FROM ARCHIVES OF GENERAL PSYCHIATRY
Cognitive therapy after trauma appears to reduce the symptoms of posttraumatic stress disorder, whether administered immediately after a traumatic event or delayed for several months, a study has shown.
Escitalopram treatment was significantly less effective than either cognitive-behavioral therapy or prolonged-exposure (PE) treatment, and no more effective than placebo in treating PTSD symptoms.
"Survivors with persistent PTSD symptoms should be encouraged to engage in early, trauma-caused cognitive-behavioral therapies," wrote Dr. Arieh Y. Shalev of Hadassah University Hospital, Jerusalem, and his colleagues. If immediate treatment is not possible, "health care providers can safely delay the onset of interventions until resources become available," he noted.
The researchers examined the effect of both types of psychological treatment given early or delayed, and medical therapy with escitalopram in 242 trauma survivors. Most patients (201) had been in motor vehicle accidents; 26 had been involved in a terrorist attack. The rest had unspecified events. At baseline, all of the patients had diagnosed PTSD.
The group was randomized to five treatment modes: prolonged-exposure therapy (63), cognitive therapy (40), escitalopram 20 mg daily (23), placebo (23), or a wait list (93). Randomization occurred a mean of 19 days after the traumatic event. The Clinician-Administered PTSD Scale (CAPS 5) assessed symptoms at baseline, and at 5 and 9 months after the incident. Patients assessed their own symptoms with the PTSD Symptom Scale Self-Report.
Those in the prolonged-exposure group received psychoe-ducation, breath training, prolonged imagination of their event memories, and in vivo exposure to avoided situations. Cognitive therapy (CT) consisted of identifying and examining negative thoughts, and modification of underlying cognitive schemas. …