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

Paula P Schnurr¹, Jessica L Hamblen¹, Jonathan Wolf², Rachael Coller³, Claire Collie⁴, Matthew A Fuller⁵, Paul E Holtzheimer¹, Ursula Kelly⁶, Ariel J Lang⁷, Kate McGraw⁸, Joshua C Morganstein⁹, Sonya B Norman¹⁰, Katie Papke¹¹, Ismene Petrakis¹², David Riggs¹³, James A Sall¹⁴, Brian Shiner¹⁵, Ilse Wiechers¹⁶, Marija S Kelber⁸

Affiliations

¹ National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (P.P.S., J.L.H., P.E.H.).
² Defense Health Agency, Falls Church, Virginia (J.W.).
³ Naval Medical Center San Diego, San Diego, California (R.C.).
⁴ Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC (C.C.).
⁵ Veterans Health Administration Pharmacy Benefits Management Service and Case Western Reserve University School of Medicine, Cleveland, Ohio (M.A.F.).
⁶ Joseph Maxwell Cleland Atlanta VA Medical Center and Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia (U.K.).
⁷ Center of Excellence for Stress and Mental Health at VA San Diego Healthcare System and University of California, San Diego, San Diego, California (A.J.L.).
⁸ Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia (K.M., M.S.K.).
⁹ Uniformed Services University of the Health Sciences, Center for the Study of Traumatic Stress, Bethesda, Maryland (J.C.M.).
¹⁰ National Center for PTSD, White River Junction, Vermont, and University of California, San Diego, San Diego, California (S.B.N.).
¹¹ National Social Work Program Office, Veterans Health Administration, Washington, DC (K.P.).
¹² National Center for PTSD, West Haven, and Yale University School of Medicine, New Haven, Connecticut (I.P.).
¹³ Uniformed Services University of the Health Sciences, Center for Deployment Psychology, Bethesda, Maryland (D.R.).
¹⁴ Evidence Based Practice, Quality and Patient Safety, Veterans Health Administration, Washington, DC (J.A.S.).
¹⁵ White River Junction VA Medical Center, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (B.S.).
¹⁶ Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC; Yale University School of Medicine, New Haven, Connecticut; and University of California, San Francisco, School of Medicine, San Francisco, California (I.W.).

PMID: 38408360
DOI: 10.7326/M23-2757

Free article

Practice Guideline

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

Paula P Schnurr et al. Ann Intern Med. 2024 Mar.

Free article

. 2024 Mar;177(3):363-374.

doi: 10.7326/M23-2757. Epub 2024 Feb 27.

Authors

Affiliations

¹ National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (P.P.S., J.L.H., P.E.H.).
² Defense Health Agency, Falls Church, Virginia (J.W.).
³ Naval Medical Center San Diego, San Diego, California (R.C.).
⁴ Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC (C.C.).
⁵ Veterans Health Administration Pharmacy Benefits Management Service and Case Western Reserve University School of Medicine, Cleveland, Ohio (M.A.F.).
⁶ Joseph Maxwell Cleland Atlanta VA Medical Center and Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia (U.K.).
⁷ Center of Excellence for Stress and Mental Health at VA San Diego Healthcare System and University of California, San Diego, San Diego, California (A.J.L.).
⁸ Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia (K.M., M.S.K.).
⁹ Uniformed Services University of the Health Sciences, Center for the Study of Traumatic Stress, Bethesda, Maryland (J.C.M.).
¹⁰ National Center for PTSD, White River Junction, Vermont, and University of California, San Diego, San Diego, California (S.B.N.).
¹¹ National Social Work Program Office, Veterans Health Administration, Washington, DC (K.P.).
¹² National Center for PTSD, West Haven, and Yale University School of Medicine, New Haven, Connecticut (I.P.).
¹³ Uniformed Services University of the Health Sciences, Center for Deployment Psychology, Bethesda, Maryland (D.R.).
¹⁴ Evidence Based Practice, Quality and Patient Safety, Veterans Health Administration, Washington, DC (J.A.S.).
¹⁵ White River Junction VA Medical Center, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (B.S.).
¹⁶ Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC; Yale University School of Medicine, New Haven, Connecticut; and University of California, San Francisco, School of Medicine, San Francisco, California (I.W.).

PMID: 38408360
DOI: 10.7326/M23-2757

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.

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Conflict of interest statement

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-2757.

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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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical