Multi-session Cognitive Behavioral Therapy-Based Approaches (Answer: D)
For a patient presenting two weeks post-trauma with acute stress symptoms (anxiety, hypervigilance, nightmares, sleep disturbance), multi-session cognitive behavior therapy-based approaches (brief CBT, 4-5 sessions) have the strongest evidence for preventing the development of chronic PTSD. 1
Evidence Supporting Brief CBT
The most relevant guideline evidence from Neuropsychopharmacology (2005) directly addresses early intervention after trauma exposure:
Brief CBT administered in 4-5 individual sessions beginning 2-5 weeks after the traumatic event is specifically designed for individuals experiencing high levels of post-traumatic stress symptoms who are vulnerable to developing chronic PTSD 1
A growing number of randomized controlled trials demonstrate that brief CBT accelerates recovery and possibly decreases the likelihood of developing chronic PTSD 1
This intervention targets the exact timeframe and symptom profile described in the clinical scenario (two weeks post-trauma with acute symptoms) 1
Why Other Options Are Inferior
Psychological Debriefing (Option A) - Not Recommended
Psychological debriefing, despite widespread dissemination and high consumer satisfaction, does NOT have evidence supporting its efficacy in preventing chronic stress reactions 1
The existing randomized controlled trials investigating psychological debriefing show that results do not support the usefulness of this intervention in the prevention of chronic stress reactions 1
This represents a critical pitfall: psychological debriefing remains widely used despite lack of efficacy data 1
Support Groups (Option B) - Insufficient Evidence
- No specific evidence was provided regarding support groups for PTSD prevention in the acute post-trauma period
Psychoeducation (Option C) - Insufficient as Standalone
- While psychoeducation may be a component of comprehensive interventions, it lacks standalone evidence as the primary prevention strategy for PTSD
Memory Structuring (Option E) - Limited Evidence
- No specific evidence was provided for memory structuring intervention as a prevention strategy in the acute phase
Clinical Implementation Algorithm
Timing is critical:
- Wait 2-5 weeks post-trauma before initiating brief CBT 1
- This patient at two weeks is entering the optimal intervention window
Target population:
- Individuals with high levels of post-traumatic stress symptoms (anxiety, hypervigilance, nightmares, sleep disturbance) 1
- This patient meets these criteria precisely
Treatment structure:
- 4-5 individual sessions of trauma-focused cognitive behavioral therapy 1
- The intervention should include exposure-based components and cognitive restructuring techniques
Additional Context on Trauma-Focused CBT
For established PTSD (not prevention), trauma-focused CBT has the strongest evidence base:
Exposure therapy has gained the greatest support across the widest range of populations for treating chronic PTSD 1
Image rehearsal therapy, a modified CBT technique, has demonstrated efficacy for sleep-related problems in PTSD including nightmares 1
The American Academy of Sleep Medicine guidelines note that trauma-focused cognitive behavioral therapy has a large body of evidence demonstrating efficacy for PTSD treatment 1
Common Pitfalls to Avoid
Do not provide psychological debriefing as routine intervention - despite its popularity and patient satisfaction, it lacks efficacy evidence and may be contraindicated 1
Do not delay intervention too long - the 2-5 week window after trauma is optimal for brief CBT intervention 1
Do not use benzodiazepines in acute stress reactions - they promote dissociation and may worsen long-term outcomes 2