Australian Guidelines for the Treatment of Acute Stress Disorder & Posttraumatic Stress Disorder

200 Pages·2016·2.54 MB·English

Promoting recovery after trauma
Australian Guidelines
for the Treatment of
Acute Stress
Disorder &
Posttraumatic
Stress Disorder
© Phoenix Australia - Centre for Posttraumatic Mental Health, 2013
ISBN Print: 978-0-9752246-0-1 ISBN Online: 978-0-9752246-1-8
This work is copyright. Apart from any use as permitted under the Copyright Act
1968, no part may be reproduced by any process without prior written permission
from Phoenix Australia - Centre for Posttraumatic Mental Health. Requests and
inquiries concerning reproduction and rights should be addressed to Phoenix
Australia - Centre for Posttraumatic Mental Health ([email protected]).
Copies of the full guidelines, and brief guides for practitioners and the public
are available online:
www.phoenixaustralia.org
www.clinicalguidelines.gov.au
The suggested citation for this document is:
Phoenix Australia - Centre for Posttraumatic Mental Health.
Australian Guidelines for the Treatment of Acute Stress Disorder
and Posttraumatic Stress Disorder.
Phoenix Australia, Melbourne, Victoria.
Legal disclaimer
This document is a general guide to appropriate practice, to be followed
only subject to the practitioner’s judgement in each individual case.
The guidelines are designed to provide information to assist decision making
and are based on the best information available at the date of publication.
In recognition of the pace of advances in the field, it is recommended that
the guidelines be reviewed and updated in five years’ time.
Publication Approval
These guidelines were approved by the Chief Executive Officer
of the National Health and Medical Research Council (NHMRC) on
4 July 2013, under Section 14A of the National Health and Medical
Research Council Act 1992. In approving these guidelines the
NHMRC considers that they meet the NHMRC standard for clinical
practice guidelines. This approval is valid for a period of 5 years.
NHMRC is satisfied that they are based on the systematic
identification and synthesis of the best available scientific evidence
and make clear recommendations for health professionals practising
in an Australian health care setting. The NHMRC expects that all
guidelines will be reviewed no less than once every five years.
This publication reflects the views of the authors and not necessarily
the views of the Australian Government.
Australian Guidelines
for the Treatment of
Acute Stress
Disorder &
Posttraumatic
Stress Disorder
Endorsed by
The Australian Psychological Society
The Royal Australian College of General Practitioners
The Royal Australian and New Zealand College of Psychiatrists
Acknowledgments
Funding bodies
We gratefully acknowledge the financial contribution of the Department of Veterans’ Affairs,
the Department of Defence and beyondblue in the development of these Guidelines.
Steering group
Professor Beverley Raphael, Psychiatrist Professor David Forbes, Clinical Psychologist
(Population Mental Health and Disasters, (Director, Phoenix Australia - Centre for
Disaster Response and Resilience Research Group, Posttraumatic Mental Health, University of Melbourne)
University of Western Sydney)
Working party
Professor Beverley Raphael, Psychiatrist Professor Justin Kenardy, Clinical Psychologist
Chair (Acting Director, Centre of National Research
(Population Mental Health and Disasters, on Disability and Rehabilitation Medicine,
Disaster Response and Resilience Research Group, University of Queensland)
University of Western Sydney)
Associate Professor Brett McDermott, Psychiatrist
Professor Richard Bryant, Clinical Psychologist (Executive Director, Mater Child and Youth Mental
(School of Psychology, University of New South Wales) Health Service)
Professor Mark Creamer, Clinical Psychologist Professor Alexander McFarlane, Psychiatrist
(Department of Psychiatry, University of Melbourne) (Director, Centre for Traumatic Stress Studies,
University of Adelaide)
Associate Professor Grant Devilly, Clinical
Psychologist Dr Lynda Matthews, Rehabilitation Psychologist
(School of Applied Psychology, Griffith University) (Senior Lecturer, Faculty of Health Sciences,
University of Sydney)
Professor David Forbes, Clinical Psychologist
(Director, Phoenix Australia - Centre for Posttraumatic
Mental Health, University of Melbourne)
Multidisciplinary panel
Professor Beverley Raphael, Psychiatrist Professor Brian Draper, Old Age Psychiatrist
Chair (Conjoint Professor, School Of Psychiatry, University
