of evidence meeting current standards (the committee summarizes clinical practice guidelines developed by others in the face of this scientific uncertainty). This overall conclusion of scientific inadequacy is not a clinical practice recommendation or guideline. It is also not a judgment on the quality of the research in this field using methods acceptable at the time. The overall conclusion also adds urgency to the committee’s recommendations for a more strategic research effort that defines the relevant populations and subpopulations; develops and tests treatment modalities alone and in combination, in individual and group formats (for psychotherapy), and of various intensities and durations; uses the latest and most rigorous methods for designing and executing study protocols; and follows all study participants through the end of treatment and for meaningful periods thereafter.
The committee was also struck by the scant evidence exploring some of the possibly unique aspects of PTSD in veterans. For the most part we cannot say whether the treatment of PTSD in veterans should be the same as in civilians, and whether important subpopulations of veterans defined by age, sex, trauma type, socioeconomic status, educational level, comorbidities, and brain injury should be treated the same or differently.
The committee could only conclude that well-designed research is needed to answer the key questions regarding the efficacy of treatment modalities in veterans. Success will depend on the collaboration of VA and other government agencies, researchers, clinicians, and patient and veterans’ groups and will further require the continued support and attention of policymakers and the public. The individuals returning from current conflicts and now re-entering civilian life with this disorder deserve no less.
Alfred O. Berg