The increase to four symptom clusters was a result of splitting avoidance/numbing into distinct clusters (avoidance and negative alteration in mood and cognition). DSM-5 transitioned from the original three symptom clusters to four symptom clusters including intrusion (five symptoms, one or more required for diagnosis), avoidance (two symptoms, one or more required for diagnosis), negative alteration in cognition and mood associated with the traumatic event (seven symptoms, two or more required for diagnosis) and marked alterations in arousal and reactivity associated with traumatic events (six symptoms, two or more required for diagnosis). DSM-III and DSM-IV included three symptom clusters (re-experiencing, avoidance/numbing and arousal). The symptom clusters of PTSD also have been revised in DSM-5. DSM-5 removed the requirement that intense fear, helplessness, or horror were present in the individual’s response to the traumatic event. The DSM-5 increased specification as to what qualifies as a traumatic event (Criterion A) and conceptualized traumatic events as exposure to actual or threatened death, serious injury, or sexual violation, as directly experiencing traumatic events, learning of the traumatic events experienced by a close family member or close friend, or repeated exposure to aversive details of the traumatic events. DSM-IV and DSM-IV-TR required that intense fear, helplessness, or horror were present in the individual’s response to the traumatic event, although it became evident that this was not universal, especially in military populations. However, with recognition that traumatic events are relatively frequent, this criterion was revised. In the initial formulation of PTSD, a traumatic stressor was defined as an event outside the range of usual human experience. The DSM-5 reclassified PTSD as a Trauma- and Stressor-Related Disorder instead of an Anxiety Disorder. Because the majority of PTSD treatment research currently published used criteria from the DSM-Fourth Edition-Text Revision (DSM-IV-TR American Psychiatric Association, 2000) or from an earlier version of the DSM, it is important to note how the DSM-5 differs from these earlier versions.
#TRAUMA FOCUSED THERAPY MANUAL#
The diagnosis of PTSD has undergone a number of changes since it was initially included in the Diagnostic and Statistical Manual of Mental Disorders Third Edition (DSM-III American Psychiatric Association, 1980), including a revision in the most recent edition released in 2013 (DSM-5 American Psychiatric Association, 2013). Fortunately, effective psychological treatments for PTSD exist. PTSD is associated with a wide range of problems including difficulties at work, social dysfunction and physical health problems (Alonso et al., 2004 Galovski and Lyons, 2004 Smith et al., 2005). Lifetime and past year prevalence rates of PTSD in community samples are 8.3% and 4.7%, respectively (Kilpatrick et al., 2013), with similar rates (8.0% and 4.8%) observed in military populations (Wisco et al., 2014). Although among most individuals these symptoms resolve within several weeks, approximately 10%–20% of individuals exposed to trauma experience PTSD symptoms that persist and are associated with impairment (Norris and Sloane, 2007). population is exposed to a traumatic event during their lifetime (Sledjeski et al., 2008) and shortly after exposure, many people experience some symptoms of PTSD. Posttraumatic stress disorder (PTSD) is a chronic, often debilitating mental health disorder that may develop after a traumatic life event, such as military combat, natural disaster, sexual assault, or unexpected loss of a loved one. Finally, we will discuss implications and future directions. Each of these treatments has a large evidence base and is trauma-focused, which means they directly address memories of the traumatic event or thoughts and feelings related to the traumatic event.
Both guidelines strongly recommended use of Prolonged Exposure (PE), Cognitive Processing Therapy (CPT) and trauma-focused Cognitive Behavioral Therapy (CBT).
The purpose of the current review article is to briefly review the methodology used in each set of 2017 guidelines and then discuss the psychological treatments of PTSD for adults that were strongly recommended by both sets of guidelines. In 2017, the Veterans Health Administration and Department of Defense (VA/DoD) and the American Psychological Association (APA) each published treatment guidelines for PTSD, which are a set of recommendations for providers who treat individuals with PTSD. Posttraumatic stress disorder (PTSD) is a chronic, often debilitating mental health disorder that may develop after a traumatic life event.
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