Center for the Study of Traumatic Stress
CSTS | Department of Psychiatry | Uniformed Services University | 4301 Jones Bridge Road, Bethesda, MD 20814-4799 | www.CSTSonline.org

Evidence-Based Management of
Posttraumatic Stress Disorder (PTSD)
ongoing assessment of safety
Posttraumatic Stress Disorderand psychiatric status, address(PTSD) is characterized by
Posttraumatic Stress Disorder (PTSD) iscomorbid disorders, and increase
symptoms of re-experiencing,characterized by symptoms of re-experiencing,
the patient’s understanding of
avoidance/numbing, andavoidance/numbing, and hyperarousal persisting
and coping with the effects ofhyperarousal persisting moreexposure to the traumatic event
than one month after exposure
more than one month after exposure to athrough implementing specificto a traumatic event or events.
traumatic event or events.
treatments (e.g. psychoeducation,
While not the only disorder
psychotherapy and/or
seen after exposure to traumaticpsychopharmacology) for PTSD.
events, PTSD is among the mostwidely noted. The American Psychiatric Association andthe U.S. Department of Veterans Affairs Ofﬁce of Quality
3. PSYCHOTHERAPY
and Performance have published Practice Guidelines for the
Early supportive interventions including psychotreatment of PTSD:
education and case management appear to facilitate
entry into further evidence-based treatments. Cognitive■ https://www.psychiatry.org/patients-families/ptsd/whatBehavior Therapy (CBT) is effective treatment for coreis-ptsd
symptoms of PTSD. Studies have not yet clariﬁed the■ https://www.va.gov/health-care/health-needscritical element(s) of CBT but the element of controlled
conditions/mental-health/ptsd/
re-exposure to traumatic recollections is shared withother PTSD psychotherapies with demonstrated efﬁcacy:
Practice guidelines do not deﬁne the standard of care.
prolonged exposure, EMDR, imagery rehearsal, and stressHowever, their synthesis of research and expert consensus
inoculation. Psychological debrieﬁngs or other singleaugments clinical experience in treating patients, educating
session techniques in the immediate aftermath of trauma
the public, guiding research, and establishing credibility forare ineffective in preventing the development of PTSD.
medical care delivery. Essential recommendations of theabove noted PTSD Practice Guidelines are outlined below:

1. ASSESSMENT
Psychological effects of trauma may result from physicalinjury, so detailed diagnostic evaluation should be continued
after a physically and psychologically safe environment has
been established, medical status has been stabilized, andpsychological reassurance has been provided. Diagnostic
evaluation may be accomplished through individual orgroup interviews or consultation. Surveillance instruments
or screening symptom checklists may expedite the process.
These may be helpful in identifying at-risk individuals forfollow-up interview when large populations are exposed totrauma (e.g. natural disaster or terrorist event).
2. MANAGEMENTClinicians managing patients with PTSD should havethe following goals: establish a therapeutic alliance, provide

4. PHARMACOLOGIC TREATMENT
Selective Serotonin Re-uptake Inhibitors are the ﬁrstline medication treatment for PTSD. Monoamine oxidase
inhibitors and tricyclic antidepressants may also be
beneﬁcial. Benzodiazapines reduce anxiety and improve
sleep but potential for dependence, withdrawal symptoms,
and increased incidence of PTSD after early treatment
with this medication class preclude recommendation asmonotherapy. Anticonvulsants may be helpful adjuncts andsecond-generation antipsychotics may reduce symptoms inpatients with co-morbid psychotic disorders.
5. COMBINATION PSYCHOTHERAPY/PHARMACOTHERAPY
Although not well-studied, combining psychotherapy
and pharmacotherapy should be considered particularly if
initial psychotherapy or medication therapy is ineffective.