M. & Guthrie, R. Treating acute stress disorder: An evaluation of cognitive behavior therapy and supportive counseling techniques. American Journal of Psychiatry, 1999, 156, 1780-1786.

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