Support the APA PTSD Treatment Guidelines

We are writing to voice our support of the APA Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD).

Please share this widely in your place of work, social media, school or email.

In recent weeks, the Guidelines have come under attack and a petition was started to contest them. We are writing in support of the Guidelines asking that APA protect them in their current format. We ask that psychologists, and people who have been impacted by PTSD either personally or who have a loved one with PTSD, consider signing.

The Guidelines were created using a systematic review of the most recent PTSD research and patient preferences. Quality of life, adverse events, and comorbid conditions were also considered in making decisions about which treatments to recommend. Decisions about the Guidelines were made by an interdisciplinary team that included: social work, psychology, psychiatry, family medicine and community members.

• PTSD is a condition that impacts 7-8% of Americans.
• When not treated, PTSD can become chronic and impact health, relationships, and work.
• There are treatments that have been rigorously studied and shown to work for PTSD.
• The treatments listed by the APA as having the strongest evidence to support their use have undergone decades of research using many types of studies including: non-randomized outcome studies, case studies, and studies in naturalistic settings.
• These therapies have been studied in people who have PTSD as the result of a variety of traumatic events including: sexual assault, combat trauma, motor vehicle accidents, childhood physical and sexual abuse, and natural disaster.
• Contrary to misinformation that has been promoted, these treatments have been studied in people with a variety of comorbid conditions and who have experienced complex trauma.
• Even though there are treatments that work, it can still be difficult for people who have PTSD to find therapists who offer empirically supported treatment.

There is a great deal of misinformation about PTSD treatment. We believe that the recent statements against the guidelines have the potential to increase this misinformation. A main concern expressed by the authors of the petition against the guidelines is that they were based on only one type of study, Randomized Controlled Trials (RCTs). And of course, this type of study is not perfect. However, we offer the following points to consider:

• RCT's though not perfect offer advantages over many other types of study designs.
• In well-designed RCT's Independent Evaluators, who do not know which treatment condition clients are in, complete assessment. This helps to eliminate bias that may be caused by the belief that one treatment works better than another.
• RCT's help prevent mistakes in attributing the reasons why symptoms improve.
• Other study designs can lead to the belief that people improve due to the treatment when there may be other factors causing change.
• The treatments that have the strongest evidence to support their use also have large effect sizes.
• The APA guidelines are similar to guidelines that have been disseminated by the International Society for Traumatic Stress Studies, Institute of Medicine, VA/DOD.

We affirm the following statements:
• The Guidelines are based on the best available research.
• People impacted by PTSD have the right to be informed about the best available treatments.
• We believe that the APA can serve as an advocate for those impacted by PTSD and provide help in finding treatments that work.
• We encourage new and innovative research to demonstrate potential to help people who have PTSD.
• Our goal in offering this statement is not to diminish the work of mental health professionals.
• We are concerned that statements against the Guidelines of Evidence-based therapies could discourage psychologists from receiving training and make available treatment even more difficult to find.

Sources of Information for those Impacted by PTSD
National Center for PTSD
https://www.ptsd.va.gov/index.asp

International Society for Traumatic Stress Studies
https://www.istss.org/am17/home.aspx