VA, DoD clinical guideline synopsis details 34 new recommendations for PTSD and acute stress disorder

VA, DoD clinical guideline synopsis details 34 new recommendations for PTSD and acute stress disorder

New guideline recommends psychotherapies over pharmacotherapy and recommends against benzodiazepines, cannabis, or cannabis-derived products


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A synopsis of new clinical guidelines from the U.S. Department of Veterans Affairs (VA) and the Department of Defense (DoD) details 34 recommendations for treating posttraumatic stress disorder (PTSD) and co-occurring conditions. The VA/DoD guidelines notably recommend the use of specific manualized psychotherapies over pharmacotherapy and recommend against the use of benzodiazepines, cannabis, or cannabis-derived products. The synopsis is published in Annals of Internal Medicine.

Seven in 10 U.S. adults will experience a traumatic event in their lifetime. Exposure can lead to substantial problems, especially PTSD, a condition that persists for more than 1 month after exposure and cause clinically significant distress or functional impairment. Acute stress disorder (ASD) can occur during the first 30 days after traumatic exposure. Individuals with occupationally related exposure face increased risk for PTSD and ASD, but its prevalence in the U.S. general population is 4 percent in men and 8 percent in women.

Researchers from the VA and DoD collaborated to revise the 2017 VA/DoD Clinical Practice Guideline for the management of PTSD and acute stress disorder. The authors made 34 recommendations in all, covering 5 treatment areas, including assessment and diagnosis, prevention, treatment, treatment of nightmares, and treatment of PTSD with co-occurring conditions. The authors recommend individual psychotherapies rather than pharmacotherapies. Specifically, they recommend the use of cognitive processing therapy (CPT), eye movement desensitization and reprocessing psychotherapy (EMDR), or prolonged exposure (PE). Medications such as paroxetine, sertraline, or venlafaxine are recommended. Secure video teleconferencing may be used to deliver treatments when that therapy has been validated for use with video teleconferencing or when other options are unavailable for the treatment of PTSD. The authors encourage providers to use this guideline to support evidence-based, patient-centered care and shared decision making to optimize individuals’ health outcomes and quality of life.

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. To speak with the corresponding author, Paula P. Schnurr, PhD, please contact Margaret Willoughby at [email protected].

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