New 2017 Clinical Practice Guidelines for PTSD and Acute Stress Disorder from US VA/DoD


USA Veterans Affairs and Department of Defence (VA/DoD) release new Evidence-based Clinical Practice Guideline (CPG) for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder

https://www.healthquality.va.gov/guidelines/MH/ptsd/

Some of  the guidelines, with a Cognitive Processing Therapy perspective:

Recommendation 11. emphasises trauma focus and structure in the treatment of PTSD.

Recommendation 11. For patients with PTSD, we recommend individual, manualised trauma focused psychotherapies that have a primary component of exposure and/or cognitive restructuring to include Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), Eye Movement Desensitisation and Reprocessing (EMDR), specific cognitive behavioural therapies for PTSD, Brief Eclectic Psychotherapy (BEP), Narrative Exposure Therapy (NET), and written narrative exposure.

Recommendation 36. is interesting, Cognitive Processing Therapy has a number of studies demonstrating the efficacy of it when delivered over secure video teleconferencing.

We recommend using trauma-focused psychotherapies that have demonstrated efficacy using secure video teleconferencing (VTC) modality when PTSD treatment is delivered via VTC.

Morland et al 2014  tested Group CPT  via telehealth with a sample of male Veterans, predominantly of the Vietnam era.

Morland et al 2015  tested individual CPT+A with women, 20% of whom were veterans.

Maieritsch et al 2015 tested individual CPT OIF/OEF veterans who were predominantly male.

These studies showed similar changes for treatment of PTSD using CPT face to face or via video tele-conferencing. All participants had significant declines in CAPS scores at post treatment and 6 month follow-up.

Recommendation 37 and 38. Highlights the concern of many clinicians when clients present with co-morbid conditions.

37. We recommend that the presence of co-occurring disorder(s) not prevent patients from receiving other VA/DoD guideline-recommended treatments for PTSD.
38. We recommend VA/DoD guideline-recommended treatments for PTSD in the presence of co-occurring substance use disorder (SUD).

Recommendations 39 and 40 are significant in that they address the importance of understanding commonly co-occurring sleep difficulties.

39. We recommend an independent assessment of co-occurring sleep disturbances in patients with PTSD, particularly when sleep problems pre-date PTSD onset or remain following successful completion of a course of treatment.

40. We recommend Cognitive Behavioural Therapy for Insomnia (CBT-I) for insomnia in patients with PTSD unless an underlying medical or environmental etiology is identified or severe sleep deprivation warrants the immediate use of medication to prevent harm.

 

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