Professional Care

In terms of prevention and treatment of PTSD, it is important that evidence-based PTSD therapies be offered to all.  Most research has focused on psychotherapies and pharmaceuticals. The following highlights are based on summary recommendations from the VA/DOD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder, which was recently updated.

Overall Recommendations

General Clinical Management.  Engage patients in shared decision-making and focus on collaborative care using evidence-based treatments.

Diagnosis and Assessment.  Screen periodically with measures like the Primary Care PTSD Screen or the PTSD Checklist.  In people with suspected PTSD, offer an appropriate diagnostic evaluation.  In people diagnosed with PTSD, use self-report measures to monitor treatment progress.

Prevention.  Evidence is limited for psychotherapy or medications in the time immediately after trauma.  If someone is diagnosed with acute stress disorder, use Trauma-Focused Psychotherapy that includes exposure and/or cognitive restructuring.  (These are described in the next section.)  Evidence for medications is insufficient.

Treatment Priorities. Start with individual, manualized, trauma-focused psychotherapy (preferred over drug therapy).  Drug therapy or non–trauma-focused psychotherapy can be used if trauma-focused psychotherapy is not available or not preferred by a patient.  Certain medications (e.g., serotonin specific reuptake inhibitors, or SSRIs) are preferred, and other drug classes are suggested if those are ineffective.

There is not enough evidence to recommend for or against “...repetitive transcranial magnetic stimulation, electroconvulsive therapy, hyperbaric oxygen therapy, stellate ganglion block, or vagal nerve stimulation.” 

Acupuncture and other CIH practices are not recommended as primary treatments.