Effective Treatments for PTSD

Third Edition
Practice Guidelines from the International Society for Traumatic Stress Studies

Edited by David Forbes, Jonathan I. Bisson, Candice M. Monson, and Lucy Berliner

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Grounded in the updated Posttraumatic Stress Disorder Prevention and Treatment Guidelines of the International Society for Traumatic Stress Studies (ISTSS), the third edition of this definitive work has more than 90% new content. Chapters describe PTSD assessment and intervention practices that have been shown to work and provide practical, real-world implementation guidance. Foremost authorities address the complexities of trauma treatment with adults, adolescents, and children in diverse clinical contexts. The book delves into common obstacles and ways to overcome them, when to stop trying a particular approach with a client, and what to do next. Special topics include transdiagnostic interventions for PTSD and co-occurring problems, dissemination challenges, and analyzing the cost-effectiveness of treatments. Prior edition editors: Edna B. Foa, Terence M. Keane, Matthew J. Friedman, and Judith A. Cohen.

New to This Edition

“When I received the review copy of this book, I immediately pressed it into service....The authors and editors of this book are to be commended for the neat package of materials they have assembled that provides information that both researchers and clinicians need in an unbiased yet easy-to-access style. I believe this book will be important for anyone interested in the current state of the art in trauma treatment or who wants to know what is happening in trauma research. I highly recommend this book for both scientists and practitioners.”

PsycCRITIQUES (on the second edition)


“The third edition builds on the extraordinary contributions of the two prior editions. The well-chosen authors have integrated standardized, rigorous reviews of the latest research with extremely helpful guidelines on how to apply the research recommendations in clinical practice settings. The book incorporates a number of significant advances and new topics and highlights future directions for the field in a thoughtful and practical way. This is a scientifically grounded, visionary book that is an essential resource for clinicians, researchers, and advanced graduate students.”

—Patricia J. Watson, PhD, psychologist, National Center for PTSD


“This impressive book thoroughly summarizes the state of the art in evidence-based approaches to early intervention and treatment for PTSD. It is unique in accomplishing something that previous (often technical and dry) consensus best-practice guidelines have not—it fleshes out research findings in a way that enables clinicians to make informed choices about how to best help trauma survivors in particular contexts. Chapters provide rich details about clinical procedures and discuss who is most likely to benefit, how to avoid pitfalls and maximize impact, and what to do about problems that arise. The editors and contributors are experts with tremendous training and clinical experience.”

—Brett T. Litz, PhD, Departments of Psychology and Psychiatry, Boston University


“The third edition of this book takes an important step in bridging the gap between evidence-based guidelines and clinical practice. Clinicians face an array of barriers attempting to integrate findings from randomized clinical trials into their day-to-day work. The book is genuinely unique and much needed—each chapter goes beyond the research evidence to explore the challenges of applied implementation, providing practical and effective treatment recommendations. If you are working with those struggling with PTSD, this is a 'must read' regardless of clinical setting. You simply won’t find more innovative, comprehensive coverage of this critical topic.”

—M. David Rudd, PhD, ABPP, President and Distinguished University Professor of Psychology, University of Memphis


“Congratulations to Dave Forbes, Jon Bisson, Candice Monson, and Lucy Berliner on overseeing this new edition. They have masterfully synthesized the wide-ranging research on treating PTSD that has been going on since the second edition of this volume came out. Their editorial vision has brought a fresh perspective to the ISTSS treatment guidelines, and offers the field an invaluable resource. We’re thrilled to see the careful work in this arena continue, giving guidance to practitioners and researchers around the world.”

—Edna B. Foa, PhD; Terence M. Keane, PhD; Matthew J. Friedman, MD, PhD; and Judith A. Cohen, MD, editors of Effective Treatments for PTSD, Second Edition

Table of Contents

I. Introduction and Background

1. Effective Treatments for PTSD: Guiding Current Practice and Future Innovation, David Forbes, Jonathan I. Bisson, Candice M. Monson, & Lucy Berliner sample

2. Trauma and PTSD: Epidemiology, Comorbidity, and Clinical Presentation in Adults, Kristina J. Korte, Tammy Jiang, Karestan C. Koenen, & Jaimie Gradus

