Psychological and drug therapies for post-traumatic stress disorder

Since the last edition of this review, there has been an impressive body of new evidence adding to our knowledge of psychological treatments. There have also been two new major reviews covering the complete range of available treatments: the second edition of the guidelines from the International Society for Traumatic Stress Studies (ISTSS) and the US Institute of Medicine's review. The National Institute for Clinical Excellence (NICE) guidelines were published before the last edition of this article, and there are currently no plans to revise them. However, the Australian guidelines build on the NICE guidelines, and provide the most comprehensive and user-friendly clinical guidance currently available. It is fascinating that such major and thorough reviews have arrived at different conclusions. The Institute of Medicine endorses trauma-focused cognitive behavioural therapy (TF-CBT) and prolonged exposure but not eye movement desensitization and reprocessing (EMDR) or drug treatment; NICE endorses TF-CBT and EMDR but not drugs; and the ISTSS guidelines, second edition, endorses drugs, EMDR, and TF-CBT. What is the bewildered therapist to do? Hopefully this review will clarify some of these issues. In truth, the discrepancy arises not because these learned and expert bodies have been perverse, negligent, or biased in their reviewing, but largely because they differ in what they have regarded as a clinically significant difference between two interventions as opposed to a statistical difference.