The second edition of After the Crash: Psychological Assessment and Treatment of Survivors of Motor Vehicle Accidents, published by the American Psychological Association (APA), adds new research to the original five-year study of MVA survivors in the Albany, New York area conducted in the early 1990s. Authors Edward B. Blanchard, Ph.D., and Edward J. Hickling, Psy.D., explain in their comprehensive review of MVA survivors the importance of getting appropriate psychological treatment along with medical treatment to overcome the psychological trauma caused by a car accident.
The first edition, published in 1997, examined over a five-year period a cohort of 158 motor vehicle survivors who sought medical attention within 48 hours of the MVA and volunteered to be assessed for PTSD one to four months after their accident. The second edition, published December 2003, examines a second cohort of 161 seriously injured motor vehicle survivors for a five-year period who also sought medical attention within 48 hours of the MVA. The difference between the two cohorts was the participants in the second cohort actively sought treatment for psychological distress and were recruited six to 24 months after their accident to meet the criteria for chronic PTSD.
Comparing the results of the two groups, the authors found that participants in the second cohort had fewer prior MVAs but both had similar levels of any prior trauma. But, note the authors, the participants in the second group had significantly higher levels of prior PTSD (42%) compared with the participants in the first group (16%). This may be why the MVA survivors in the second cohort actively sought treatment, say the authors.
Among the second cohort, 110 of the participants were diagnosed with PTSD, 33 were diagnosed with subclinical PTSD and 18 were not diagnosed with PTSD. Approximately 60 percent of the participants in this second group who were diagnosed with PTSD were also diagnosed with major depression. From a questionnaire developed to assess anxiety created by car travel, close to 95 percent of the participants diagnosed with PTSD endured noticeable to high levels of anxiety when driving in some situations and avoided certain driving situations (i.e. nighttime driving, driving on the highway or in bad weather).
PTSD caused by MVAs and other traumas is a serious mental health problem and must be appropriately diagnosed, said Blanchard and Hickling. "If it isn't diagnosed or misdiagnosed, the trauma victim could suffer from life long PTSD." The authors address this in the second edition by offering some new perspectives on treatments for chronic PTSD, comorbid depression and anxiety based on a randomized controlled trial of a cognitive-behavioral therapy (CBT) protocol.
Out of the 161 participants in the second cohort, 98 participated in this therapy protocol. Twenty-seven percent were men and the average age was 41. On average, the participants suffered the MVA 14 months prior to starting therapy. This protocol had a better than 75 percent success rate on measures of PTSD as well as improving major role functioning, relations with family and friends, participation in recreation and overall functioning. The benefits held up well for the intermediate and long-term (one and two year follow up). Ninety-one percent of the participants were also suffering from lingering physical injuries and 59 percent were involved in litigation.
According to the authors, brief supportive psychotherapy was also effective for these MVA survivors with chronic PTSD. The benefits, although not as great as CBT, were better for survivors who were on the waitlist for treatment. Earlier trauma, said the authors, increased the likelihood of developing PTSD following a MVA. A combination of psychological and pharmacological treatments may also benefit those MVA survivors who are suffering from multiple maladies, like depression, chronic pain and sleep problems, said Drs. Blanchard and Hickling.
The following conclusions were noted about other treatment studies:
- Single session occurring in the first two weeks after the MVA were found not to be effective and detrimental for those survivors who had high scores on the Impact of Event Scale.
- Multiple sessions using cognitive-behavioral treatments administered early to high-risk MVA survivors were effective in preventing later PTSD.
- Early education and supportive counseling over several sessions with high risk MVA survivors does not appear to prevent short-term PTSD and may lead to a poorer outcome than no treatment at all.
According to the National Co-Morbidity Survey that examined over 8,000 individuals between the ages of 15 to 54 on lifetime and 12-month prevalence of psychiatric disorders in 1990-1992 reviewed in After the Crash, close to 40 percent of the sample who did not receive mental health treatment for PTSD resulting from either a MVA or other cause within six years after the trauma continued to suffer from PTSD as long as 10 years after the initial trauma.
Treatments for MVA survivors may also be effective for survivors of physical injuries, railroad and boating accidents, airplane crashes, rape and assault, said the authors. "Because MVAs are the most common trauma in the United States affecting both men and women, young and old," said Dr. Blanchard, "we see this latest research as an important addition to our model of what can work to help people recover from PTSD and other psychological disorders resulting from a MVA and other traumas."
Book: "After the Crash: Psychological Assessment and Treatment of Survivors of Motor Vehicle Accidents," Edward B. Blanchard, Ph.D., Director of the Center for Stress and Anxiety Disorders at the University of Albany; Edward J. Hickling, Psy.D., Private Practice in Albany and on faculty at the Sage Colleges and Albany Medical College
(Complimentary copies of the book are available from the APA Public Affairs Office)
Edward B. Blanchard, PhD can be reached by phone (518) 442-4025 or by email, and Edward J. Hickling, PsyD can be reached by phone at (518) 438-6590 or by email at ehickling@nycap.rr.com
The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 53 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.