Feature

The new website for the APA clinical guideline for treating post-traumatic stress disorder, or PTSD, is now live, featuring the guideline itself, plus links to user-friendly resources to help clinicians, researchers, patients and families, and others gain knowledge of the disorder and the interventions shown to be most effective in treating it.

Called the APA Clinical Practice Guideline for the Treatment of PTSD in Adults, the document and related materials are available at www.apa.org/ptsd-guideline. The guideline:

  • Strongly recommends the use of four psychosocial treatments—cognitive-behavioral therapy, cognitive processing therapy, cognitive therapy and prolonged exposure therapy.
  • Suggests the use of three other therapies—brief eclectic psychotherapy, eye-movement desensitization and reprocessing, and narrative exposure therapy, as well as specific medications.
  • Notes "insufficient evidence" for a range of other treatments and medications, including relaxation therapy and risperidone, an antipsychotic medication.

Developed over four years using a rigorous process, the PTSD guideline is the first clinical guideline released by APA. It will be followed by other guidelines, including two that will be released this fall for public comment: one on treatment of depression across the lifespan, and another on treatment of children and adolescents with obesity.

These guidelines offer the field a number of benefits, says Bethany Teachman, PhD, chair of the PTSD guideline's advisory steering committee.

For providers, they offer recommendations based on a systematic review that quickly summarizes which treatments have been shown to work for hundreds or even thousands of patients with related problems.

For insurers and health-care administrators, they provide a stamp of credibility when making reimbursement and other financial decisions.

And for families, they provide clear information on best treatments and what to expect from them, as well as information on how to find trained providers.

Still, it's important to note that the PTSD guideline and others to follow are just that—guidelines, not mandates, says Lynn Bufka, PhD, APA's associate executive director for practice research and policy.

"We don't expect any clinician to become proficient in an intervention by visiting the website," she says. "But we wanted to make sure that the guideline and resources provide enough sense of what the recommended interventions entail, that providers will have an idea of where to go next to become competent."

APA developed the guideline using a widely accepted methodology created by the Institute of Medicine that draws on international standards, hence bringing U.S. psychology closer to international health-care practice and thinking, adds Bufka.

"Clinical practice guidelines are used around the world, across all kinds of disciplines, to try and sort through and evaluate research on different interventions," she says.

Developing a guideline entails two parts. The first is a comprehensive literature review conducted by an independent group of methodological experts. For the PTSD guideline, that constituted reviewers from the Research Triangle Institute International–University of North Carolina Evidence-based Practice Center, one of 13 sites funded by the federal Agency for Healthcare Research and Quality to develop systematic reviews on a variety of health topics.

The second part of the process involves input from a multidisciplinary panel of experts overseen by APA. In addition to psychology, the disciplines represented on the panel include primary care, psychiatry and social work, as well as members of the public. The stakeholders discuss the findings, debate differences, and develop recommendations based on the scientific evidence, while also factoring in information about harms and burdens of treatments and patient preferences and values, Bufka explains.

The guideline recommendations are based upon thorough information on PTSD treatments, but they are not intended as advice on how to conduct the entire therapy process with patients who have PTSD or other conditions related to trauma, adds Christine Courtois, PhD, who chaired APA's PTSD guideline development panel.

"While we used a rigorous methodology to come up with these recommendations," she says, "it's important that clinicians apply them mindfully, with attention to the particular patient or patients they are treating."

The guideline appears at www.apa.org/ptsd-guideline. APA's treatment guideline for PTSD will be followed by two others: one for depression and another for obesity among children and adolescents.

PTSD facts

7 to 8

Percentage of people who will have PTSD at some point in their lives

1 in 10

Number of women who are affected by PTSD

1 in 25

Number of men who are affected by PTSD

Source: The National Center for PTSD