this article and any supplementary material should be cited as follows: nash wp, watson pj. review...

This article and any supplementary material should be cited as follows: Nash WP, Watson PJ. Review of VA/DOD Clinical Practice Guidelineon management of acute stress and interventions to prevent posttraumatic stress disorder. J Rehabil Res Dev. 2012;49(5):637–48.http://dx.doi.org/10.1682/JRRD.2011.10.0194

Slideshow ProjectDOI:10.1682/JRRD.2011.10.0194JSP

Review of VA/DOD Clinical Practice Guideline on

management of acute stress and interventions to prevent

posttraumatic stress disorderWilliam P. Nash, MD; Patricia J. Watson, PhD



• Aim– Summarize revised Department of Veterans Affairs

(VA)/Department of Defense (DOD) Clinical Practice Guideline (CPG) for Management of Post-Traumatic Stress recommendations pertaining to acute stress and prevention of posttraumatic stress disorder (PTSD).

– Describe 4 interventions illustrating early intervention principles in VA/DOD CPG.

• Relevance– Revised version draws greater attention to prevention of

PTSD and other adverse outcomes of exposure to traumatic stress.



Recommendations• First 4 days after potentially traumatic event:

– Attend to safety and basic needs. – Provide access to physical, emotional, and social resources.

• Psychological first aid is recommended for acute stress.– Psychological debriefing is discouraged.

• Further medical and psychiatric assessment and brief, trauma-focused cognitive-behavioral therapy warranted if:– Significant distress or functional impairment persists or worsens after

2 days.– Acute stress disorder criteria are met.

• Follow-up monitoring and rescreening for 6 months for everyone experiencing significant posttraumatic stress.



VA/DOD Programs

• 4 early interventions founded on concepts and actions described in CPG and developed by DOD and VA personnel:– Psychological First Aid.– Combat and Operational Stress First Aid.– Skills for Psychological Recovery.– Families Overcoming Under Stress.



Conclusions• Still need research to evaluate effectiveness of early

interventions with Active Duty and veteran populations, who are often in situations of ongoing threat and cumulative stress from loss, inner conflict, traumatic exposure, and wear and tear. – Many are not open to help, do not believe that they need help,

believe that acknowledgment of distress indicates weakness, or will only seek informal support from family and friends early on.

– Early interventions recommended in CPG must be tested in different settings and for various outcomes and recipient preferences.

this article and any supplementary material should be cited as follows: nash wp, watson pj. review...

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