Washington State Institute for Public Policy
Posttraumatic stress disorder (PTSD) prevention following trauma
Adult Mental Health: Trauma
Benefit-cost estimates updated May 2017.  Literature review updated May 2014.
The studies in this review examined Cognitive Behavior Therapy (CBT) treatment for persons in the first weeks and months following trauma but before a diagnosis of PTSD could be made. Treatments in the studies in this review involved five to ten hours of individual therapy that combined education on effects of trauma, relaxation, and exposure.
BENEFIT-COST
META-ANALYSIS
CITATIONS
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2016). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $1,873 Benefits minus costs $4,654
Participants $3,260 Benefit to cost ratio $6.45
Others $571 Chance the program will produce
Indirect ($196) benefits greater than the costs 100 %
Total benefits $5,508
Net program cost ($854)
Benefits minus cost $4,654
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Benefits from changes to:1 Benefits to:
Taxpayers Participants Others2 Indirect3 Total
Labor market earnings associated with PTSD $1,412 $3,109 $0 $0 $4,522
Health care associated with PTSD $461 $150 $571 $229 $1,411
Adjustment for deadweight cost of program $0 $0 $0 ($425) ($425)
Totals $1,873 $3,260 $571 ($196) $5,508
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $772 2008 Present value of net program costs (in 2016 dollars) ($854)
Comparison costs $0 2008 Cost range (+ or -) 15 %
This intervention takes place over five to ten weekly sessions. The per-participant cost of treatment by modality (group/individual) was weighted by the treatment Ns reported in the studies. Cost per session is $33.63/session for group and $96.63 for individual therapy (2009 dollars). This is based on actuarial tables reported in Mercer (2009) Behavioral Health Data Book for the State of Washington For Rates Effective January 1, 2010. In this set of studies, we assume a comparison cost of $0 because typically, this group of people would not receive treatment.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Estimated Cumulative Net Benefits Over Time (Non-Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in non-discounted dollars to simplify the “break-even” point from a budgeting perspective. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Primary or secondary participant No. of effect sizes Treatment N Adjusted effect sizes (ES) and standard errors (SE) used in the benefit-cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Major depressive disorder 6 232 -0.192 0.099 38 -0.100 0.121 39 -0.356 0.002
Post-traumatic stress 11 405 -0.336 0.076 38 -0.336 0.076 39 -0.641 0.001
Citations Used in the Meta-Analysis

Blanchard, E.B., Hickling, E.J., Devineni, T., Veazey, C.H., Galovski, T.E., & Mundy, E. (2003). A controlled evaluation of cognitive behavioral therapy for posttraumatic stress in motor vehicle accident survivors. Behavior Research and Therapy, 41(1): 79-96.

Bryant, R.A., Moulds, M.L., Guthrie, R.M., & Nixon, R.D.V. (2005). The additive benefit of hypnosis and cognitive- behavioral therapy in treating acute stress disorder. Journal of Consulting and Clinical Psychology, 73(2), 334-340.

Bryant, R.A., Harvey, A.G., Dang, S.T., Sackville, T., & Basten, C. (1998). Treatment of acute stress disorder: A comparison of cognitive-behavioral therapy and supportive counseling. Journal of Consulting and Clinical Psychology, 66(5), 862-866.

Bryant, R.A., Mastrodomenico, J., Felmingham, K.L., Hopwood, S., Kenny, L., Kandris, E., . . . Creamer, M. (2008). Treatment of acute stress disorder: A randomized controlled trial. Archives of General Psychiatry, 65(6), 659-667.

Davis, J.L., Rhudy, J.L., Pruiksma, K.E., Byrd, P., Williams, A.E., McCabe, K.M., & Bartley, E.J. ( 2011). Physiological predictors of response to exposure, relaxation, and rescripting therapy for chronic nightmares in a randomized clinical trial. Journal of Clinical Sleep Medicine, 7(6), 622-631.

Davis, J.L., & Wright, D.C. (2007). Randomized clinical trial for treatment of chronic nightmares in trauma-exposed adults. Journal of Traumatic Stress, 20(2), 123-33.

Ford, J.D., Steinberg, K.L., & Zhang, W. (2011). A randomized clinical trial comparing affect regulation and social problem-solving psychotherapies for mothers with victimization-related PTSD. Behavior Therapy, 42(4), 560-578.

Shalev, A.Y., Ankri, Y., Israeli-Shalev, Y., Peleg, T., Adessky, R., & Freedman, S. (2012). Prevention of posttraumatic stress disorder by early treatment: results from the Jerusalem Trauma Outreach And Prevention study. Archives of General Psychiatry, 69(2), 166-76.

Sijbrandij, M., Olff, M., Reitsma, J.B., Carlier, I.V.E., de, V.M.H., & Gersons, B.P.R. (2007). Treatment of Acute Posttraumatic Stress Disorder With Brief Cognitive Behavioral Therapy: A Randomized Controlled Trial. American Journal of Psychiatry, 164(1), 82-90.

For more information on the methods
used please see our Technical Documentation.
360.664.9800
institute@wsipp.wa.gov