Chapter 4 - Management of posttraumatic stress disorder

Abstract

This chapter evaluates the various treatment modalities used in the management algorithm of posttraumatic stress disorder (PTSD) and the evidence behind their effectiveness. The first-line treatment for PTSD is individualized manualized trauma-focused psychotherapy. Trauma-focused psychotherapies include a component of exposure and/or cognitive restructuring. These trauma-focused psychotherapies include Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), Eye Movement Desensitization and Reprocessing (EMDR), specific cognitive-behavioral therapies for PTSD, Brief Eclectic Psychotherapy (BEP), Narrative Exposure Therapy (NET), and written narrative exposure. PTSD pharmacotherapies are second-line treatment overall. Of the pharmacotherapies, the first-line pharmacotherapies include monotherapy with sertraline, paroxetine, fluoxetine, or venlafaxine. All the previously mentioned treatments are discussed. The chapter briefly discusses second-line therapies in psychotherapy, pharmacotherapy, and complementary and alternative medicine and the current evidence available behind them. The PTSD Checklist for DSM-5 (PCL-5) is a helpful questionnaire to monitor treatment response over time.