Updated PTSD Guidelines and Recommendations Released: Learn About the Changes

Updated PTSD Guidelines and Recommendations Released: Learn About the Changes
DHCC graphic
By Alia H. Creason, Ph.D.
July 6, 2017

On Monday, the Department of Veterans Affairs (VA) and Department of Defense (DoD) released an updated version of the VA/DoD Clinical Practice Guideline (CPG) for the Management of Posttraumatic Stress Disorder (PTSD) and Acute Stress Disorder (ASD). The new version incorporates research conducted since the last revision in 2010 and covers treatment for both PTSD and ASD. There are several new recommendations, so both seasoned and new mental health practitioners should take time to review it.

What’s in the updated PTSD CPG?

The CPG contains the latest recommendations based on evidence spanning prevention, screening, assessment, diagnosis, treatment, and clinical management. There are visual algorithms to use as quick references for acute stress reaction, assessment and diagnosis of ASD and PTSD, and management of ASD and PTSD. It’s important to note the CPG provides recommendations for the management of ASD and PTSD in adults only, not children or adolescents.

Here are some recommendations provided in the CPG.

The updated CPG provides more specificity regarding recommendations for and against medications for the treatment of PTSD. This information is summarized in multiple tables throughout the guideline, as well as in the VA/DoD PTSD CPG – Pocket Card and the VA/DoD PTSD CPG – Clinician Summary.

Selected recommendations:

  • The CPG provides a strong recommendation for the first line of treatment for PTSD: individual, manualized trauma-focused psychotherapy, over use of pharmacologic and non-pharmacologic interventions for primary treatment. Only if the patient prefers not to use this therapy or it is not available, then pharmacotherapy or other specified evidence-based individual non-trauma focused psychotherapy can be used (see CPG for details). However, in an effort to increase access to care, the CPG strongly recommends using those trauma-focused psychotherapies that have demonstrated efficacy using secure video teleconferencing (VTC).
  • The CPG presents a strong recommendation for use of selective serotonin reuptake inhibitors (SSRIs) fluoxetine, paroxetine, or sertraline and serotonin norepinephrine reuptake inhibitor (SNRI) venlafaxine for patients diagnosed with PTSD who choose not to engage in or are unable to access trauma-focused psychotherapy.
  • The CPG makes a strong recommendation against treating PTSD with divalproex, tiagabine, guanfacine, risperidone, benzodiazepines, ketamine, hydrocortisone, or D-cycloserine, as monotherapy due to the lack of strong evidence for their efficacy and/or known adverse effect profiles and associated risks.
  • The CPG recommends against using atypical antipsychotics, benzodiazepines, and divalproex as augmentation therapy for the treatment of PTSD due to low quality evidence or the absence of studies and their association with known adverse effects.
  • For nightmares associated with PTSD, there is insufficient evidence to recommend for or against the use of prazosin as mono- or augmentation therapy.
  • There is insufficient evidence to recommend using any complementary and integrative health (CIH) practices including mindfulness, yoga, meditation, or acupuncture as the primary treatment for PTSD.
  • The CPG strongly recommends against using cannabis to treat PTSD because of the lack of evidence for efficacy, known adverse effects, and associated risks.

These are just a few details from the guideline, but there’s so much more! As a provider, it’s important to get familiar with the PTSD CPG so you can deliver the latest evidence-based quality of care for our service members.

Clinical support tools and other PTSD information

Deployment Health Clinical Center (DHCC) collaborates with the DoD/VA Evidence Based Practice Work Group to develop clinical support tools to help make CPGs easier to use in daily practice. These tools are for providers, clinic leaders, line leaders, patients, and families to provide general information about PTSD, explain changes in PTSD treatments, and offer resources. The clinical support tools for PTSD are currently being updated to align with the new CPG so check back soon for updated tools and information!

In the meantime, check out DHCC’s PTSD section for general information on PTSD, related DoD policy guidance and resources, and Psychological Health by the Numbers reports for the latest surveillance data on PTSD and other mental health conditions in the military.       

Dr. Alia Creason is a contracted licensed clinical psychologist on the evidence-based practice team at the Deployment Health Clinical Center. She has a doctorate in counseling and human systems and a master of public health in maternal and child health.

The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.


  • Any contemporary clinical work on war trauma needs to have significant dedication to the moral wound/moral injury that one can experience from being involved in actions that result in people getting killed or witnessing people getting killed, especially if there has been betrayal by the government and people in terms of reasons for having been sent to kill. Hopefully this guide addresses this or has important references to it.

  • What about Military induced PTSD? Patient was 10 y/o female attacked, molested, sexually asulted by soldier at USDB. Prisoners were allow in housing & they next to the USDB walls. Now she is 62. She spent over 16 yrs living on Military Bases in the US as well as Germany. Mother was a War Refugee-Germany & father was abusive(physically and emotional) as well as being an Army lifer. Any comments would be appreciated. Also any direction as to who she speak with regarding this within the Military. Seeing the same dx with symptoms as described for soldiers.

    • Please encourage this person to seek care and continue with care as symptoms of post-traumatic stress can improve or resolve with appropriate treatment. It is true symptoms of post-traumatic stress can be caused by many types of trauma. The DCoE Outreach Center (866-966-1020) provides free, customized information to address psychological health concerns and could help connect this person to programs and resources in her area. The Department of Veterans Affairs National Center for PTSD (www.ptsd.va.gov) also provides information and resources for families and friends of veterans and the general public.

  • Where do we get the manual?

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