(Population Mental Health and Disasters, Disaster of NSW and Acting Director, Academic Department
Response and Resilience Research Group, for Old Age Psychiatry, Prince of Wales Hospital)
University of Western Sydney)
Dr Rob Gordon, Clinical Psychologist
(Clinical and Consulting Psychologist)
Trauma specialists
Dr Chris Lee, Clinical Psychologist
Associate Professor David Crompton, Psychiatrist (Senior Lecturer, School of Psychology and
(Executive Director, Addiction and Mental Health, Exercise Science, Murdoch University)
Metro South Hospital and Health Service, and
Disaster Advisor, Centre for Disaster, Trauma,
Ms Cait McMahon, Psychologist
Resilience and Recovery)
(Managing Director, Dart Centre for Journalism
and Trauma – Asia Pacific)
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Professor Helen Milroy, Psychiatrist Australian Child and Adolescent Trauma,
(Director, Centre for Aboriginal Medical and Loss and Grief Network
Dental Health, University of Western Australia) Ms Michelle Roberts (Psychologist)
Associate Professor Shirley Morrissey, Australian College of Mental Health Nurses
Clinical and Health Psychologist Professor Brenda Happell (Fellow)
(School of Applied Psychology, Griffith University)
Australian Guidance and Counselling Association
Professor Louise Newman, Psychiatrist Ms Roslyn Isles (President)
(Director, Centre for Developmental Psychiatry
and Psychology, Monash University) Australian Guidance and Counselling Association
Ms Lesley Fraser (Secretary)
Associate Professor Reginald D. V. Nixon,
Clinical Psychologist Australian Psychological Society
(Director, Clinical Psychology Program, Mr David Stokes (Executive Manager, Professional
Flinders University) Practice)
Dr Rebecca Reay, Senior Research Coordinator Australian College of Rural and Remote Medicine
(Academic Unit of Psychological Medicine, Dr Gerald Goodhand
Australian National University)
Occupational Therapy Australia
Professor Kevin Ronan, Clinical Psychologist Ms Ann Drew
(Foundation Professor in Psychology and Chair,
Clinical Psychology, CQUniversity) Royal Australian College of General Practitioners
Dr Caroline Johnson (Fellow)
Professor Derrick Silove, Psychiatrist

(Director, Psychiatry Research and Teaching Unit,
University of New South Wales) Consumer representatives nominated by
the Mental Health Council of Australia
Dr Kevin Vaughan, Psychiatrist
(Clinical Senior Lecturer, Sydney Medical School, Ms Cassandra Bertram
University of Sydney)
Ms Karene Eggleton
Mr Richard Weston, Chief Executive Officer Ms Larisa Trotter
(Healing Foundation)
Industry representatives
Ms Carolyn Worth, Manager
(South Eastern Centre Against Sexual Assault) Australian Red Cross
Mr Andrew Coghlan (National Manager,
Ms Ruth Wraith, OAM Emergency Services)
(Child Psychotherapist)
beyondblue
Ms Suzanne Pope (Director, Research and Planning)
Professional colleges/associations
Australian Defence Force Centre for Mental Health
Australian and New Zealand College
Dr Duncan Wallace (Psychiatrist)
of Psychiatrists
Professor Malcolm Hopwood (President Elect)
Australian Association of Social Workers
Ms Elizabeth Sommerville (Mental Health
Professional Officer)
iii
Special population and trauma types area experts
Aboriginal and Torres Strait Islander peoples Military and veterans
Professor Helen Milroy, Psychiatrist Professor Mark Creamer, Clinical Psychologist
(Director, Centre for Aboriginal Medical and Dental (Department of Psychiatry, University of Melbourne)
Health, University of Western Australia)
Professor Alexander McFarlane, Psychiatrist
Mr Tom Brideson, State-wide Coordinator (Director, Centre for Traumatic Stress Studies,
(NSW Aboriginal Mental Health Workforce Program) University of Adelaide)
Dr Ann Harrison, Psychiatrist Dr Duncan Wallace, Psychiatrist
(Winnunga Aboriginal Community Controlled Health (Australian Defence Force Centre for Mental Health)
Organisation)
Professor Ernest Hunter, Psychiatrist Emergency services
(Adjunct Professor, James Cook University)
Mr Andrew Coghlan, National Manager
Ms Joyleen Koolmatrie, Psychologist (Emergency Services, Australian Red Cross)
(Aboriginal Psychological Counselling and Consultancy)
Professor Alexander McFarlane, Psychiatrist
Professor Beverley Raphael, Psychiatrist (Director, Centre for Traumatic Stress Studies,
(Population Mental Health and Disasters, Disaster University of Adelaide)
Response and Resilience Research Group, University
of Western Sydney)
Disasters
Mr Richard Weston, Chief Executive Officer
