Primary prevention
Immediate psychological interventions targeted at everyone involved in a traumatic event are not recommended in current practice guidelines.[35][52][53] Instead, it is recommended that immediate practical, social, and emotional support is offered by non-mental health professionals. A stance of watchful waiting is adopted, combined with the provision of psychological first aid, if required.[54] Psychological first aid is evidence-informed and aims to provide information, as well as emotional and practical support.[55] One systematic review and meta-analysis of clinical trials found that delivery of psychological therapies early in the postpartum period after traumatic childbirth reduced symptoms of childbirth-related post-traumatic stress disorder (PTSD).[56]
Additional assistance should be provided according to individual need. People who wish to discuss the experience should be supported in doing so, provided they are believed to be able to tolerate the distress that may be associated with this.
One Cochrane review of pharmacological treatments aimed at preventing or mitigating PTSD found no conclusive evidence in support of any of the interventions, including hydrocortisone, propranolol, dexamethasone, or gabapentin.[57] Another Cochrane review of pharmacological treatments aimed at preventing PTSD in people experiencing acute traumatic stress symptoms also found no conclusive evidence in support of any of the interventions (escitalopram, hydrocortisone, intranasal oxytocin, or temazepam).[58]
Secondary prevention
People with severe ongoing symptoms are offered formal assessment and intervention if it is detected that the disorder is not improving. Individual, trauma-focused cognitive behavioural therapy commenced within 3 months of the traumatic event is considered effective for people with acute traumatic stress symptoms.[82]
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