with controls. The sessions focused on changing cognitions, for example, replacing automatic negative thoughts with more constructive ones. At three-year follow-up, participants had experienced significantly fewer episodes of generalized anxiety disorder and fewer moderate (but not severe) depressive episodes than controls.

Although the preventive interventions for anxiety disorders evaluated to date are all based on CBT approaches, recent research suggests that these approaches may not be optimal (Biglan, Hayes, and Pistorello, 2008). Growing evidence suggests greater effectiveness for acceptance-based interventions (Hayes, 2004; Hayes, Luoma, et al., 2006), which teach people to accept anxiety as a normal part of living a value-focused life. Support for this approach also comes from evidence that efforts to control unwanted thoughts and feelings may exacerbate them (e.g., Wegner, 1992, 1994). Additional research is needed to develop and evaluate preventive interventions based on acceptance-based approaches and to determine the effectiveness of these approaches relative to traditional CBT.

Prevention of Posttraumatic Stress Disorder (PTSD)

Although it appears plausible that providing some sort of counseling to all trauma victims could prevent PTSD, empirical research has not shown this to be the case. Critical incident stress debriefing (CISD) is a technique widely used to prevent adverse reactions to trauma. As soon as possible after the traumatic event, victims are encouraged to discuss the details of their experience, their emotional reactions, any actions they have taken, and any symptoms they have experienced. They are reassured that their reactions are normal, told of adverse reactions that are typical, and encouraged to resume usual activities. The intervener tries to assess whether any adverse reactions have occurred and, if so, refers the person for further assistance. Typically there is a follow-up contact with the victim. Recent research found that CISD is ineffective and possibly harmful (American Psychiatric Association, 2004). A meta-analysis found no benefit from its use and suggested a detrimental effect compared with no intervention or minimal help (van Emmerik, Kamphuis, et al., 2002).

In contrast, randomized controlled trials of CBT for individuals who are symptomatic in the weeks after a trauma reveal significant efficacy (Boris, Ou, and Singh, 2005). Some evidence suggests that this includes children (Chemtob, Nakashima, and Hamada, 2002).

In a quasi-randomized controlled trial, Berger, Pat-Horenczyk, and Gelkopf (2007) evaluated a school-based intervention consisting of an eight-session structured program designed to prevent and reduce children’s stress-related symptoms, including PTSD. Compared with the wait-list controls, the study group reported significant improvement on all measures.



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