Treatment of Posttraumatic Stress Disorder (PTSD) in Adults

Publication Date: February 24, 2017
Last Updated: March 2, 2023

Recommendations

Psychotherapy

For adult patients with PTSD, the panel strongly recommends that clinicians offer one of the following psychotherapies/interventions (listed alphabetically):
  • cognitive behavioral therapy- (CBT)1
  • cognitive processing therapy (CPT)
  • cognitive therapy (CT)
  • prolonged exposure therapy (PE)
(Recommendation)
1 The RTI UNC review refers to this as CBT-mixed therapy. CBT-Mixed is a category that includes interventions using aspects of CBT that do not fit neatly into the other CBT categories. It will be referred to in the present document as CBT.
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For adult patients with PTSD, the panel suggests that clinicians offer one of the following psychotherapies/interventions (listed alphabetically):
  • brief eclectic psychotherapy (BEP)
  • eye movement desensitization and reprocessing therapy (EMDR)
  • narrative exposure therapy (NET).
(Conditional recommendation)
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For adult patients with PTSD, there is insufficient evidence to recommend for or against clinicians offering the following psychotherapies/interventions (listed alphabetically):
  • relaxation (RX)
  • Seeking Safety (SS).
(Insufficient evidence)
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Pharmacotherapy

For adult patients with PTSD, the panel suggests that clinicians offer one of the following (listed alphabetically):
  • fluoxetine
  • paroxetine
  • sertraline
  • venlafaxine
(Conditional recommendation)
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There is insufficient evidence to recommend for or against clinicians offering the following medications (listed alphabetically) for treatment of adults with PTSD.
  • risperidone
  • topiramate
(Insufficient evidence)
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Comparative Effectiveness

For adult patients with PTSD, the panel recommends clinicians offer either prolonged exposure or prolonged exposure plus cognitive restructuring when both are being considered. (Recommendation)
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For adult patients with PTSD, the panel recommends clinicians offering either venlafaxine ER or sertraline when both are being considered.2 (Recommendation)
2 The recommendation for the comparison between venlafaxine ER vs sertraline is different than the recommendation for Seeking Safety vs active controls, even though there is moderate evidence of no difference between the two treatments being compared for both comparisons (i.e., venalfaxine ER vs sertraline and Seeking Safety vs active controls). The reason the recommendations are different for venlafaxine ER vs sertraline than for Seeking Safety vs active controls is that the panel made a conditional recommendation for venlafaxine compared to no intervention and a conditional recommendation for sertraline compared to no intervention but did not make any recommendations for Seeking Safety compared to no intervention or active controls compared to no intervention because there was insufficient/very low evidence. In other words, the panel believed that because there was evidence that both venlafaxine and sertraline had demonstrated efficacy compared to inactive intervention, it was reasonable to recommend either treatment when both are being considered. However, because neither Seeking Safety nor active controls had demonstrated efficacy compared to no intervention, the panel concluded that evidence was insufficient to recommend for or against either treatment.
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For adult patients with PTSD, the panel suggests clinicians offer CBT rather than relaxation when both CBT and relaxation are being considered. (Conditional recommendation)
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For adult patients with PTSD, the panel suggests clinicians offer prolonged exposure therapy rather than relaxation when both prolonged exposure therapy and relaxation are being considered. (Conditional recommendation)
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For adult patients with PTSD, the panel concludes that the evidence is insufficient to recommend for or against clinicians offering Seeking Safety versus active controls. (Insufficient evidence)
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Recommendation Grading

Overview

Title

Treatment of Posttraumatic Stress Disorder (PTSD) in Adults

Authoring Organizations

Publication Month/Year

February 24, 2017

Last Updated Month/Year

August 3, 2023

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The purpose of this guideline is to provide recommendations on the treatment of posttraumatic stress disorder (PTSD) in adults.

Inclusion Criteria

Female, Male, Adult

Health Care Settings

Ambulatory, Emergency care

Intended Users

Psychologist, nurse, nurse practitioner, physician, physician assistant

Scope

Management, Treatment

Diseases/Conditions (MeSH)

D013313 - Stress Disorders, Post-Traumatic

Keywords

Mental health, ptsd, Posttraumatic Stress Disorder

Supplemental Methodology Resources

Evidence Tables, Data Supplement