Statement of Task

  1. 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.

  2. 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:

    1. 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.

    2. 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

    3. The committee shall consider the following framework to make conclusions about the strength of the available evidence for treatment modalities:

      1. Evidence is sufficient to conclude the efficacy of X in the treatment of PTSD. (A qualifier of magnitude may be added if appropriate.)

modality was suggestive that it was ineffective or harmful (see Statement of Task II.C.4 and C.5).

The committee conducted a systematic and comprehensive search of the relevant published literature and identified a total of 2,771 studies, and from that list included only randomized controlled trials (RCTs; placebo-controlled pharmacotherapy trials and wait-list or similar controls in the psychotherapy trials) in its review. The committee identified 37 RCTs on pharmacotherapies and 52 studies on psychotherapies (see Chapter 2 for more details about the committee’s methods). The committee excluded

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