longest follow-up 2 years post-treatment in studies examined by the committee. Many of these studies reassessed their subjects two or three times after treatment concluded.

CONCLUDING OBSERVATIONS

In this report the committee sought to describe the evidence regarding the efficacy of available treatment modalities for PTSD, identify some of the major issues in the field, and make recommendations to help guide further research in PTD treatment. The committee’s findings, conclusions, and recommendations about the evidence for the treatment modalities reviewed in this report are not clinical practice guidelines. The committee does not intend to imply that, for example, exposure therapy is the only treatment that should be used in treating individuals with PTSD. The committee recognizes that the transparent presentation and assessment of evidence is just one part of the larger picture of PTSD treatment that includes many other factors. Further, assessing the scientific evidence may reveal areas of uncertainty. The next step in the process toward clinical decisionmaking is developing recommendations for clinical practice—a step the committee was not asked to, and did not, take. Such recommendations must propose strategies in the face of scientific uncertainty that are informed by clinician and patient preferences, access, safety, cost, alternatives, local practice patterns, medicolegal issues, ethical concerns, and other factors.

The committee applied contemporary standards to evaluate research, including research dating back to 1980 when PTSD was first defined. The principal finding of the committee is that the scientific evidence on treatment modalities for PTSD does not reach the level of certainty that would be desired for such a common and serious condition among veterans. For some modalities, for example, novel antipsychotic drugs and SSRIs, the committee debated whether to characterize the body of evidence as “suggestive” or “inadequate.” It is important to emphasize that in the larger picture of PTSD treatment, had the debate ended with “suggestive” conclusions (rather than the “inadequate” conclusions the committee finally reached), the core message that better-quality research is needed would not have been rendered less urgent in consequence. The committee reached a strong consensus that additional high-quality research is essential for every treatment modality. This extends equally to the one treatment modality—exposure therapies—for which the committee found the evidence to be the strongest. As outlined in the recommendations above, better understanding of the most important and active components of exposure therapy, determining optimal administration and length of treatment, attention to principal subpopulations, and determining whether group therapies can be made as



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