(Healing Foundation) Mr Andrew Coghlan, National Manager
(Emergency Services, Red Cross)
Refugees and asylum seekers
Sexual assault
Professor Derrick Silove, Psychiatrist
(Director, Psychiatry Research & Teaching Unit, Ms Carolyn Worth, Manager
University of New South Wales) (South Eastern Centre Against Sexual Assault)
Mr Mariano Coello, Research Coordinator
(Service for the Treatment and Rehabilitation of Torture Victims of crime
and Trauma Survivors)
Associate Professor Grant Devilly, Clinical
Psychologist
Dr Ida Kaplan, Clinical Psychologist
(School of Applied Psychology, Griffith University)
(Direct Services Manager, Victorian Foundation for
Survivors of Torture)
Motor vehicle accidents
Associate Professor Harry Minas, Psychiatrist
(Director, Victorian Transcultural Psychiatry Unit)
Professor Richard Bryant, Clinical Psychologist
(School of Psychology, University of New South Wales)
Older people
Dr Richard Bonwick, Psychiatrist Terrorism
(Deputy Editor, International Psychogeriatric
Professor Mark Creamer, Clinical Psychologist
Association)
(Department of Psychiatry, University of Melbourne)
Professor Brian Draper, Old Age Psychiatrist
(Conjoint Professor, School Of Psychiatry, University
of NSW and Acting Director, Academic Department
for Old Age Psychiatry, Prince of Wales Hospital)
iv
Phoenix Australia project team
Project Leader Dr Andrea Phelps
Project Managers Dr Lisa Dell
Dr Bronwyn Wolfgang
Writers Dr Vanessa Cobham
Ms Susan Fletcher
Ms Alexandra Howard
Special Populations
Contributors Professor David Forbes
Dr Andrea Phelps
Ms Anne Laure Couineau
Ms Dzenana Kartal
Associate Professor Meaghan O’Donnell
Consultant methodologist
Dr Adele Weston
(Executive Vice President, Optum AsiaPacific)
Systematic review team
Adelaide Health Technology Assessment
Tracy Merlin Joanne Milverton
Managing Director Research Officer
Skye Newton Judy Morona
Senior Research Officer Research Officer
Jacqueline Parsons Stynke Docter
Senior Research Officer Research Officer
Ben Ellery Zhaohui Liufu
Research Officer Senior Research Officer
v

Contents
Acknowledgements ii
List of abbreviations xiv
Plain language statement 1
Executive summary 2
Complete list of Guideline recommendations 6
1 Introduction 16
Comparison with the 2007 Guidelines 16
Guideline aims 16
Scope of the Guidelines 17
Development of the Guidelines 18
Additional notes 19
Implementation of the Guidelines 20
Disclaimer 20
References 20
2 Trauma and trauma reactions 22
Trauma, traumatic event and potentially traumatic event 22
Potentially traumatic events 22
Common responses to potentially traumatic events 22
Traumatic stress syndromes 23
Acute stress disorder 23
Posttraumatic stress disorder 25
Re-experiencing symptoms 25
Avoidance and numbing symptoms 25
Arousal symptoms 25
Features commonly associated with PTSD 27
Prevalence and incidence of PTSD 27
Comorbid conditions 28
The course of PTSD 28
Resilience in the face of potentially traumatic events 28
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Posttraumatic mental health disorders:
Key differences between ASD and PTSD 29
Screening, assessment and diagnosis 29
Comprehensive assessment of PTSD 30
Diagnosis 32
Differential diagnosis 32
‘Recovered memories’ 33
Symptom exaggeration and malingering 33
Assessment instruments 33
Structured clinical interviews 34
Self-report measures 34
Intervention planning 37
Factors influencing treatment outcome 37
Chronicity and delay in treatment 37
Comorbidity 37
Compensation 39
Therapeutic alliance and treatment expectations 39
Motivation for change 39
Demographics 39
Treatment setting 40
Potential mechanisms of change 40
Treatment goals 41
Cultural and linguistic diversity (CALD) 42
The impact of PTSD on family 42
General professional issues 43
Self-care 44
References 45
3 General considerations when working
with children and adolescents 52
Trauma and trauma reactions 53
Trauma, traumatic event and potentially traumatic event 53
Clinical presentations in children and adolescents following
potentially traumatic events 53
Traumatic stress syndromes 54
Acute stress disorder 54
Posttraumatic stress disorder 54
Moving to DSM-5 55
Prevalence 55
Comorbid conditions 55
The course and prognosis of PTSD in children and adolescents 56
Risk factors 56
Relational PTSD patterns: The importance of parents 57
Assessment 57
Who to talk to? The low rate of agreement between parents and children 58
When to assess for trauma exposure and symptoms 58
How to assess for trauma exposure and symptoms 58
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