Can early counselling prevent post traumatic stress induced by heart attacks?

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 percent 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 hours 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, the 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, the 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.