Early interventions: from e-health to neurobiology

E ighty percent of adults experience at least one traumatic event throughout their lives and approximately 10% of them subsequently develop a posttraumatic stress disorder (PTSD; e.g., De Vries & Olff, 2009). Trauma exposure, especially when prolonged and in childhood, may have negative health consequences throughout the lifespan, in severe cases leading not only to psychological morbidity but also to increased physical diseases such as cardiac disease, cancer, and early death (Vaccarino et al., 2013; Wahlström, Michélsen, Schulman, Backheden, & Keskinen-Rosenqvist, 2013). Thus, there clearly is a significant public health impact of exposure to trauma and much to gain with effective preventive interventions. Most trauma-exposed individuals will display acute symptoms of posttraumatic stress, but in most of them these will gradually disappear over time. However, a subgroup of trauma-exposed individuals will continue to develop a trauma-related psychiatric disorder. Some time ago, it was believed that ‘‘debriefing’’ was a good solution, helping people to express their emotions and giving them psycho-education after trauma. However, research soon showed that the classical forms of debriefing were not effective and even worsened symptoms in some (Sijbrandij, Olff, Reitsma, Carlier, & Gersons, 2006). Psychosocial support and psychological first aid are evidence-informed interventions expected to be beneficial (Olff, 2012). To provide the highly needed easily applicable and costeffective early interventions, researchers have focused on finding new forms of potential early interventions using both pharmacological (e.g., hydrocortisone [Delahanty et al., 2013], morphine [Mouthaan et al., 2015] or oxytocin [Koch et al., 2014]) and psychological routes, such as innovative dyadic CBT by Brunet, Bousquet Des Groseilliers, Cordova, and Ruzek (2013), whereas Rothbaum et al. (2012) performed the first trial showing early exposure treatment to be effective shortly after trauma. Recently, e-health has been added as a promising agent to deliver preventive interventions (Mouthaan et al., 2013; Olff, 2015). At the AMC, we are currently testing the efficacy of the neuropeptide oxytocin shortly after trauma (BONDS) and the efficacy of mobile apps to detect and reduce trauma-related symptoms (SAM, SUPPORT Coach). In the BONDS study, we examine the efficacy of intranasal administration of the neuropeptide oxytocin in the prevention of PTSD (Frijling et al., 2014, Olff et al., 2015). Recently traumatized individuals at increased risk for PTSD due to high levels of acute distress are identified at various emergency departments throughout Amsterdam. Within 10 days posttrauma they commence an 8-day treatment regimen of either intranasal oxytocin or placebo. Follow-up occurs at 1.5, 3, and 6 months after trauma. Results of interim analyses on the first 120 randomized participants regarding PTSD symptoms at 1.5 months after trauma will be presented. SAM, Smart Assessment on your Mobile, is a brief mobile screener to assess psychological problems and resilience after a traumatic event as well as risk and protective factors (Van der Meer et al., 2014). We investigate the validity and usability, and collect data in different samples of trauma-exposed employees in high-risk professions such as the police. Preliminary results demonstrate SAM’s usability and point at high user satisfaction. Our second ehealth project concerns the Dutch equivalent of the PTSD Coach: The SUPPORT Coach, a smartphone application designed to support adults who suffer from posttraumatic stress symptoms (PTSS). In an ongoing RCT, we test the effectiveness of the SUPPORT Coach in reducing PTSS and satisfaction with the app in individuals in high-risk professions, such as emergency department personnel and ambulance workers. PSYCHOTRAUMATOLOGY EUROPEAN JOURNAL OF