Other prevention efforts seek to detect and treat disorder in its early stages (for example, treat those who meet the criteria for acute stress disorder [ASD]) often before it presents clinically as chronic PTSD. Several studies (for example, Bryant et al., 1999, 2003; Shalev et al., 2011) have demonstrated that early interventions for ASD result in significant reductions of ASD symptoms and the prevention of the onset of PTSD in the majority of individuals treated. Prophylactic interventions can be implemented immediately after a trauma (within 48 hours) or during the acute period (within weeks) to prevent full onset of PTSD symptoms (Litz, 2008), although the efficacy of this approach is unknown. And prevention may refer to measures taken to mitigate the consequences of existing symptoms by improving functioning and reducing complications. The latter type of PTSD prevention includes interventions in patients who have subthreshold PTSD symptoms, ASD, and ancillary problems; it provides treatment for clinical PTSD and recurrence prevention through rehabilitation programs. Treatment and rehabilitation programs for PTSD are covered in depth in Chapter 7 and 8, respectively; the present chapter discusses interventions to limit the development of clinical PTSD (that is, beyond subclinical symptoms) and to prevent recurrence.

Prevention is considered here in three phases:

  1. Interventions that are applied to an entire population before a traumatic event and regardless of the potential for exposure. These are often called primary or universal interventions.
  2. Interventions that are applied to individuals who are known to have been exposed to a traumatic event and thus to be at risk for PTSD and who may or may not be showing symptoms of stress. These are called secondary or selective interventions.
  3. Interventions aimed at individuals who are displaying symptoms of or have received a diagnosis of PTSD with the goals of preventing worsening of the symptoms and improving functioning. These are called tertiary or indicated interventions.

As noted by Lau and Rapee (2011), universal interventions do not require screening, and they reduce the possibility that specific persons will be labeled unfavorably by others for having a mental illness. Selective and indicated interventions are targeted at persons viewed to be vulnerable, and therefore, pose a risk that such persons will be labeled as mentally disordered and viewed unfavorably.

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