Treatment of complex PTSD: results of the ISTSS expert clinician survey on best practices.
Abstract
This study provides a summary of the results of an expert opinion survey initiated by the International Society for Traumatic Stress Studies Complex Trauma Task Force regarding best practices for the treatment of complex posttraumatic stress disorder (PTSD). Ratings from a mail‐in survey from 25 complex PTSD experts and 25 classic PTSD experts regarding the most appropriate treatment approaches and interventions for complex PTSD were examined for areas of consensus and disagreement. Experts agreed on several aspects of treatment, with 84% endorsing a phase‐based or sequenced therapy as the most appropriate treatment approach with interventions tailored to specific symptom sets. First‐line interventions matched to specific symptoms included emotion regulation strategies, narration of trauma memory, cognitive restructuring, anxiety and stress management, and interpersonal skills. Meditation and mindfulness interventions were frequently identified as an effective second‐line approach for emotional, attentional, and behavioral (e.g., aggression) disturbances. Agreement was not obtained on either the expected course of improvement or on duration of treatment. The survey results provide a strong rationale for conducting research focusing on the relative merits of traditional trauma‐focused therapies and sequenced multicomponent approaches applied to different patient populations with a range of symptom profiles. Sustained symptom monitoring during the course of treatment and during extended follow‐up would advance knowledge about both the speed and durability of treatment effects.
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ISTSS guidelines indicate sufficient evidence and clinical rationale to support the phase-oriented approach with an initial period of stabilization and establishment of safety.
“On the other hand, ISTSS guidelines indicate sufficient evidence and clinical rationale to support the phase-oriented approach with an initial period of stabilization and establishment of safety (46, 84, 95).”
Attaining relative safety and stability is the foundation of stage 1 treatment of PTSD with complex presentations, as well as dissociative disorders.
“Attaining relative safety and stability is the foundation of stage 1 treatment of PTSD with complex presentations (complex PTSD), as well as dissociative disorders, which are highly linked to developmental traumas (46, 84–87).”
Clinical presentations extending beyond those described by the ICD-10 diagnosis of PTSD, particularly among individuals who experienced extreme, prolonged or multiple forms of trauma, have been reported by clinicians and researchers over several decades.
“Clinical presentations that extend beyond those described by the ICD-10 diagnosis of PTSD, particularly among individuals who experienced extreme, prolonged or multiple forms of trauma, have been reported by clinicians and researchers over several decades 18,19 .”
The selection of specific symptoms and symptom clusters for complex PTSD reflecting difficulties in affect, identity and relationships was guided by the DESNOS formulation in the DSM-IV field trials and by an expert consensus survey on complex PTSD.
“The selection of specific symptoms and symptom clus ters reflecting difficulties in these domains was guided by the DESNOS formulation in the DSM-IV field trials 26 as well as by an expert consensus survey on complex PTSD 19 .”
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“On the other hand, ISTSS guidelines indicate sufficient evidence and clinical rationale to support the phase-oriented approach with an initial period of stabilization and establishment of safety (46, 84, 95).”
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- Authors
- Cloitre, M., Courtois, C. A., Charuvastra, A., Carapezza, R., Stolbach, B. C., & Green, B. L.
- Affiliations
- Nathan Kline Institute for Psychiatric Research (US)
- New York University (US)
- University of Chicago (US)
- Georgetown University (US)
- Venue
- Journal of Traumatic Stress
- Publisher
- Wiley
- Published
- 2011-12
- Volume
- 24
- Issue
- 6
- Pages
- 615-627
- ISSN
- 0894-9867 (ISSN-L)
- 1573-6598
- OpenAlex
- W2060194889
- Semantic Scholar
- 66c85744f58c1baa8a14113872bcade4c5c0efab
- Cited by
- 593
- References
- 42
- Citations by year
- 2026: 31 · 2025: 48 · 2024: 34 · 2023: 40 · 2022: 38 · 2021: 46 · 2020: 56 · 2019: 54 · 2018: 39 · 2017: 54 · 2016: 40 · 2015: 30 · 2014: 36 · 2013: 35 · 2012: 9
- FWCI
- 27.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Traumatic Stress (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- complex PTSD, expert consensus, trauma-focused psychotherapy, emotion regulation, trauma narration, cognitive restructuring, mindfulness, meditation, interpersonal skills training, aggression, treatment duration, symptom monitoring
- MeSH terms
- Female, Health Personnel, Humans, Male, Practice Patterns, Physicians', Stress Disorders, Post-Traumatic, United States, Health Care Surveys
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