A randomized controlled trial published in the current issue of Psychotherapy and Psychosomatics indicates that early counseling has a very limited role in preventing distress after heart attacks.

Acute coronary syndrome (ACS)-induced posttraumatic stress disorder (PTSD) and clinically significant PTSD symptoms are found in 4 and 12% of patients, respectively. Hence, this randomized-controlled trial aimed to test whether early trauma-focused counseling with a psychological first-aid approach prevents the incidence of PTSD symptoms in patients with high distress during ACS.

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. Results showed that in patients at risk to develop ACS-induced PTSD, trauma-focused counseling showed no benefit for the prevention of clinician-rated PTSD/PTSS when controlled to an active control intervention at 3 months of follow-up. Specifically, Authors found neither statistical nor clinical evidence (effect size 0.13) that a single session of individual trauma-focused counseling was more effective than stress counseling for the prevention of the primary outcome interviewer-rated PTSS. Trauma-focused counseling did also no better than the active control intervention at reducing scores of the individual PTSD symptom clusters and the prevalence of a psychiatric diagnosis of PTSD. Trial results were also negative in terms of secondary outcomes self-rated PTSS, depressive symptoms, and global psychological distress, although different from findings for interviewer-rated posttraumatic stress.

In this negative trial, Authors did not find benefits 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.


Source: Journal of Psychotherapy and Psychosomatics
Full bibliographic information
Early Psychological Counseling for the Prevention of Posttraumatic Stress Induced by Acute Coronary Syndrome: The MI-SPRINT Randomized Controlled Trial. Psychother Psychosom 2018;87:75–84