Key result
A single session of trauma-focused counseling did not significantly improve interviewer-rated posttraumatic stress symptoms compared to stress counseling in distressed ACS patients (mean 11.33 vs 9.88; P=0.40).
Why the study?
Does single-session trauma-focused counseling reduce posttraumatic stress symptoms in highly distressed patients with acute coronary syndrome?
RCT (n=190)
Single-blind (interviewer-rated)
randomized
Does single-session trauma-focused counseling reduce posttraumatic stress symptoms in highly distressed patients with acute coronary syndrome?
Absolute Event Rate: 11.33% vs 9.88%
p-value: p=0.40
Early single-session trauma-focused counseling does not prevent posttraumatic stress symptoms in highly distressed ACS patients and may worsen self-rated symptoms compared to general stress counseling.
Single-session trauma-focused counseling offers no benefit for posttraumatic stress in distressed ACS patients; challenges efficacy of brief trauma-focused interventions.
BACKGROUND: Acute coronary syndrome (ACS)-induced posttraumatic stress disorder (PTSD) and clinically significant PTSD symptoms (PTSS) are found in 4 and 12% of patients, respectively. We hypothesized that trauma-focused counseling prevents the incidence of ACS-induced PTSS. METHODS: Within 48 h of hospital admission, 190 patients with high distress during ACS were randomized to a single-session intervention of either trauma-focused counseling or an active control intervention targeting the general role of stress in patients with heart disease. Blind interviewer-rated PTSS (primary outcome) and additional health outcomes were assessed at 3 months of follow-up. Trial results about prevalence were compared with data from previous studies on the natural incidence of ACS-induced PTSS/PTSD. RESULTS: Intention-to-treat analyses revealed no difference in interviewer-rated PTSS between trauma-focused counseling (mean, 11.33; 95% Cl, 9.23-13.43) and stress counseling (9.88; 7.36-12.40; p = 0.40), depressive symptoms (6.01, 4.98-7.03, vs. 4.71, 3.65-5.77; p = 0.08), global psychological distress (5.15, 4.07-6.23, vs. 3.80, 2.60-5.00; p = 0.11), and the risk for cardiovascular-related hospitalization/all-cause mortality (OR, 0.67; 95% CI, 0.37-1.23). Self-rated PTSS indicated less beneficial effects with trauma-focused (6.54; 4.95-8.14) versus stress counseling (3.74; 2.39-5.08; p = 0.017). The completer analysis (154 cases) confirmed these findings. The prevalence rates of interviewer-rated PTSD (0.5%, 1/190) and self-rated PTSS were in this trial much lower than in meta-analyses and observation studies from the same cardiology department. CONCLUSIONS: Benefits were not seen for trauma-focused counseling when compared with an active control intervention. Nonetheless, in distressed ACS patients, individual, single-session, early psychological counseling shows potential as a means to prevent posttraumatic responses, but trauma-focused early treatments should probably be avoided.
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Känel et al. (2018) conducted an RCT in Acute coronary syndrome with high distress (n=190). Trauma-focused counseling vs. Stress counseling (active control) was evaluated on Interviewer-rated posttraumatic stress symptoms (PTSS) (p=0.40). A single session of trauma-focused counseling did not significantly improve interviewer-rated posttraumatic stress symptoms compared to stress counseling in distressed ACS patients (mean 11.33 vs 9.88; P=0.40).
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