Early Psychological Counseling for the Prevention of Posttraumatic Stress Induced by Acute Coronary Syndrome: The MI-SPRINT Randomized Controlled Trial.

von Känel, Roland; Barth, Jürgen; Princip, Mary; Meister, Rebecca Elisabeth; Schmid-Walker, Jean-Paul; Znoj, Hansjörg; Herbert, Claudia; Schnyder, Ulrich (2018). Early Psychological Counseling for the Prevention of Posttraumatic Stress Induced by Acute Coronary Syndrome: The MI-SPRINT Randomized Controlled Trial. Psychotherapy and psychosomatics, 87(2), pp. 75-84. Karger 10.1159/000486099

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BACKGROUND Acute coronary syndrome (ACS)-induced posttraumatic stress disorder (PTSD) and clinically significant PTSD symptoms (PTSS) are found in 4 and 12% of patients, respectively. We hypothesized that trauma-focused counseling prevents the incidence of ACS-induced PTSS. METHODS Within 48 h of hospital admission, 190 patients with high distress during ACS were randomized to a single-session intervention of either trauma-focused counseling or an active control intervention targeting the general role of stress in patients with heart disease. Blind interviewer-rated PTSS (primary outcome) and additional health outcomes were assessed at 3 months of follow-up. Trial results about prevalence were compared with data from previous studies on the natural incidence of ACS-induced PTSS/PTSD. RESULTS Intention-to-treat analyses revealed no difference in interviewer-rated PTSS between trauma-focused counseling (mean, 11.33; 95% Cl, 9.23-13.43) and stress counseling (9.88; 7.36-12.40; p = 0.40), depressive symptoms (6.01, 4.98-7.03, vs. 4.71, 3.65-5.77; p = 0.08), global psychological distress (5.15, 4.07-6.23, vs. 3.80, 2.60-5.00; p = 0.11), and the risk for cardiovascular-related hospitalization/all-cause mortality (OR, 0.67; 95% CI, 0.37-1.23). Self-rated PTSS indicated less beneficial effects with trauma-focused (6.54; 4.95-8.14) versus stress counseling (3.74; 2.39-5.08; p = 0.017). The completer analysis (154 cases) confirmed these findings. The prevalence rates of interviewer-rated PTSD (0.5%, 1/190) and self-rated PTSS were in this trial much lower than in meta-analyses and observation studies from the same cardiology department. CONCLUSIONS Benefits were not seen for trauma-focused counseling when compared with an active control intervention. Nonetheless, in distressed ACS patients, individual, single-session, early psychological counseling shows potential as a means to prevent posttraumatic responses, but trauma-focused early treatments should probably be avoided.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology > Centre of Competence for Psychosomatic Medicine
07 Faculty of Human Sciences > Institute of Psychology > Clinical Psychology and Psychotherapy
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
07 Faculty of Human Sciences > Institute of Psychology
07 Faculty of Human Sciences > Institute of Psychology > Psychological and Behavioral Health
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DCR Unit Sahli Building > Forschungsgruppe Neurologie

UniBE Contributor:

von Känel, Roland; Princip, Mary; Meister, Rebecca Elisabeth; Schmid-Walker, Jean-Paul and Znoj, Hans Jörg

Subjects:

100 Philosophy > 150 Psychology
600 Technology > 610 Medicine & health

ISSN:

0033-3190

Publisher:

Karger

Language:

English

Submitter:

Stefanie Hetzenecker

Date Deposited:

23 Apr 2018 12:42

Last Modified:

23 Oct 2019 13:24

Publisher DOI:

10.1159/000486099

PubMed ID:

29462823

Uncontrolled Keywords:

Acute coronary care Behavioral cardiology Emergency psychiatry Myocardial infarction Posttraumatic stress disorder Prevention Psychological stress Trauma stress

BORIS DOI:

10.7892/boris.112530

URI:

https://boris.unibe.ch/id/eprint/112530

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