The International Society for Traumatic Stress Studies New Guidelines for the Prevention and Treatment of Posttraumatic Stress Disorder: Methodology and Development Process

TLDR

Treatment guidelines have become key tools for evidence‑based care, and ISTSS first issued PTSD guidelines in 2000, updating them in 2018 with additional position papers on complex PTSD. This paper outlines the ISTSS guideline development methodology and presents its findings, discussing how to interpret and implement the recommendations. The authors used a rigorous process that included scoping questions, systematic reviews of 361 RCTs, 208 meta‑analyses, and narrative reviews to produce 125 recommendations and position papers on complex PTSD. The guideline identified eight strong, eight standard, five low‑effect, 26 emerging, and 78 insufficient‑evidence recommendations, and chose not to include separate scoping questions for complex PTSD due to definitional and study‑availability issues.

Abstract

Abstract Over the last two decades, treatment guidelines have become major aids in the delivery of evidence‐based care and improvement of clinical outcomes. The International Society for Traumatic Stress Studies (ISTSS) produced the first guidelines for the prevention and treatment of posttraumatic stress disorder (PTSD) in 2000 and published its latest recommendations, along with position papers on complex PTSD (CPTSD), in November 2018. A rigorous methodology was developed and followed; scoping questions were posed, systematic reviews were undertaken, and 361 randomized controlled trials were included according to the a priori agreed inclusion criteria. In total, 208 meta‐analyses were conducted and used to generate 125 recommendations (101 for adults and 24 for children and adolescents) for specific prevention and treatment interventions, using an agreed definition of clinical importance and recommendation setting algorithm. There were eight strong , eight standard , five low effect , 26 emerging evidence , and 78 insufficient evidence to recommend recommendations. The inclusion of separate scoping questions on treatments for complex presentations of PTSD was considered but decided against due to definitional issues and the virtual absence of studies specifically designed to clearly answer possible scoping questions in this area. Narrative reviews were undertaken and position papers prepared (one for adults and one for children and adolescents) to consider the current issues around CPTSD and make recommendations to facilitate further research. This paper describes the methodology and results of the ISTSS Guideline process and considers the interpretation and implementation of the recommendations.