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 Casebook to the APA
Clinical Practice Guideline
for the Treatment of

PTSD
 Casebook to the APA
Clinical Practice Guideline
for the Treatment of

PTSD
Edited by Lynn F. Bufka, Caroline Vaile Wright, and Raquel W. Halfond
Copyright © 2020 by the American Psychological Association. All rights reserved. Except
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Title: Casebook to the APA clinical practice guideline for the treatment of PTSD /
edited by Lynn F. Bufka, Caroline Vaile Wright, and Raquel W. Halfond.
Description: Washington, DC : American Psychological Association, [2020] |
Includes bibliographical references and index.
Identifiers: LCCN 2019059295 (print) | LCCN 2019059296 (ebook) |
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Printed in the United States of America

10 9 8 7 6 5 4 3 2 1
CONTENTS

Contributors vii
Preface ix
Raquel W. Halfond, Caroline Vaile Wright, and Lynn F. Bufka

1. Overview of the Volume 3

Lynn F. Bufka and Jeffrey H. Sonis

2. Foundations of PTSD Treatments 21

Caroline Vaile Wright

3. Cognitive Behavior Therapy for PTSD 47

Dawn M. Johnson and Taylor L. Ceroni

4. Cognitive Processing Therapy for PTSD 69

Kathleen M. Chard and Ellen T. Healy

5. Cognitive Therapy for PTSD 91

Anke Ehlers and Jennifer Wild

6. Prolonged Exposure for PTSD 123

Thea Gallagher, Julie Petersen, and Edna B. Foa

7. Brief Eclectic Psychotherapy for PTSD 139

Berthold P. R. Gersons, Mirjam J. Nijdam, Geert E. Smid,
and Marie-Louise Meewisse

8. Eye-Movement Desensitization and Reprocessing Therapy

for PTSD 163
Louise Maxfield, Roger M. Solomon, and E. C. Hurley

v
vi Contents

9. Narrative Exposure Therapy for PTSD 187

Frank Neuner, Thomas Elbert, and Maggie Schauer

10. Pharmacotherapy for PTSD: What Psychologists Need

to Know 207
Matthew J. Friedman and Jeffrey H. Sonis

11. Conclusion: PTSD Treatment Themes, Shared Components,

and Future Research Directions 233
Raquel W. Halfond

Index 243
About the Editors 255
CONTRIBUTORS

Lynn F. Bufka, PhD, American Psychological Association, Washington, DC

Taylor L. Ceroni, PhD, University of Akron, Akron, OH; now at Southeast
Louisiana Veterans Health Care System, New Orleans, LA
Kathleen M. Chard, PhD, Cincinnati VA Medical Center and University
of Cincinnati, Cincinnati, OH
Anke Ehlers, PhD, Department of Experimental Psychology, University
of Oxford, Oxford, England
Thomas Elbert, PhD, Department of Psychology, Universität Konstanz,
Konstanz, Germany
Edna B. Foa, PhD, University of Pennsylvania Perelman School of Medicine,
Philadelphia
Matthew J. Friedman, MD, PhD, National Center for PTSD, U.S. Depart-
ment of Veterans Affairs and Department of Psychiatry, Geisel School of
Medicine at Dartmouth, Hanover, NH
Thea Gallagher, PsyD, University of Pennsylvania Perelman School of
Medicine, Philadelphia
Berthold P. R. Gersons, MD, PhD, ARQ National Psychotrauma Center,
Amsterdam University Medical Centers, Amsterdam, Netherlands
Raquel W. Halfond, PhD, American Psychological Association,
Washington, DC
Ellen T. Healy, PhD, VA Boston Healthcare System, National Center
for PTSD, and Boston University School of Medicine, Boston, MA
E. C. Hurley, DMin, PhD, Soldier Center, Clarkesville, TN
Dawn M. Johnson, PhD, Department of Psychology, University of Akron,
Akron, OH

vii
viii Contributors

Louise Maxfield, PhD (retired), Ridgetown, Ontario, Canada

Marie-Louise Meewisse, PhD, Abate, Center of Expertise in Trauma
and Anxiety, Enkhuizen, Netherlands
Frank Neuner, PhD, Department of Psychology, Universität Bielefeld,
Bielefeld, Germany
Mirjam J. Nijdam, PhD, ARQ National Psychotrauma Center, Amsterdam
University Medical Centers, Amsterdam, Netherlands
Julie Petersen, BS, Utah State University, Logan
Maggie Schauer, PhD, Department of Psychology, Universität Konstanz,
Konstanz, Germany
Geert E. Smid, MD, PhD, ARQ National Psychotrauma Center, Diemen,
Netherlands, and University of Humanistic Studies, Utrecht, Netherlands
Roger M. Solomon, PhD, Licensed Psychologist/Consultant, Arlington, VA
Jeffrey H. Sonis, MD, MPH, Departments of Social Medicine and
Family Medicine, University of North Carolina at Chapel Hill
Jennifer Wild, DClinPsy, Department of Experimental Psychology,
University of Oxford, Oxford, England
Caroline Vaile Wright, PhD, American Psychological Association,
Washington, DC
PREFACE
Raquel W. Halfond, Caroline Vaile Wright, and Lynn F. Bufka

