early support after exposure to trauma

Conditions: Post-traumatic Stress Disorder

Summary: a significant proportion of people who are exposed to traumatic events suffer from post-traumatic sequelae, such as post-traumatic stress disorder (ptsd). indicated preventive interventions soon after trauma could be appropriate. yet, there is limited evidence for the efficacy of such interventions. moreover, no evidence-based preventive interventions are readily available for victims in the aftermath of crises and disasters in norway. condensed internet-delivered prolonged exposure (cipe) is a preventive intervention designed for victims with symptoms of ptsd (ptss) approximately one month after a traumatic event. the treatment is an internet-delivered, therapist assisted intervention, based on principles from prolonged exposure. cipe has proven to be feasible, safe, and effective in previous studies. this study aims to test the effectiveness and cost-effectiveness of cipe in the context of psychosocial crisis services in norwegian municipalities. hypotheses effectiveness h1 participants receiving cipe + treatment as usual (tau) will have significantly less ptss than participants receiving tau at 2.5-, 6-, and 12- months after the traumatic incident. h2 significantly fewer participants receiving cipe+tau will fulfill the criteria for ptsd than participants receiving tau, at 6- and 12-months post trauma. h3 participants receiving cipe+tau will have significantly less symptoms of depression and insomnia than participants receiving tau at 2.5-, 6-, and 12- months after the traumatic incident. h4 participants in the cipe+tau-condition will report significantly higher treatment satisfaction at post-treatment, compared to those in the tau-condition. h5 participants with traumatic loss receiving cipe+tau will have significantly less symptoms of prolonged grief than such participants receiving tau 12 months after the loss. cost-effectiveness h6 fewer participants in the cipe+tau-condition will be referred to second-tier specialty mental health services, and more will achieve improved quality of life within the first year after the traumatic incident, compared to participants in the tau-condition. h7 the cipe+tau implementation is more cost-effective compared to the tau in the short run and may even dominate tau in the long run (i.e., more effective and less costly).


Eligibility criteria:
inclusion criteria: * receives support from a municipal crisis team * exposure to a traumatic event (as defined by criteria a for the diagnosis of post-traumatic stress disorder (ptsd) in the dsm-5) within the last month before randomization * a total score of 10 or above on the ptsd symptom checklist-5 at the time of randomization * age 16 or above * written informed consent * writes and speaks english and/or norwegian exclusion criteria: * severe psychopathology in need of specialized health care (e.g., psychotic symptoms, or high suicide risk) or substance dependence syndrome in need of specialized health care * known or evident severe cognitive impairment * ongoing traumatization, violence, or threats * unstable dose of psychotropic medication two weeks prior to randomization * concurrent therapy elsewhere before randomization

Keywords: cipe ptsd indicated prevention prolonged exposure