Cognitive Behavioral Therapy for Acute Post-trauma Distress: A Randomized, Controlled, Proof-of-Concept Study among Hospitalized Adults with Burns

Publication date: Available online 15 February 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): James A. Fauerbach, Amanda K. Gehrke, Shawn T. Mason, Neda F. Gould, Stephen M. Milner, Julie Caffrey

Abstract

Objective

(1) To evaluate the feasibility of conducting a randomized controlled trial (RCT) of the Safety, Meaning, Activation and Resilience Training (SMART) intervention versus Non-Directive Supportive Psychotherapy (NDSP) in an acutely hospitalized adult burn survivor sample; (2) To assess the preliminary impact of SMART on Acute Stress Disorder (ASD)/Posttraumatic Stress Disorder (PTSD) and Major Depress Disorder (MDD) symptom reduction as secondary prevention.

Design

Proof-of-concept, parallel group, RCT design.

Setting

Regional burn center.

Participants

Acutely injured, hospitalized adult burn survivors.

Interventions

SMART is a manualized, 4-session cognitive behavioral therapy-based psychological intervention targeting ASD/PTSD and MDD symptoms. NDSP is a manualized, 4-session protocol.

Main Outcome Measures

Davidson Trauma Scale (DTS; diagnostic proxy for ASD/PTSD; clinical cutoff = 40-higher score = higher severity) and the Patient Health Questionnaire-9 (PHQ-9; diagnostic proxy for MDD; clinical cutoff = 10-higher score = higher severity) at pre-treatment, immediate post-treatment, and 1-month post-treatment.

Results

Burn survivors (n= 50) were randomly assigned to SMART (n = 28) or NDSP (n = 22). Due to drop out and missing data, final sample size was 40, SMART (n = 21) and NDSP (n = 19). At baseline, median DTS scores and PHQ-9 scores were above clinical cutoffs and did not differ across groups. At 1-week and 1-month post-treatment, median DTS and PHQ-9 scores were beneath clinical cutoffs in the SMART group; scores remained above clinical cutoffs in the NDSP group at these time points.

Conclusions

It is feasible to conduct an RCT of SMART in hospitalized adult burn survivors. SMART has the potential to yield clinically significant outcomes. Additional studies are needed to replicate and extend these findings.

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