3. Epidemiology, Clinical Presentation, and Developmental Considerations in Children and Adolescents, Eva Alisic, Rowena Conroy, & Siri Thoresen

4. Diagnosis, Assessment, and Screening for PTSD and Complex PTSD in Adults, Jonathan I. Bisson, Chris R. Brewin, Marylene Cloitre, & Andreas Maercker

5. Screening, Assessment, and Diagnosis in Children and Adolescents, Lucy Berliner, Richard Meiser-Stedman, & Andrea Danese

6. ISTSS PTSD Prevention and Treatment Guidelines: Methodology, Jonathan I. Bisson, Catrin Lewis, & Neil Roberts

7. ISTSS PTSD Prevention and Treatment Guidelines: Recommendations, Jonathan I. Bisson, Lucy Berliner, Marylene Cloitre, David Forbes, Tine Jensen, Catrin Lewis, Candice M. Monson, Miranda Olff, Stephen Pilling, David Riggs, Neil Roberts, & Francine Shapiro

II. Early Intervention in Adults

8. Early Intervention for Trauma-Related Psychopathology, Meaghan L. O’Donnell, Belinda J. Pacella, Richard A. Bryant, Miranda Olff, & David Forbes

9. Early Pharmacological Intervention Following Exposure to Traumatic Events, Jonathan I. Bisson, Laurence Astill Wright, & Marit Sijbrandij

III. Early Intervention in Children and Adolescents

10. Preventative and Early Interventions, Justin Kenardy, Nancy Kassam-Adams, & Grete Dyb

IV. Treatments for Adults

11. Psychological Treatments: Core and Common Elements of Effectiveness, Miranda Olff, Candice M. Monson, David Riggs, Christopher W. Lee, Anke Ehlers, & David Forbes

12. Prolonged Exposure, David S. Riggs, Larissa Tate, Kelly Chrestman, & Edna B. Foa

13. Cognitive Processing Therapy, Kathleen M. Chard, Debra L. Kaysen, Tara E. Galovski, Reginald D. V. Nixon, & Candice M. Monson

14. Eye Movement Desensitization and Reprocessing Therapy, Francine Shapiro, Mark C. Russell, Christopher W. Lee, & Sarah J. Schubert

15. Cognitive Therapy, Anke Ehlers

16. Pharmacological and Other Biological Treatments, Jonathan I. Bisson, Mathew Hoskins, & Dan J. Stein

17. Combined Psychotherapy and Medication Treatment, Mark Burton, Jessica Maples-Keller, Mathew Hoskins, Yilang Tang, Katarzyna Wyka, JoAnn Difede, & Barbara O. Rothbaum

18. E-Mental Health, Catrin Lewis & Miranda Olff

19. Complementary, Alternative, and Integrative Interventions, Ariel Lang & Barbara Niles

20. Treatment of Complex PTSD, Marylene Cloitre, Thanos Karatzias, & Julian Ford

V. Treatments for Children and Adolescents

21. Treatment of PTSD and Complex PTSD, Tine Jensen, Judy Cohen, Lisa Jaycox, & Rita Rosner

VI. Application, Implementation, and Future Directions

22. Treatment Considerations for PTSD Comorbidities, Neil P. Roberts, Sudie E. Back, Kim Mueser, & Laura K. Murray

23. Building a Science of Personalized Interventions for PTSD, Marylene Cloitre, Zachary Cohen, & Ulrich Schnyder

24. Training and Implementation of Evidence-Based Psychotherapies for PTSD, David S. Riggs, Maegan M. Paxton, Sybil Mallonee, Craig Rosen, Shannon Wiltsey Stirman, & Shannon Dorsey

25. A Health Economics View, Ifigeneia Mavranezouli & Cathy Mihalopoulos

26. The Future of Traumatic Stress Treatments: Time to Grasp the Opportunity, David Forbes, Jonathan I. Bisson, Candice M. Monson, & Lucy Berliner


About the Editors

David Forbes, PhD, is Director of Phoenix Australia Centre for Posttraumatic Mental Health and Professor in the Department of Psychiatry at the University of Melbourne. He began practicing as a clinical psychologist in the mid-1990s and has a strong research track record in the assessment and treatment of mental health problems in trauma survivors, with a specialty in military, veteran, emergency services, and post-disaster mental health. Dr. Forbes led the development of the Australian Guidelines for the Treatment of Acute Stress Disorder and PTSD and is Co-Chair of the 5-Eyes Mental Health Research and Innovation Collaboration.