This casebook is meant to illustrate how the treatments recommended by the

Clinical Practice Guideline for the Treatment of PTSD (American Psychological
Association [APA], 2017) are used in practice. As staff members at APA, housed
within the Practice Directorate in the Practice Research and Policy Department,
we were all involved in the development of this guideline.1
The purpose of the APA Clinical Practice Guideline was to make recom-
mendations regarding the efficacy of interventions for treating adults with
posttraumatic stress disorder (PTSD; see https://www.apa.org/ptsd-guideline/
ptsd.pdf). In addition, a website for the guideline with many resources
(including additional case examples) is available (see https://www.apa.org/
ptsd-guideline/). The information and case examples included in this book
represent each of the recommended treatments for PTSD and are intended to
illustrate distinct elements of treatment and how they are implemented in
practice. This casebook is educational, and, as is true with the APA Clinical
Practice Guideline, it is not intended to be a mandate or required standard
for practice. Furthermore, no attempt is made to match particular symptoms
to particular treatments. Rather, given that evidence-based practice in psychol-
ogy is the integration of the best available evidence with clinician expertise

1
Lynn Bufka is the senior director, practice transformation and quality and, together
with her counterpart in APA’s Science Directorate, oversees development of clinical
practice guidelines. Caroline Vaile Wright is the senior director, health care innovation
and conducted the additional searches for information on potential harms and
burdens for the PTSD guideline. Raquel Halfond is the director of evidence based
practice and worked most closely with the guideline development panel. All
three editors are licensed clinical psychologists.

ix
x Preface

and patients’ preferences, culture, and individual characteristics (APA, 2006),

the casebook describes the treatments, briefly summarizes their evidence
bases, and shows readers how some clinicians have used the treatments with
particular clients so that readers can make their own clinical choices.
Although the APA Clinical Practice Guideline was approved as policy with
a majority vote by APA’s Council of Representatives, there was and there
continues to be controversy surrounding this guideline. Concerns were raised
that the guideline did not include or did not give a strong enough recommen-
dation to some treatments that are commonly used in practice but for which
there is a less robust research base than is available for other treatments. This
situation stems in part from the decision to follow the standards for guideline
development from the former Institute of Medicine (IOM [now the National
Academy of Medicine], 2011), which some argue are a poor fit for mental
and behavioral health guidelines because they adhere to a medical model.
Others raised concerns that insufficient attention was given in the guideline
to aspects that are important to care, such as the nature and quality of the
therapeutic relationship and patient individual differences. While these areas
are indeed important, methods for evaluating the quality of this body of
research to inform guideline recommendations do not meet the rigor and
transparency of systematic reviews and established standards for evaluating
the efficacy of interventions, and the panel determined it could not make
recommendations in these areas.
To address these concerns, APA is developing a companion professional
practice guideline to address the role of contextual and nonspecific factors in
providing evidence-based practice and another to address issues relevant to
trauma-specific care. Professional practice guidelines are based in the profes-
sional literature but differ from clinical practice guidelines (CPGs) in that pro-
fessional practice guideline recommendations are developed through expert
consensus without a systematic search for and evaluation of the quality of the
evidence base. Furthermore, as APA has continued to produce additional CPGs,
its process has worked to address concerns raised about the PTSD guideline.
CPG development will continue to evolve, and as APA becomes a leader in
guideline development, APA will be positioned to identify and incorporate
new methodologies to evaluate evidence that could be well suited for mental
and behavioral health topics.
Combined, these efforts support the same goal: to help individuals living
with PTSD to cope, feel better, and lead productive and fulfilling lives through
informed, evidence-based care. Many of us in the mental and behavioral health
field have been touched professionally and personally by the horrible ravages
of PTSD in our patients, families, friends, loved ones, or even selves, and
many of us know firsthand the impact of PTSD and importance of treatment
that works. While much remains to be understood about the development,
maintenance, and treatment of PTSD, this is a starting point. It is our sincere
hope that this book will contribute to efforts to bridge this gap, more closely tie
research with pragmatic practice application, and ultimately better the lives
of individuals living with PTSD and of their family, friends, and loved ones.
 Preface xi

REFERENCES
American Psychological Association. (2017). Clinical practice guideline for the treatment of
PTSD. http://dx.doi.org/10.1037/e514052017-001
American Psychological Association, Presidential Task Force on Evidence-Based Practice.
(2006). Evidence-based practice in psychology. American Psychologist, 61, 271–285.
http://dx.doi.org/10.1037/0003-066X.61.4.271
Institute of Medicine. (2011). Clinical practice guidelines we can trust. Washington, DC:
National Academies Press.
 Casebook to the APA
Clinical Practice Guideline
for the Treatment of

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