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Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence
Statement of Task
The Department of Veterans Affairs has asked the IOM to convene a new committee to review the literature on various treatment modalities (including pharmacotherapy and psychotherapy) and treatment goals for individuals with PTSD.
Specifically, the committee will conduct an evidence-based review on best treatment practices and types and timing of specific interventions, and comment on the prognosis of individuals diagnosed with PTSD (and existing comorbidities). As part of its assessment, the IOM committee shall:
Develop descriptive evidence tables including type of study and identify potential bias and generalizations of the study. The committee shall also search for and classify systematic and narrative reviews on the topic of treatment and recovery of individuals with PTSD.
The committee shall examine and classify the existing studies on various treatment modalities for PTSD. The committee will report on the highest levels of evidence available. For each study the committee will consider the quality of design and execution, and will be guided by the following classification:
I Randomized controlled trial
II-1 Controlled trial without randomization
II-2 Cohort or case-control study
II-3 Time series or uncontrolled experiment
III Opinion of respected authority, case report, and expert committee
The committee shall consider the following framework to make conclusions about the strength of the available evidence for treatment modalities:
Evidence is sufficient to conclude the efficacy of X in the treatment of PTSD. (A qualifier of magnitude may be added if appropriate.)
of treatment; and, finally, note areas where the evidence base is limited by insufficient research attention or poorly conducted studies (see Box 1-1 for the complete Statement of Task).
In conducting its search of the literature, the committee excluded studies on patient groups that did not fully meet the Diagnostic and StatisticalManual of Mental Disorders definition.2Box 1-2 below lists other topics that are not included in this report.
Two exceptions were studies that included a majority of patients with PTSD and a minority of patients with subsyndromal PTSD.