A guide to guidelines for the treatment of posttraumatic stress disorder in adults: An update.

Abstract

Clinical practice guidelines (CPGs) are used to support clinicians and patients in diagnostic and treatment decision-making. Along with patients’ preferences and values, and clinicians’ experience and judgment, practice guidelines are a critical component to ensure patients are getting the best care based on the most updated research findings. Most CPGs are based on systematic reviews of the treatment literature. Although most reviews are now restricted to randomized controlled trials, others may consider nonrandomized effectiveness trials. Despite a reliance on similar procedures and data, methodological decisions and the interpretation of the evidence by the guideline development panel can result in different recommendations. In this article, we will describe key methodological points for 5 recently released CPGs on the treatment of posttraumatic stress disorder in adults and highlight some of the differences in both the process and the subsequent recommendations.

Cost-effectiveness of psychological treatments for post-traumatic stress disorder in adults

“…The NICE guideline recommendations on TF-CBT and EMDR for adults with PTSD are consistent with other published PTSD clinical practice guidelines (compared in [41]). Three more guidelines make recommendations of equal strength for TF-CBT and EMDR [42][43][44], whereas one guideline makes a strong recommendation for TF-CBT while EMDR has been given a moderate rating [45].…”

Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis

“…The results of our analysis are consistent with those of other published reviews, according to which TF-CBT interventions and EMDR have the strongest evidence of effectiveness posttreatment and at short follow-up, both showing highest effects versus inactive controls compared with other psychological interventions (Bisson et al, 2013;Cusack et al, 2016;Forman-Hoffman et al, 2018). This finding is also in line with five recently published PTSD clinical practice guidelines (as compared in Hamblen et al, 2019 whereas in one guideline (American Psychological Association, 2017) TF-CBT interventions are favoured with a strong recommendation while EMDR has been given a moderate rating.…”

“…There is some published evidence suggesting that non-TF-CBT (Bisson et al, 2013), present-centered therapy (Frost et al, 2014) and self-help (mainly internet-based TF-CBT and expressive writing therapy) (Kuester et al, 2016;Sijbrandij et al, 2016;van Emmerik et al, 2013) are also effective options in the treatment of PTSD in adults. There are also recommendations for other psychotherapies in recently published clinical PTSD guidelines, although there was less consistency than for TF-CBT and EMDR (Hamblen et al, 2019 , 2017). This evidence, from both published reviews and clinical guidelines, is in line with our findings that suggest that non-TF-CBT, present-centered therapy and self-help (with or without support) are effective relative to waitlist for improving PTSD symptoms.…”

“…Some reviews (for example Bisson et al, 2013;Khan et al, 2018) have followed our approach and have evaluated the overall effects of the TF-CBT class, rather than looking at the effects of specific interventions within the TF-CBT class separately. The Departments of Veterans Affairs and Defense (2017) guideline also grouped TF-CBT interventions together but chose to list the specific treatments for which there was the strongest support, which is a similar approach to the one taken by the NICE clinical guideline (Hamblen et al 2019). There is now an emerging number of reviews that have attempted to evaluate the effects of distinct interventions within the TF-CBT class (e.g.…”

Evidence-based prescribing for post-traumatic stress disorder

“…Ultimately, the differences in recommendations between these and the other major PTSD treatment guidelines are minor and they provide a clear and relatively consistent prescribing message. 1 Implementing PTSD treatment guideline recommendations in practice…”