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Early cognitive–behavioural therapy for post-traumatic stress symptoms after physical injury: Randomised controlled trial

  • Jonathan I. Bisson (a1), Jonathan P. Shepherd (a2), Deborah Joy (a2), Rachel Probert (a2) and Robert G. Newcombe (a3)...
Abstract
Background

Early single-session psychological interventions, including psychological debriefing following trauma, have not been shown to reduce psychological distress. Longer early psychological interventions have shown some promise.

Aims

To examine the efficacy of a four-session cognitive–behavioural intervention following physical injury.

Method

A total of 152 patients attending an accident and emergency department displaying psychological distress following physical injury were randomised 1–3 weeks post-injury to a four-session cognitive–behavioural intervention that started 5–10 weeks after the injury or to no intervention and then followed up for 13 months.

Results

At 13 months, the total Impact of Event Scale score was significantly more reduced in the intervention group (adjusted mean difference=8.4, 95% CI 2.4–14.36). Other differences were not statistically significant.

Conclusions

Abrief cognitive–behavioural intervention reduces symptoms of post-traumatic stress disorder in individuals with physical injury who display initial distress.

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Copyright
Corresponding author
Jonathan I. Bisson, Department of Liaison Psychiatry, Cardiff and Vale NHS Trust, Monmouth House, University Hospital of Wales, Heath Park, Cardiff CFI4 4XW, UK. Tel: 029 20743940; fax: 029 20743928; e-mail: BissonJI@Cardiff.ac.uk
Footnotes
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See editorial, pp. 3–4, this issue.

Declaration of interest

None.

Footnotes
References
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Early cognitive–behavioural therapy for post-traumatic stress symptoms after physical injury: Randomised controlled trial

  • Jonathan I. Bisson (a1), Jonathan P. Shepherd (a2), Deborah Joy (a2), Rachel Probert (a2) and Robert G. Newcombe (a3)...
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eLetters

CBT Interventions in Post-Traumatic Stress Disorder - Methodological Issues

Richard H. Baker, Specialist Registrar
26 January 2004

Dear Madam, Sir

With reference to Bisson et al. (2004) we want to express our admiration for the clear, well – presented and important study. We wouldlike, to raise, however, a few issues in regards to this publication:

-We wonder whether an ANCOVA is the optimal approach to analyse the result of this study; we felt that repeated measure ANOVAs, taking the patients as their own control, might be at least as good or even preferable as a second pathway of analysis.

-Linear regression analysis is originally designed for continuous variables, yet the IES and HADS used are scales using categorical variables. We are aware that in ignorance of the actual IES cut-off this is often ignored, but we wonder whether this might make the regression analysis less applicable and whether logistic regression analysis might bepreferable.

-Although the raters in this study were excellently ‘blinded’, the approach to the participants who did not receive intervention meant that the study was clearly not double blind. Additionally, the clinicians delivering the intervention were clearly not blinded. The “gold standard of clinical research” is the randomised double-blind design, defined as “neither the patient nor the physician is aware of the treatment assignment.”(1) A series of sham CBT with the non-intervention group might be possible, but naturally the delivering clinician would know that it is only a sham treatment. Given the possible interaction with dynamic factors, like interpersonal skills, empathy and nonverbal communication inCBT, the question how much of the results in CBT are a result of these non-specific confounding factors, or the actual CBT technique as such, is notalways easy to answer. Maybe in psychological interventions proper double-blinding is inherently impossible to achieve.

Reference(1) Rosner, P., Fundamentals of Biostatistics, Pacific Grove (CA), Duxbury2000, p. 167.
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