PTSD - Minimising risk / Prevention

The prevention of post traumatic stressRelating to injury or concern. disorder (PTSD) may be considered on three tiers:[1]

  • Primary: Primary prevention of PTSD essentially involves the avoidance of any trauma which might cause PTSD
  • Secondary: Secondary prevention of PTSD involves measures to prevent the development of PTSD immediately after a person has experienced a significant trauma
  • Tertiary: Tertiary prevention of PTSD involves measures to prevent PTSD worsening once it has been diagnosed.

In practice, most efforts concentrate on preventing the development of PTSD after exposure to trauma. However, it is important to tread carefully; routinely giving medical care to people who have experienced trauma may actually sometimes interfere with a normal recovery process.[2]

There are two main considerations in minimising the risk for PTSD:

Psychological care after a traumatic event

It is believed that after a trauma is experienced, there is a window of opportunity to prevent the development of psychological consequences such as PTSD.[2]

Acute distress management aims to modify the emotional response to an event, and to help encourage a full return to normal daily functioning and activity.[2]

Research is encouraging for the use of cognitive behavioural therapy, a therapy which focuses on thought patterns and their associated behaviours.[1]

At one point, it was considered beneficial to have a debriefing session - that is, to go over the events of the trauma. However, more recent research suggests that people who forget the traumatic event are actually less likely to develop PTSD. Because of this, it is now believed that debriefing may not be helpful after all, and may actually lead to less positive outcomes.[1,2]

Further research is underway regarding these issues.[3]

Pharmacological therapy

The only medications that are currently given specifically for PTSD are a group called 'selective serotonin reuptake inhibitors' (SSRIs). These medications are also used as antidepressants. While trials of these drugs in the prevention of PTSD involved their use months or years after exposure to the traumatic event, it is believed that early administration may help to prevent the development of PTSD.[2]

Recent research suggests that another type of medication, called a 'beta blocker' may help to prevent PTSD if given after a traumatic event.[4] Beta blockers may also reduce the symptoms of PTSD, for example by lowering the heart rate.[1]

Recent research suggests that medications that help to prevent the consolidation of the traumatic memory might be helpful.[2]

  1. Davidson JRT. Surviving disaster: what comes after the trauma? British Journal of Psychiatry 2002; 181: 366-8.
  2. Zohar J, Sonnino R, Juven-Wetzler A et al. Can post-traumatic stressRelating to injury or concern. disorder be prevented? CNS Spectr 2009; 14: 1(Suppl 1) 44-51.
  3. Stein DJ, Cloitre M, Nemeroff CB et al. Cape town consensus on posttraumatic stressRelating to injury or concern. disorder. CNS Spectr 2009; 14: 1(Suppl 1): 52-8.
  4. Grinage BD. Diagnosis and management of post-traumatic stressRelating to injury or concern. disorder. Am Fam Physician 2003; 68: 2401-8,2409.