Clinical practice guidelines for the treatment of PTSD: A review and meta-guideline

Abstract

Background: International clinical practice guidelines provide recommendations for the treatment of post-traumatic stress disorder (PTSD). However, their methodological approaches, classifications, and recommendations vary significantly. This review aimed to compare and systematically rank psychological interventions for PTSD treatment in adults across guidelines to offer clearer guidance for treatment selection. Methods: A structured literature and online search identified international guidelines addressing PTSD treatment in adults. Recommendations were extracted and recategorized into three levels: first-line treatment, second-line treatment, and limited evidence to recommend for or against. A point-based system was applied to calculate mean scores and establish a ranking. Results: Ten clinical practice guidelines met the inclusion criteria. Eight psychological interventions were evaluated: Brief Eclectic Psychotherapy (BEP), Cognitive Processing Therapy (CPT), Cognitive Therapy (CT), Eye Movement Desensitization and Reprocessing (EMDR), Narrative Exposure Therapy (NET), Present-Centered Therapy (PCT), Prolonged Exposure (PE), and Stress Inoculation Training (SIT). PE and CPT ranked highest, followed by CT, EMDR, NET, PCT, SIT, and BEP. Conclusions: The review revealed notable inconsistencies in how guidelines classify and recommend psychological interventions for PTSD treatment in adults. The proposed ranking offers a structured international comparison to support clinical decision-making.