Review of VA/DOD Clinical Practice Guideline on management of acute stress and interventions to prevent posttraumatic stress disorder

Abstract

Abstract-This article summarizes the recommendations of the Department of Veterans Affairs (VA)/Department of Defense (DOD) VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress that pertain to acute stress and the prevention of posttraumatic stress disorder, including screening and early interventions for acute stress states in various settings. Recommended interventions during the first 4 days after a potentially traumatic event include attending to safety and basic needs and providing access to physical, emotional, and social resources. Psychological first aid is recommended for management of acute stress, while psychological debriefing is discouraged. Further medical and psychiatric assessment and provision of brief, trauma-focused cognitive-behavioral therapy are warranted if clinically significant distress or functional impairment persists or worsens after 2 days or if the criteria for a diagnosis of acute stress disorder are met. Follow-up monitoring and rescreening are endorsed for at least 6 months for everyone who experiences significant acute posttraumatic stress. Four interventions that illustrate early intervention principles contained in the VA/DOD Clinical Practice Guideline are described.

Traumatic Stress and Affect Management in Military Families

“…Many military service members and veterans who were in situations of ongoing threat and cumulative stress from exposure to war do not seek professional help but may seek informal support from family and friends instead (Nash & Watson, 2012). An emphasis on the veteran's PTSD symptoms that excludes the other family members in the home can perpetuate a deficit model of psychological coping rather than one of resilience that is based on strengths and enhanced family functioning.…”

Vietnam in the Later Family: Self-reported Symptoms and Interpretations of Posttraumatic Stress

“…Public policy should recognize that the shadow army of military families does not disappear when deployment or enlistment ends. Clinical application of the new VA/DOD guidelines suggest the importance of family involvement early on for assessment and treatment (Monson, Macdonald, & Brown-Bowers, 2012;Nash & Watson, 2012). Advances are forthcoming with new diagnostic criteria for PTSD (APA, 2013) and new assessment tools for measuring functional impairment related to PTSD (Rodriguez et al, 2012).…”

The Air Force Deployment Transition Center: Assessment of Program Structure, Process, and Outcomes

“…In fact, two rigorous evaluations found that debriefing was associated with an increased risk of PTSD (Bisson et al, 1997;Hobbs et al, 1996). At this date, researchers and clinical practice guidelines recommend that civilian-style debriefing programs not be offered to trauma survivors (U.S. Department of Veterans Affairs and U.S. Department of Defense, 2010;McNally, Bryant, and Ehlers, 2003;Nash and Watson, 2011;Rose et al, 2002). Because the DTC includes program elements that are similar to those used in critical incident stress debriefing, it is likely that those particular elements are contraindicated by existing DoD and U.S. Department of Veterans Affairs treatment guidelines.…”

“…In fact, two studies reported that debriefing was associated with an increased risk of PTSD (Bisson et al, 1997;Hobbs et al, 1996). At this date, the recommendation in the scientific literature is not to conduct such interventions (McNally, Bryant, and Ehlers, 2003;Nash and Watson, 2011;Rose et al, 2002). As a result of a series of methodologically rigorous studies finding either no effect or adverse effects, current clinical practice guidelines for treating traumatized persons strongly suggest that such programs should not be used.…”

“…Psychological first aid has been described as "evidence-informed" (Hobfoll et al, 2007;Nash and Watson, 2011;Uhernik and Husson, 2009), a descriptor that indicates that elements of the intervention (e.g., positive social support) are supported by empirical evidence. For example, psychological first aid incorporates efforts to reconnect survivors with their social support network, which is supported by correlational evidence that shows that trauma survivors cope better when they have access to positive social support (Brewin, Andrews and Valentine, 2000;Ozer et al, 2003).…”