Jonathan I. Bisson, DM, FRCPsych, is Professor of Psychiatry at Cardiff University School of Medicine, Wales, United Kingdom, and a practicing psychiatrist. He is Chair of the Treatment Guidelines Committee of the International Society for Traumatic Stress Studies and is currently developing an All Wales Traumatic Stress Quality Improvement Initiative. Dr. Bisson was Co-Chair of the first PTSD Guideline Development Group of the United Kingdom's National Institute for Health and Care Excellence. He is a past president of the European Society for Traumatic Stress Studies, and led the development of Veterans NHS Wales. He has conducted widely cited research on the prevention and treatment of PTSD.

Candice M. Monson, PhD, is Professor of Psychology at Ryerson University in Toronto, Ontario, Canada. She is a Fellow of the American and Canadian Psychological Associations, the Association for Behavioral and Cognitive Therapies, and the Royal Society of Canada. Dr. Monson is a foremost expert on traumatic stress and the use of individual and conjoint therapies to treat PTSD. She is coauthor of Cognitive Processing Therapy for PTSD and Cognitive-Behavioral Conjoint Therapy for PTSD and coeditor of Effective Treatments for PTSD, Third Edition, among other books.

Lucy Berliner, MSW, is Director of the Harborview Center for Sexual Assault and Traumatic Stress at the University of Washington, where she is also Clinical Associate Professor in the School of Social Work and in the Department of Psychiatry and Behavioral Sciences. Her activities include clinical practice with child and adult victims of trauma and crime; research on the impact of trauma and the effectiveness of clinical and societal interventions; and participation in local and national social policy initiatives to promote the interests of trauma and crime victims.

Contributors

Eva Alisic, PhD, Child and Community Wellbeing Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia

Sudie E. Back, PhD, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina

Lucy Berliner, MSW, Harborview Abuse and Trauma Center, Seattle, Washington

Jonathan I. Bisson, DM, FRCPsych, Department of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom

Chris R. Brewin, PhD, Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom

Richard A. Bryant, PhD, School of Psychology, University of New South Wales, Sydney, Australia

Mark Burton, PhD, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia

Kathleen M. Chard, PhD, Trauma Recovery Center, Cincinnati VA Medical Center and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio

Kelly Chrestman, PhD, Center for Deployment Psychology, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland

Marylene Cloitre, PhD, National Center for PTSD, Palo Alto VA Health Care Services, Palo Alto, California; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California

Judith Cohen, MD, Department of Psychiatry, Drexel University College of Medicine, Pittsburgh, Pennsylvania

Zachary Cohen, PhD, National Center for PTSD, Palo Alto, California; Department of Psychiatry, University of California, Los Angeles, Los Angeles, California

Rowena Conroy, PhD, School of Psychological Sciences, University of Melbourne, Melbourne, Australia

Andrea Danese, MD, PhD, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom

JoAnn Difede, PhD, Department of Psychology, Weill Cornell Medicine, New York, New York

Shannon Dorsey, PhD, Department of Psychology, University of Washington, Seattle, Washington

Grete Dyb, MD, PhD, Norwegian Centre for Violence and Traumatic Stress Studies and Institute of Clinical Medicine, University of Oslo, Oslo, Norway

Anke Ehlers, PhD, Oxford Centre for Anxiety Disorders and Trauma, Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom

Edna B. Foa, PhD, Center for the Study and Treatment of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania

David Forbes, PhD, Phoenix Australia Centre for Posttraumatic Mental Health and Department of Psychiatry, University of Melbourne, Melbourne, Australia

Julian D. Ford, PhD, ABPP, Center for Trauma Recovery and Juvenile Justice, Center for the Treatment of Developmental Trauma Disorders, and Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut

Tara E. Galovski, PhD, National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts

Jaimie Gradus, DSc, MPH, Department of Epidemiology, Boston University School of Public Health; and Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts

Mathew D. Hoskins, MBBCh, MSc, MRCPsych, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom

