Motor vehicle accidents (MVAs) have been found to be the single leading cause of posttraumatic stress disorder in the general population. They are the most frequent, directly experienced trauma for men and the second most frequent trauma for women. Since the 1997 edition of After the Crash, there has been a monumental new wave of research in the assessment and treatment of MVA survivors.

In this timely second edition, written in a clear and lucid style and illustrated by a wealth of charts, guides, case studies, and clinical advice, the authors report on new, international research and provide updates on their own longstanding research protocols within the groundbreaking Albany MVA Project. This volume will appeal to a broad audience of practitioners, researchers, and physicians; attorneys who handle MVA survivor cases; and those interested in public safety issues.

Table of Contents


Introduction to the Second Edition

Prologue: The Case of Mary J.

I. Quantifying the Problem

  1. Overview of the Volume
  2. The Magnitude of the Problem
  3. What Proportion of MVA Survivors Develop PTSD?

II. Psychological Effects of MVAs

  1. Albany MVA Project
  2. What Are the Psychosocial Effects of MVAs on Survivors?
  3. Determining Who Develops PTSD From MVAs
  4. What Is the Short-Term Natural History of MVA-Related PTSD and What Predicts Remission?
  5. Delayed-Onset PTSD
  6. The Role of Physical Injury in the Development and Maintenance of PTSD Among MVA Survivors
  7. The Role of Litigation in the Remission of MVA-Related PTSD
  8. Acute Stress Disorder Among MVA Survivors
  9. Psychophysiological Assessment With MVA Survivors
  10. Can You Detect Malingered MVA-Related PTSD? The Albany MVA Project's Answer

III. Treatment for Survivors

  1. The Treatment of MVA-Related PTSD: A Review of the Early Literature
  2. The Treatment of MVA-Related PTSD: A Review of the Recent Controlled Literature
  3. The Early, Uncontrolled Albany Studies of the Treatment of MVA Survivors
  4. The Albany Treatment Study: A Randomized, Controlled Comparison of Cognitive–Behavioral Therapy and SUPPORT in the Treatment of Chronic PTSD Secondary to MVAs
  5. The Treatment Manual: An In-Depth Look at the Albany MVA Project's Cognitive–Behavioral Therapy
  6. Supportive Psychotherapy Manual
  7. Closing Remarks


  1. MVA Interview
  2. Longitudinal Course Scoring Form
  3. Transcript of the Home Practice Relaxation Tape
  4. Therapy Activity Checklist


Author Index

Subject Index

About the Authors

Author Bios

Edward B. Blanchard received his PhD in clinical psychology from Stanford University in 1969. After holding faculty positions at the University of Georgia, University of Mississippi Medical Center, and University of Tennessee Center for Health Sciences, he came to the University at Albany, State University of New York in 1977 and has remained there since. In 1990 he was named Distinguished Professor of Psychology. He is currently director of the Center for Stress and Anxiety Disorders at the University at Albany.

He began work on posttraumatic stress disorder in collaboration with Dr. Larry Kolb at the Albany Veterans Administration in 1981, focusing primarily on assessment research with Vietnam War veterans. In 1990 he began collaborative research on motor vehicle accident survivors with Dr. Hickling.

Edward J. Hickling received his PsyD in clinical psychology from the University of Denver, School of Professional Psychology, in 1982. He worked as the director of training and as a consultation liaison psychologist at the Veterans Administration Medical Center in Albany, New York, until 1987, when he left to enter full-time private practice. In addition to his practice in clinical psychology, he is on the faculty at the Sage Colleges and Albany Medical College. His earlier research in posttraumatic stress disorder included the assessment and treatment of Vietnam War veterans. He has collaborated with Dr. Blanchard since 1990 on psychological assessment and treatment of motor vehicle accident survivors.

Reviews & Awards

This state-of the art-book is scholarly, comprehensive, and clinically relevant. This work should be required reading for researchers and clinicians who deal with traumatized populations. I am certain that it will be extensively cited and become the standard in its field.
—Philip A. Saigh, PhD, Professor of Psychology & Education, Department of Health & Behavior Studies, Teachers College, Columbia University