Treatment of post-traumatic stress reactions to traffic accidents

by Fecteau, Gary W.

Post traumatic stress disorder and other reactions including driving phobias and depression have in recent years been ciearly identified as common accident sequelae. These disorders affect a siteable minority of those involved in traffic acddents of sufficient severity to necessitate medical attention. This minority can be consenratively estimated at 20 to 25% of accident victirns after one year. Their psychological symptoms and distress can be persistent over years, and disabling. Unfortunately. no treatment outcome data exist beyond case study reports and only one pilot investigation has been published upon which to base dinical practice. For post traumatic stress disorder (PTSD) in general, and for non-combat related trauma, in particular, controlled therapy outcome research is sparse. The present research was a randomized control clinical therapy outcome study for PTSD in motor vehicle accident victims. Twenty volunteer participants who had motor vehicle accidents resulting in physical injury requiring medical attention and PTSD wera recniited throug h rehabilitationservice providers, other psychologists. community physicians. and Iswyers. Participants wmpleted assessments including a structured interview for diagnosis of post traumatic stress disorder (Clinician Administered PTSD Scale) by an independent rater, a range of self-report symptom questionnaires and a behavioural test wherein they had their heart rate and subjective distress measured in reaction to idiosyncratic audio descriptions of their accident. They were then randomly assigned to eight to ten houn of individualcognitive-behaviourdtherapy @=IO) or to a wait list control group (n=lO). Treatment included education about post-trauma reactions, relaxation training, exposure therapy with cognitive restruduring and instruction for selfd irecfed graduated behaviour practice. The assessrnents were conducted both prior to and upon wmpletion of therapy or equivalent time for wait-list controls. A mail follow-up of symptom questionnaires was also completed three months and six months after the end of therapy. Results demonstrated statistically significant treatment effects across structured interviews, serreport questionnaires and the behavioural test. Analysis of clinical significanœ also supported the efficacy of treatment. Treatment gains were maintained over the six month follow-up penod. The vast majonty of participants also experienced chronic pain often with concurrent depression. These depressive symptoms, which were not targeted by treatment, were resistant to change. In addition to efficacy of treatment, potentiat predictors of initial PTSD symptom levels were explored by multiple regression. Avoidant coping style, fear level experienced during the trauma, and, crisis support were found to be significant variables related to PTSD symptoms. The present research is the first controlled therapy trial with this treatment population and the findings are discussed in tens of the therapeutic needs of this group and PTSD outcame research. iii