Navigating treatment recommendations for PTSD: A rapid review

Abstract

As a hidden epidemic, trauma is a serious public health concern that negatively affects individuals and communities globally. There have been ongoing debates and conflictual guidelines surrounding how mental health professionals diagnose trauma, and what would be empirically supported treatment (EST) approaches to address trauma. With the aim of informing the clinical decision-making process, this study critically reviews and synthesizes published empirical research on psychological treatments of post-traumatic stress disorder (PTSD). A form of rapid evidence assessment was conducted to map out the existing literature on psychological treatments for PTSD, considering client demographics, types of trauma, therapy modes, and service delivery and intensity. All studies included in the final review (N = 14) are mostly systematic review or meta-analysis. In total, our review encompassed 486 ESTs (mostly RCTs = 474 and total participants =37,222). Our review was categorized into five areas: empirically supported psychological treatments in adults or children; trauma-focused or non-trauma-focused treatments; group therapies; web-based therapies; and intensity/duration of treatment. The consistent finding is that all active psychological treatments for PTSD are more effective than a waitlist. Therefore, a first line of PTSD treatment is to reduce a waitlist and provides services at the time of need. In this regard, findings on innovative service delivery, such as online approaches, delivering massed treatment options, and group therapies are promising. The study limitations, clinical implications, and areas of future research are discussed.

Keywords:

• Trauma
• PTSD
• clinical guidelines
• attrition
• psychotherapy

Notes

1 Given the diagnostic conflict, we found that the term PTSD has been used to encompass both PTSD and cPTSD in most studies unless specified as studies on cPTSD. Accordingly, we use PTSD hereafter, but clarify types of trauma experiences (e.g., child abuse, domestic violence, and war torture) when available.

Additional information

Funding

This project is funded by the Social Science and Humanities Research Council of Canada Institutional Grant (2019).