Treating PTSD: The latest recommendations from the Australian treatment guidelines

At any point in time 4.4% of Australians have posttraumatic stress disorder or PTSD – that is over one million people.


PTSD is the second most common mental health condition next to depression and can have a profound impact on the individual and their family.


Last month we launched the updated Australian Guidelines for the Prevention and Treatment of Acute Stress Disorder, Posttraumatic Stress Disorder and Complex PTSD, approved by the NHMRC. Here, we outline for mental health practitioners what’s new in these Guidelines.


But firstly, a quick overview of what the Guidelines aim to do and the background to this current version.


The Guidelines aim to support high quality treatment for children, adolescents, and adults with acute stress disorder (ASD), posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) by providing a framework of best practice around which to structure treatment.


The Guidelines are based on a systematic review of the peer reviewed literature and were developed in collaboration with a Guideline Development Group comprising Australia’s leading trauma experts, specialist practitioners working with people affected by trauma, and individuals with lived experience of trauma.


This latest version of the Guidelines is published in an innovative online ‘living guideline’ format, providing the potential to update recommendations when there is sufficient new evidence to do so, ensuring that the advice is always current and up to date.


The recommendations provided in the Guidelines are categorised in four ways: strong or conditional, for or against an intervention. Below you will find the main strong and conditional recommendations for an intervention. A more complete listing of the recommendations and summary of the interventions themselves can be found on the online platform, and additional supporting documents are available on our website.


While complex PTSD has been included in the Guidelines for the first time, high quality research into effective treatment for complex PTSD is not yet available. For this reason, there are no specific treatment recommendations made at this time. The Guideline Development Group has, however, written a chapter on complex PTSD addressing conceptual, diagnostic, assessment and treatment issues, and outlining the treatment outcome research that is currently underway.


The key treatment recommendations


Interventions for adults with early PTSD symptoms


Strong recommendation for:

  • A stepped or collaborative care model in which people receive evidence-based treatment tailored to the severity and complexity of their need


Conditional recommendations (in preference to doing nothing) for:

  • Trauma-focussed CBT (TF-CBT)
  • Eye movement and desensitisation reprocessing (EMDR).


Interventions for adults with PTSD


Strong recommendations for:

  • TF-CBT
  • Prolonged exposure
  • Cognitive processing therapy (CPT)
  • Trauma-focussed cognitive therapy (CT)
  • EMDR


Conditional recommendations (when trauma-focussed cognitive behavioural therapies or EMDR are unavailable or unacceptable to the individual) for:

  • Guided internet-based trauma-focussed CBT
  • Narrative exposure therapy (NET)
  • Present-centred therapy (PCT)
  • Stress inoculation training (SIT)
  • Trauma-focussed CBT (group)


Medication for adults with PTSD


Conditional recommendations (where it is not possible to provide a recommended psychological treatment) for:

  • Serotonin reuptake inhibitors (SSRIs – Paroxetine, Fluoxetine, Sertraline)
  • Serotonin noradrenaline reuptake inhibitor (SNRI – Venlafaxine).


Interventions for children and adolescents with early symptoms of PTSD
Conditional recommendation for:

  • Child and family traumatic stress intervention (CFTSI) in preference to supportive counselling


Interventions for children and adolescents with PTSD
Strong recommendation for:

  • TF-CBT delivered to the child or adolescent, with the inclusion of their caregiver if appropriate.


Conditional recommendation (when TF-CBT is unavailable or unacceptable) for

  • EMDR


Associate Professor Andrea Phelps, Deputy Director of Phoenix Australia, led the development of the Guidelines. She says,

“The Guidelines are a vital tool for practitioners who provide care to people affected by trauma because delivering evidence-based treatment will lead to better outcomes for their patients.”