Australian guidelines for the prevention and treatment of posttraumatic stress disorder: Updates in the third edition

Abstract

Objective: This paper describes the development of the third edition of the National Health and Medical Research Australian Guidelines for the Prevention and Treatment of Acute Stress Disorder, posttraumatic stress disorder and Complex posttraumatic stress disorder, highlighting key changes in scope, methodology, format and treatment recommendations from the previous 2013 edition of the Guidelines. Method: Systematic review of the international research was undertaken, with GRADE methodology used to assess the certainty of the evidence, and evidence to decision frameworks used to generate recommendations. The Guidelines are presented in an online format using MAGICApp. Results: Key changes since the publication of the 2013 Guidelines include a new conditional recommendation for Child and Family Traumatic Stress Intervention for children and adolescents with symptoms within the first 3 months of trauma, and a strong recommendation for trauma-focused cognitive behaviour therapy for the child alone or with a caregiver, for those with diagnosed posttraumatic stress disorder. For adults with posttraumatic stress disorder, strong recommendations are made for specific types of trauma-focused cognitive behaviour therapy and conditional recommendations are made for five additional psychological interventions. Where medication is indicated for adults with posttraumatic stress disorder, venlafaxine is now conditionally recommended alongside sertraline, paroxetine or fluoxetine. Conclusion: These Guidelines, based on systematic review of the international literature, are intended to guide decision making for practitioners, service planners, funders and those seeking treatment for trauma related mental health concerns. For an Australian Guideline, a critical limitation is the absence of research on the treatment of Australian Aboriginal and Torres Strait Islander peoples. The new online format of the Australian posttraumatic stress disorder Guidelines means that they can be updated as sufficient new evidence becomes available.

A review of selected psychotherapies for PTSD, their efficacy and treatment guidelines in adults

“…W pracy zaprezentowano również zalecenia terapeutyczne (treatment guidelines) dotyczące omawianych metod terapeutycznych. Wybrano zalecenia Amerykańskiego Towarzystwa Psychologicznego [20], National Institute of Health and Care Excellence Wielkiej Brytanii [21], Australijskiego Towarzystwa Psychologicznego [22] oraz Wydziału ds. Weteranów Departamentu Obrony USA [23].…”

Psychotherapeutic interventions for childhood posttraumatic stress disorder: an update

“…Multiple systematic reviews over recent years [4 ▪ ,5–8,9 ▪ ,10,11,12 ▪▪ ,13,14 ▪▪ ] also support this recommendation, underpinned by evidence from a recent network analysis finding TF-CBT and in particular individually delivered forms to be most effective treatment for adolescents and children [12 ▪▪ ]. In addition, 13 RCTs on TF-CBT with the child and caregiver included in treatment led to a strong recommendation for interventions that include parents or caregivers to support children's skills development and enhance parental support [3 ▪▪ ].…”

“…In recent decades, research on interventions for child and adolescent posttraumatic stress disorder (PTSD) has led to a number of treatments that have established efficacy or show significant promise. Consensus among published treatment guidelines on childhood PTSD is that individual trauma-focused cognitive behavioural therapy (TF-CBT), with and without a caregiver, should be the first-line treatment for children aged 6 years and older with PTSD [1,2,3 ▪▪ ]. Eye Movement Desensitization and Reprocessing (EMDR) is also acknowledged as an intervention with evidence for efficacy [3 ▪▪ ].…”

“…Consensus among published treatment guidelines on childhood PTSD is that individual trauma-focused cognitive behavioural therapy (TF-CBT), with and without a caregiver, should be the first-line treatment for children aged 6 years and older with PTSD [1,2,3 ▪▪ ]. Eye Movement Desensitization and Reprocessing (EMDR) is also acknowledged as an intervention with evidence for efficacy [3 ▪▪ ]. Despite this consensus, much work remains in ensuring that PTSD focused interventions are suitable for and accessible to the widest possible population of trauma-exposed youth.…”

Some observations on remote delivery of eye‐movement desensitisation and reprocessing to people with intellectual disabilities

“…On the basis of evidence from systematic reviews and meta-analyses, the United Kingdom National Institute of Clinical Excellence (NICE) and other clinical guidelines recommend trauma-focussed psychological therapies for PTSD (American Psychological Association, 2004;Bisson et al, 2019; National institute for Clinical Excellence, 2005aExcellence, , 2005bPhelps et al, 2021), since therapies that do not require the patient to focus on traumatic memories are less effective (Bisson et al, 2013). The best-supported trauma-focussed interventions are trauma-focussed cognitive behavioural therapy (TF-CBT) and eye movement desensitisation and reprocessing (EMDR) (Bisson et al, 2013).…”