Discussion
pain, traumatic
SECONDARY, COMPLICATIONS, EVENT
This double-blind multicentre RCT with an active placebo control group tested the effect of a single-session behavioural intervention for IMs including a visuospatial task, delivered by trained maternity clinicians, to prevent the development of broader CB-PTSD symptoms. Participants who received the intervention tended to report fewer CB-PTSD symptoms at six weeks postpartum. This was not only the case for the total number of symptoms but also for intrusions and arousal symptoms although, importantly, Given the rigorous design of this study, these results have clinical implications and are a further step towards an implementation study into routine clinical care. This intervention, carried out by first line clinicians, is brief and fully compatible with routine clinical care. Our results cautiously confirm its efficacy in the secondary prevention of CB-PTSD symptoms development, as already reported in a previous proof-of-principle RCT with a passive control group [In line with our hypotheses, the intervention group reported half as many IMs as the control group during the first postpartum day. However, unexpectedly, the groups did not differ over the rest of the diary period. This contrasts with previous studies reporting that such visuospatial interventions led to fewer IMs within the week following the traumatic event [Compared to midwife-led debriefing, currently the main technique used to prevent CB-PTSD but whose efficacy remains unclear [This RCT had many strengths, including double-blinding, an active control group, and a prospective trial registration. The intervention was carried out by rigorously trained first-line clinicians. Furthermore, participants were followed-up until six months post-intervention. The analyses, conducted by a senior statistician, were based on innovative models and included covariates of major clinical and statistical importance. However, several limitations need to be highlighted. For example, although validated, the self-report questionnaires used may be subject to well-known biases, such as social desirability or recall bias. Furthermore, for ethical reasons, we did not include mothers who had given birth before 34 weeks of gestation or whose baby had died, and it was not necessarily possible to approach women with the most severe complications as they still underwent important care procedures, were too distressed, or experienced severe pain within the six first hours. This limits the generalisability of the results. As for the attention-placebo control task, unlike the intervention, it was not computer-based. However, in the absence of a validated task excluding any visuospatial processing, this comparator appeared relevant since it had already been used in a previous trial [Future research should investigate the implementation of a care pathway involving the routine screening of women with regard to perceived threat during childbirth and then systematically offering this single-session brief intervention to those who screened positively. This would also require investigation of how well the perception of threat to one’s own life and/or to that of one’s infant during childbirth (as applied in the current study) predicts the development of maternal CB-PTSS, which in turn could be the basis for the development of an evidence-based brief screening tool.Overall, this double-blind multicentre RCT with an active placebo group provides evidence that a single-session intervention including a visuospatial task can prevent the development of CB-PTSD symptoms up to six months postpartum. Crucially, this intervention, carried out by trained clinicians, is brief, highly acceptable, and easy to integrate into routine clinical care. Future research may thus evaluate its implementation.