The management of posttraumatic stress disorder and acute stress disorder: Synopsis of the 2023 U. S. Department of Veterans Affairs and U. S. Department of Defense clinical practice guideline

This article summarizes the 2023 clinical practice guideline (CPG) and discusses assessments and treatments for which evidence was sufficient to support a recommendation for or against. Recommendations are given for EMDR therapy as psychotherapy treatment for PTSD.

Article Abstract

“Description: The U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) worked together to revise the 2017 VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder. This article summarizes the 2023 clinical practice guideline (CPG) and its development process, focusing on assessments and treatments for which evidence was sufficient to support a recommendation for or against.

Methods: Subject experts from both departments developed 12 key questions and reviewed the published literature after a systematic search using the PICOTS (population, intervention, comparator, outcomes, timing of outcomes measurement, and setting) method. The evidence was then evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. Recommendations were made after consensus was reached; they were based on quality and strength of evidence and informed by other factors, including feasibility and patient perspectives. Once the draft was peer reviewed by an external group of experts and their inputs were incorporated, the final document was completed.

Recommendations: The revised CPG includes 34 recommendations in the following 5 topic areas: assessment and diagnosis, prevention, treatment, treatment of nightmares, and treatment of posttraumatic stress disorder (PTSD) with co-occurring conditions. Six recommendations on PTSD treatment were rated as strong. The CPG recommends use of specific manualized psychotherapies over pharmacotherapy; prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy; paroxetine, sertraline, or venlafaxine; and secure video teleconferencing to deliver recommended psychotherapy when that therapy has been validated for use with video teleconferencing or when other options are unavailable. The CPG also recommends against use of benzodiazepines, cannabis, or cannabis-derived products. Providers are encouraged to use this guideline to support evidence-based, patient-centered care and shared decision making to optimize individuals’ health outcomes and quality of life.“

—Description from publisher

Article Access

Open Access Synopsis Article

Schnurr, P. P., Hamblen, J. L., Wolf, J., Coller, R., Collie, C., Fuller, M. A., Holtzheimer, P. E., Kelly, U., Lang, A. J., McGraw, K., Morganstein, J. C., Norman, S. B., Papke, K., Petrakis, I., Riggs, D., Sall, J. A., Shiner, B., Wiechers, I., & Kelber, M. S. (2024). The management of posttraumatic stress disorder and acute stress disorder: Synopsis of the 2023 U. S. Department of Veterans Affairs and U. S. Department of Defense clinical practice guideline. Annals of Internal Medicine, Online. Open access: https://doi.org/10.7326/M23-2757

Open Access Guidelines

Management of Posttraumatic Stress Disorder and Acute Stress Disorder Work Group.  (2023). VA/DoD clinical practice guideline for management of posttraumatic stress disorder and acute stress disorder. Department of Veterans Affairs & Department of Defense. Washington DC: U.S. Government Printing Office. Open access retrieval: https://www.healthquality.va.gov/guidelines/MH/ptsd/

About the Journal

“Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide.”

—Description from publisher