Immediate psychiatric therapy provided in the emergency room for arriving trauma patients may reduce the likelihood of the onset of Post-Traumatic Stress Disorder (PTSD), a new study from the Emory University School of Medicine shows.

Presented at the 32nd Annual Anxiety Disorders Association of America (ADAA) conference on April 13, 2012, the research revealed that emergency room trauma patients — especially those suffering from a sexual assault — who received extensive psychiatric intervention in the emergency room experienced fewer PTSD symptoms when evaluated three months later than similar patients who received only basic assessment.

As noted by lead investigator, Barbara Olasov Rothbaum, Ph.D., the findings indicate a need to reach people immediately after exposure to a trauma, whether on the battlefield or at the emergency site. It is important to reach the victim before he has a chance to sleep, as sleep solidifies memories.

Lasting Effects of Trauma

PTSD is a serious anxiety disorder triggered upon experiencing a traumatic, life-threatening event. It is often characterized by flashbacks, nightmares, isolation, angry outbursts, difficulty concentrating and avoidance of people or places that remind the person of the event. Genetics, environment, gender, previous history of emotional trauma or illness, and other factors contribute to the likelihood of the emergence of PTSD.

In conducting the study, researchers randomly divided 137 trauma patients from a level 1 trauma center into two groups: 68 were assessed for injuries, and 69 received the same assessment plus psychiatric therapy designed to prevent PTSD from developing. Most were in their early 30s, and approximately two-thirds of the participants were black women. Traumas included rape, car accidents, and nonsexual attacks.

The therapy patient group underwent three therapy sessions, with the initial one occurring in the emergency department, the second one a week later, and the last another week afterword. During the first intervention, which occurred in the hospital emergency room about seven hours after the trauma, patients were encouraged to verbalize the event, with the investigators recording it for playback to the patients. This first phase intervention occurred rapidly, lasting about one hour, and just prior to the patients' discharge from the hospital. During all therapy sessions, participants were given exercises to use at home to help them identify feelings of avoidance associated with the trauma.

Immediate Therapy After Trauma is Key

Scientists conducted assessments four and twelve weeks after the intervention to review the emotional status of the participants. Those receiving only the basic assessment and not the immediate psychiatric therapy experienced significantly more PTSD symptoms than their study counterparts. Meanwhile, the test group's score on trauma measurements remained stable at both follow-up periods. The most benefit was seen with the group of sexual assault victims, while the smallest benefit was seen for the patients who suffered from nonsexual physical attacks.

Rothman suggested that the intervention was beneficial because, unlike past psychological debriefings, this therapy occurred privately, rather than in a group setting, and patients received the therapy in three sessions with home exercises given in between.

Helping trauma victims avoid the development of long-lasting mental illnesses is the goal of intervention; future studies are focused on finding the best ways to achieve such objectives.

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