Australian Guidelines for the Treatment of Adults with Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) have recently been published. The Guidelines, developed by the Australian Centre for Posttraumatic Mental Health (ACPMH) in collaboration with national trauma experts, have been approved by the National Health and Medical Research Council (NHMRC) and endorsed by the Australian Psychological Society and the Royal Australian and New Zealand College of Psychiatrists.
In an era of evidence-based treatment and demands for greater accountability on the part of treatment providers, guidelines can be a useful tool to assist psychologists in their decisions about appropriate care. The past four to five years has seen an emerging consensus on the best approaches to treatment for ASD and PTSD. However there remains a significant gap between evidence-based treatment and routine clinical care in this field. Treatment guidelines are not intended to replace expert clinical judgement, but are an important component of treatment planning which also takes into account the person's preferences and values, practitioners' experience and the available resources.
The Guideline Development Group comprised a steering committee to oversee the process, a working party to guide the systematic review of the literature, summarise the evidence and develop recommendations, and a multidisciplinary panel of consumers and practitioners to provide advice on the scope and final form of the Guidelines to ensure their relevance across the broad range of trauma types and healthcare contexts throughout Australia. Research specialists, Adelaide Health Technology Assessment, conducted the systematic review.
The challenge now is to disseminate the Guidelines to psychologists and other health practitioners and to support their implementation. Briefings will be held in each State in August-September this year funded by the Department of Health and Ageing (dates will be published on the ACPMH website). Symposia on the Guidelines are scheduled for upcoming professional conferences including the 42nd Annual APS Conference in Brisbane. Over the coming months ACPMH will also be conducting a series of skills workshops around Australia, designed to address any gaps between Guideline recommendations and the routine care currently provided to people with ASD and PTSD.
Summary of Australian Guidelines for the Treatment of Adults with ASD and PTSD
For adults with PTSD
Psychological interventions:Adults with PTSD should be provided with trauma-focused interventions (trauma-focused Cognitive Behaviour Therapy or Eye Movement Desensitisation and Reprocessing in addition to in vivo exposure) (A) Non trauma-focused interventions such as supportive counselling and relaxation should not be provided to adults with PTSD in preference to trauma-focused interventions (B)
Where symptoms have not responded to a range of trauma-focused interventions, evidence-based non trauma-focused interventions (such as stress management) and/or pharmacotherapy should be considered (C)
Pharmacological interventions:Drug treatments for PTSD should not be used as a routine first-line treatment for adults, either by general medical practitioners or by specialist mental health professionals, in preference to a trauma-focused psychological therapy (A)
Where medication is considered for the treatment of PTSD in adults, SSRI antidepressants should be the first choice for both general practitioners and mental health specialists (B)
For all, following exposure:For adults exposed to trauma, structured psychological interventions such as psychological debriefing should not be offered on a routine basis (C) In the immediate aftermath of trauma, practitioners should adopt a position of "psychological first aid", which includes monitoring of the person's mental state, provision of general emotional support and information and encouraging the active use of social supports and self care strategies (GPP)
For adults with ASD:Adults displaying ASD or PTSD reactions at least two weeks after the traumatic event should be offered trauma-focused CBT including exposure and/or cognitive therapy once a clinical assessment has been undertaken (A)
Drug treatments should generally not be used to treat ASD unless the person's distress / hyperarousal can not be managed by psychological means alone (GPP)