Lisa Jaycox, PhD, RAND Corporation, Arlington, Virginia

Tine Jensen, PhD, Department of Psychology, University of Oslo, and Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway

Tammy Jiang, MPH, Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts

Thanos Karatzias, PhD, School of Health and Social Care, Edinburgh Napier University, and NHS Lothian Rivers Centre for Traumatic Stress, Edinburgh, United Kingdom

Nancy Kassam-Adams, PhD, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

Debra L. Kaysen, PhD, Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Palo Alto, California

Justin Kenardy, PhD, School of Psychology, University of Queensland, Queensland, Australia

Karestan C. Koenen, PhD, Departments of Epidemiology and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Cambridge, Massachusetts

Kristina J. Korte, PhD, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts

Ariel J. Lang, PhD, MPH, VA San Diego Center for Excellence for Stress and Mental Health and Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, San Diego, California

Christopher Lee, PhD, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia

Catrin Lewis, PhD, Division of Psychological Medicine and Clinical Neurosciences,

School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom

Andreas Maercker, MD, PhD, Department of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland

Sybil Mallonee, PhD, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland

Jessica Maples-Keller, PhD, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia

Ifigeneia Mavranezouli, MD, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom

Richard Meiser-Stedman, PhD, Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, United Kingdom

Cathrine Mihalopoulos, PhD, School of Health and Social Development, Deakin University, Geelong, Australia

Candice M. Monson, PhD, Department of Psychology, Ryerson University, Toronto, Ontario, Canada

Kim T. Mueser, PhD, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts

Laura K. Murray, PhD, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Barbara Niles, PhD, National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts

Reginald D. V. Nixon, PhD, College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia

Meaghan L. O’Donnell, PhD, Phoenix Australia Centre for Posttraumatic Mental Health and Department of Psychiatry, University of Melbourne, Melbourne, Australia

Miranda Olff, PhD, Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands; ARQ National Psychotrauma Centre, Diemen, Netherlands

Belinda J. Pacella, MClinPsych, Phoenix Australia Centre for Posttraumatic Mental Health and Department of Psychiatry, University of Melbourne, Melbourne, Australia

Stephen Pilling, PhD, Division of Psychology and Language Sciences, University College London, London, United Kingdom

David S. Riggs, PhD, Center for Deployment Psychology, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland

Neil P. Roberts, DClinPsy, Cardiff and Vale University Health Board and Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom

Craig Rosen, PhD, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California

Rita Rosner, DPhil, DiplPsych, Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany

Barbara O. Rothbaum, PhD, ABPP, Emory Healthcare Veterans Program and Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia

Mark C. Russell, PhD, School of Applied Psychology, Counseling and Family Therapy, Antioch University, Seattle, Washington

Ulrich Schnyder, MD, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital, University of Zurich, Zurich, Switzerland

Sarah J. Schubert, PhD, private practice, Brentwood, Australia

Francine Shapiro, PhD (deceased), Mental Research Institute, Palo Alto, California; EMDR Institute, Watsonville, California

Marit Sijbrandij, PhD, Department of Clinical, Neuro, and Developmental Psychology and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije University Amsterdam, Amsterdam, Netherlands

Dan J. Stein, FRCPC, PhD, SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa

Shannon Wiltsey Stirman, PhD, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California; Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California Yilang Tang, MD, PhD, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, and Atlanta VA Medical Center, Atlanta, Georgia

Larissa Tate, MS, MPS, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland

Siri Thoresen, PhD, Norwegian Centre for Violence and Traumatic Stress Studies and Department of Psychology, University of Oslo, Oslo, Norway

Maegan M. Paxton Willing, BS, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland

Laurence Astill Wright, MBBCH, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom

Katarzyna Wyka, PhD, Department of Psychiatry, Weill Cornell Medicine, New York, New York

Audience

Clinical psychologists, psychiatrists, clinical social workers, counselors, and psychiatric nurses; graduate students and residents.

Course Use

Serves as a text in graduate-level courses on trauma and PTSD.
Previous editions published by Guilford:

Second Edition, © 2009
ISBN: 9781609181499

First Edition, © 2000
ISBN: 9781593850142
New to this edition: