title: A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessments as early interventions for posttraumatic stress disorder.
abstract: BACKGROUND
  It is unclear what psychological help should be offered in the aftermath of traumatic events. Similarly, there is a lack of clarity about the best way of identifying people who are unlikely to recover from early posttraumatic symptoms without intervention.
  
  
  OBJECTIVE
  To determine whether cognitive therapy or a self-help booklet given in the initial months after a traumatic event is more effective in preventing chronic posttraumatic stress disorder (PTSD) than repeated assessments.
  
  
  METHODS
  Randomized controlled trial. Patients Motor vehicle accident survivors (n = 97) who had PTSD in the initial months after the accident and met symptom criteria that had predicted persistent PTSD in a large naturalistic prospective study of a comparable population.
  
  
  METHODS
  Patients were recruited from attendees at local accident and emergency departments.
  
  
  METHODS
  Patients completed a 3-week self-monitoring phase. Those who did not recover with self-monitoring (n = 85) were randomly assigned to receive cognitive therapy (n = 28), a self-help booklet based on principles of cognitive behavioral therapy (n = 28), or repeated assessments (n = 29).
  
  
  METHODS
  Symptoms of PTSD as assessed by self-report and independent assessors unaware of the patient's allocation. Main assessments were at 3 months (posttreatment, n = 80) and 9 months (follow-up, n = 79).
  
  
  RESULTS
  Twelve percent (n = 12) of patients recovered with self-monitoring. Cognitive therapy was more effective in reducing symptoms of PTSD, depression, anxiety, and disability than the self-help booklet or repeated assessments. At follow-up, fewer cognitive therapy patients (3 [11%]) had PTSD compared with those receiving the self-help booklet (17 [61%]; odds ratio, 12.9; 95% confidence interval, 3.1-53.1) or repeated assessments (16 [55%]; odds ratio, 10.3; 95% confidence interval, 2.5-41.7). There was no indication that the self-help booklet was superior to repeated assessments. On 2 measures, high end-state functioning at follow-up and request for treatment, the outcome for the self-help group was worse than for the repeated assessments group.
  
  
  CONCLUSIONS
  Cognitive therapy is an effective intervention for recent-onset PTSD. A self-help booklet was not effective. The combination of an elevated initial symptom score and failure to improve with self-monitoring was effective in identifying a group of patients with early PTSD symptoms who were unlikely to recover without intervention.
authors.affiliation: Department of Psychology, Institute of Psychiatry, London, UK. a.ehlers@iop.kcl.ac.uk
authors.forename: Anke
authors.initials: A
authors.lastname: Ehlers
authors.forename: David M
authors.initials: DM
authors.lastname: Clark
authors.forename: Ann
authors.initials: A
authors.lastname: Hackmann
authors.forename: Freda
authors.initials: F
authors.lastname: McManus
authors.forename: Melanie
authors.initials: M
authors.lastname: Fennell
authors.forename: Claudia
authors.initials: C
authors.lastname: Herbert
authors.forename: Richard
authors.initials: R
authors.lastname: Mayou
mesh_terms: D000063:Accidents, Traffic / Q000523:psychology*; D001638:Bibliotherapy / Q000379:methods; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D006801:Humans; D008016:Life Change Events; D010174:Pamphlets; D010555:Personality Inventory; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D017741:Survivors / Q000523:psychology; D016896:Treatment Outcome