A critical review of mechanisms of adaptation to trauma: Implications for early interventions for posttraumatic stress disorder. (April 2021) - Bryant, Richard A.
Abstract: Although many attempts have been made to limit development of posttraumatic stress disorder (PTSD) by early intervention after trauma exposure, these attempts have achieved only modest success. This review critiques the biological and cognitive strategies used for early intervention and outlines the extent to which they have prevented PTSD. The major predictors of PTSD are reviewed, with an emphasis on potential mechanisms that may underpin the transition from acute stress reaction to development of PTSD. This review highlights that there is a wide range of biological and cognitive factors that have been shown to predict PTSD. Despite this, the major attempts at early intervention have focused on strategies that attempt to augment extinction processes or alter appraisals in the acute period. The documented predictors of PTSD indicate that a broader range of potential strategies could be explored to limit PTSD. The evidence that people follow different trajectories of stress response following trauma and there is a wide array of acute predictors of PTSD indicates that a flexible and tailored approach needs to be investigated to evaluate more effective early intervention strategies. Highlights: Current early intervention strategies to limit PTSD after trauma exposure have achieved limited success. Longitudinal studies indicate that trauma survivors follow distinct trajectories of stress response. There are diverse acute predictors of PTSD, encompassing a range of biological and cognitive factors. The different posttrauma trajectories indicates that early intervention strategies need a more flexible approach. Evidence suggests that early intervention strategies need a flexible approach that accommodate the different mechanisms.