Optimal Dose of Early Intervention to Prevent PTSD

The precipitant for adult posttraumatic stress disorder (PTSD) is a known event, which
allows for immediate intervention and presents the potential to prevent the occurrence of
this serious condition. However, there currently are no accepted interventions for the early
intervention and prevention of PTSD in the immediate aftermath of trauma. This study will
determine whether providing exposure therapy to people who have recently experienced trauma
will significantly reduce the severity of PTSD symptoms post-trauma and if delivery of three
exposure sessions will result in larger reductions in the symptoms of PTSD post-trauma than
one exposure session. This study will also examine predictors for treatment response.

Participation in this study will last 12 months. Participants will first undergo an
evaluation session that will include an interview and questionnaires. They will then be
randomly assigned to one of the following three conditions: 1-session exposure therapy,
3-session exposure therapy, or assessment only. Participants receiving 1-session exposure
therapy will complete one treatment session in the emergency department (ED). Participants
receiving 3-session exposure therapy will complete three weekly treatment sessions, with the
first occurring in the ED. 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, 3, 6, and 12 months after the initial evaluation
session.

Inclusion Criteria:

- Presenting to the emergency department of Emory University School of Medicine/Grady
Memorial Hospital for trauma 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

- Have a memory of what happened during the trauma

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

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