An Appraisal of the American Psychological Association's Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder

• Published in: Psychotherapy (Chicago, Ill.) Ill.), 2019-09, Vol.56 (3), p.347-358
• Main Authors: Silver, Kristin E, Levant, Ronald F
• Format: Article
• Language: English
• Subjects: Adult; American Psychological Association; Attitude of Health Personnel; Clinical Judgment (Not Diagnosis); Clinical Practice; Clinicians; Comorbidity; Evidence Based Practice; Evidence-Based Practice - methods; Evidence-Based Practice - standards; Human; Humans; Posttraumatic Stress Disorder; Practice Guidelines as Topic; Professional Autonomy; Psychotherapy; Psychotherapy - methods; Psychotherapy - standards; Societies, Scientific; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - psychology; Stress Disorders, Post-Traumatic - therapy; Treatment; Treatment Guidelines; United States
• ISSN: 0033-3204; 1939-1536
• DOI: 10.1037/pst0000230

In 2017, the American Psychological Association published the Clinical Practice Guidelines for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. Although the Guideline Development Panel aimed to produce guidelines based on the best available scientific evidence, concerns were raised that the guidelines would constrain the implementation of some effective psychotherapies and limit clinician autonomy, potentially leading to coverage for only manualized, time-limited, cognitive-behavioral treatments. The following article reviews the PTSD guidelines in light of the evidence-based practice in psychology policy adopted by the American Psychological Association in 2006. We highlight the strengths of the guidelines as currently written while recognizing areas in which the guidelines do not meet evidence-based practice in psychology recommendations. A clinical vignette of the treatment of a complex patient with PTSD and significant comorbidities is provided to illustrate the difficulty of clinical decision-making and how the guidelines may complicate the delivery of effective treatments. We conclude with recommendations on how to consider a broad range of research evidence, appropriately integrate clinician expertise, and better appreciate the role of patient values and preferences in PTSD treatment decision-making. Clinical Impact Statement Question: The applied clinical practice topic this article will address is how posttraumatic stress disorder (PTSD) treatment decision-making may be impacted by the American Psychological Association's (APA, 2017) Clinical Practice Guidelines for the Treatment of PTSD. Findings: This article will provide clinicians with an assessment of the strengths and limitations of the APA Clinical Practice Guidelines for the Treatment of PTSD that they can use in their applied practice. Meaning: We encourage clinicians to follow the APA Presidential Task Force on Evidence-Based Practice's (2006) policy on evidence-based practice in psychology, which recommends the tripartite evidence-based approach (i.e., research, clinical expertise and judgment, and patient characteristics and preferences) to treatment decision-making. Next Steps: We urge practitioners to consider a broad range of research evidence, appropriately integrate clinician expertise, and include the role of patient values and preferences in PTSD treatment decision-making, and we recommend the APA Clinical Practice Guidelines for the Treatment of PTSD be revised