Examining the Effectiveness of an Early Psychological Intervention to Prevent Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a disorder that forms in response to a traumatic
event. The symptoms of PTSD, such as hyper-arousal and re-experiencing the traumatic event,
are common in all people who have recently experienced a trauma, but those who develop PTSD
continue to have these symptoms more than a month after the trauma. Some researchers believe
that developing PTSD is the result of a failure to adequately recover from the trauma. This
study will determine whether providing a common form of treatment for PTSD, prolonged
exposure (PE) therapy, to people who have recently experienced trauma will prevent them from
developing PTSD. The study will also seek to identify predictive markers, such as hormone
levels and genes, for developing PTSD.

Participation in this study will last 3 months. Participants will first undergo an
evaluation session that will include an interview, questionnaires, and a medical chart
review for blood pressure and heart rate measurements taken after their trauma. They will
then be randomly assigned to receive either PE therapy or assessments only. Participants
receiving PE therapy will complete three weekly treatment sessions, with the first occurring
immediately after the evaluation session. Treatment will involve reviewing memories of a
recent trauma out loud with a therapist and audio-recording these discussions for review at
home. All participants will undergo assessments 1 and 3 months after the initial evaluation
session. The 1-month assessment will involve an interview and questionnaires similar to the
evaluation session, and the 3-month session will involve only a brief phone interview. Some
participants will also be asked to complete an optional part of the study in which they
provide two saliva samples to researchers: one to measure stress hormones and one to test
for genetic bases of trauma response.

Inclusion Criteria:

- Presenting to the emergency department of Emory University School of Medicine/Grady
Memorial Hospital for rape in the past 72 hours

- Meets DSM-IV diagnostic criterion A in which both of the following are present: (i)
The person experienced, witnessed, or was confronted with an event or events that
involved actual or threatened death or serious injury or a threat to the physical
integrity of self or others (ii) The person's response involved intense fear,
helplessness, or horror

- Speaks and understands spoken English

- Can see the assessment forms, hear instructions, and function at an emotional and
intellectual level sufficient to allow accurate completion of all assessment
instruments

- No significant traumatic injuries, as determined by the physician

Exclusion Criteria:

- Current or history of mania, schizophrenia, or other psychoses

- Current (past month) prominent suicidal ideation or recent (past 3 months)
parasuicidal behavior or other self-injurious behavior, such as low lethality cutting

- Current (past month) substance dependence; people who meet criteria for current
substance abuse but not dependence, or past dependence and have been in remission for
at least 1 month are eligible.

- Experienced a loss of consciousness for more than 5 minutes as a result of injuries
sustained during the trauma

- Intoxicated, altered, or highly distressed to the degree that accurate completion of
the study assessments or participation in study procedures is not possible

- Blood alcohol level above .08, determined by breathalyzer in the emergency department

- Not alert, oriented, and coherent

- In severe pain, active labor, or respiratory distress or hemodynamically compromised
in any way