Prevention of PTSD by Early Treatment

描述（由申请人提供）：广泛的恐怖主义的出现需要仔细注意预防多种创伤后应激障碍（PTSD）病例。对照研究表明，早期心理干预可以在选定的幸存者群体中预防PTSD。早期干预对大量幸存者的有效性尚不清楚。药物预防的效果同样未知。这项提议的工作将测试认知行为疗法（CBT）和独立的舍曲林（sertraline）在创伤事件发生一个月内提供给高度痛苦的幸存者（这些幸存者是在大量暴露于创伤的个体中系统识别出来的）将有效预防创伤后应激障碍的假设。它还将评估通过早期干预系统地预防创伤后应激障碍的方案在多大程度上是可行的，幸存者可以接受的，并有效地降低发病率。拟议的工作包括两个嵌入式程序：在创伤事件发生后一周和七个月，对4000名幸存者进行全面的外联和结构化的电话评估；在创伤事件发生后一个月内，对有急性应激障碍症状的幸存者进行CBT、舍曲林和等待名单的嵌入式随机对照试验。等待名单上的幸存者将在三个月后接受CBT治疗。反复临床评估，探讨治疗效果。反复电话评估将评估治疗效果。这项研究将为大规模幸存者PTSD二级预防的可行性和有效性提供重要的知识。

DESCRIPTION (provided by applicant): The advent of widespread terrorism requires careful attention to preventing multiple cases of post-traumatic stress disorder (PTSD). Controlled studies suggest that early psychological interventions can prevent PTSD in selected groups of survivors. The effectiveness of early interventions in large groups of survivors is unknown. The effect of pharmacological prevention is equally unknown. The proposed work will test the hypothesis that cognitive behavioral therapy (CBT) and, independently, sertraline will effectively prevent PTSD when provided, within a month of a traumatic event, to highly distressed survivors, who are systematically identified in a large cohort of trauma-exposed individuals. It will also evaluate the extent to which a program to systematically prevent PTSD by early interventions is feasible, acceptable to survivors and effectively reduces morbidity. The proposed work consists of two embedded procedures: a comprehensive outreach and structured telephone evaluation of 4000 survivors, performed one week and seven months following a traumatic event, and an embedded randomized controlled trial of CBT, sertraline, and a wait list, offered within a month of a traumatic event to survivors with symptoms of acute stress disorder. Survivors in the wait list will receive CBT three months later. Repeated clinical assessments will probe treatment efficacy. Repeated telephone evaluations will assess treatment effectiveness. The study will generate vital knowledge about the feasibility and the effectiveness of secondary prevention of PTSD in large cohorts of survivors.