Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Post-Traumatic Stress Disorder

Abstract

Over the past 2-3 years, clinical practice guidelines (CPGs) for post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) have been developed in the USA and UK. There remained a need, however, for the development of Australian CPGs for the treatment of ASD and PTSD tailored to the national health-care context. Therefore, the Australian Centre for Posttraumatic Mental Health in collaboration with national trauma experts, has recently developed Australian CPGs for adults with ASD and PTSD, which have been endorsed by the National Health and Medical Research Council (NHMRC). In consultation with a multidisciplinary reference panel (MDP), research questions were determined and a systematic review of the evidence was then conducted to answer these questions (consistent with NHMRC procedures). On the basis of the evidence reviewed and in consultation with the MDP, a series of practice recommendations were developed. The practice recommendations that have been developed address a broad range of clinical questions. Key recommendations indicate the use of trauma-focused psychological therapy (cognitive behavioural therapy or eye movement desensitization and reprocessing in addition to in vivo exposure) as the most effective treatment for ASD and PTSD. Where medication is required for the treatment of PTSD in adults, selective serotonin re-uptake inhibitor antidepressants should be the first choice. Medication should not be used in preference to trauma-focused psychological therapy. In the immediate aftermath of trauma, practitioners should adopt a position of watchful waiting and provide psychological first aid. Structured interventions such as psychological debriefing, with a focus on recounting the traumatic event and ventilation of feelings, should not be offered on a routine basis.

Whiplash-associated disorder: musculoskeletal pain and related clinical findings

“…24,71 These findings indicate the need for additional psychological evaluation of these patients 72 and clinicians should be aware of this factor in their assessment of whiplash injured people. 73 Notably there appears to be no relationship between psychological factors and the intensity of electrical stimulation required to elicit a flexor withdrawal response in biceps femoris neither in patients with chronic whiplash 10,11,72 nor in controls. 15,27,74 These findings indicate that psychological factors may play a role in central hyperexcitability.…”

The Transformation of Post-Traumatic Stress Disorder: From Neurosis to Neurobiology

“…The Institute of Medicine (2008) report goes so far as to assert there is insufficient evidence for the efficacy of pharmacotherapy, though it should be noted that this report did not definitively conclude that medications were ineffective for PTSD. Some national guidelines recommend SSRI medication or psychotherapy as first line treatments (Baldwin et al, 2005;Swinson et al, 2006;Ursano et al, 2004;Benedek et al, 2009) whereas others recommend relegating medications to second line treatments to be used only if psychotherapy fails or is unavailable (Forbes et al, 2007;National Collaborating Centre for Mental Health, 2005). Actual treatment choices in clinical practice are influenced by other factors, including treatment availability, patient preference, and the presence of significant comorbid disorders, such as depression, bipolar disorder, or other anxiety disorders (Rakofsky & Dunlop, 2011).…”

On the efficacy of Narrative Exposure Therapy

“…The classical rationale of this type of exposure therapy is that processes of habituation and extinction, which occur through exposure, lead to a decrease of fear and phobic disorder. For the treatment of PTSD, the international treatment guidelines recommend traumafocusedtherapies (National Institute for Clinical Excellence,2004;Forbes et al, 2007), such as NET. However, while the common factor for all variants of trauma focused treatments is that the patient is con fronted with memories of the past traumatis ing experiences, none of the theories behind these approaches are based merely on a habituation and extinction rationale.…”