Authors' recommendations: This report was produced to help support the development of guidance for credentialing and privileging of CAM practitioners in VA, based on sound scientific evidence. It considered the best available evidence of effectiveness from controlled studies of CAM for treatment of PTSD in adults. CAM modalities included those not considered mainstream or not administered by already licensed and credentialed practitioners.A comprehensive systematic review of a range of CAM interventions for anxiety disorders failed to identify conclusive evidence of effectiveness of CAM therapies for treatment of PTSD in adult populations (Jorm 2004). Therefore, the best available evidence found in this VATAP review is limited to two small, but rather well-designed, pilot RCTs, using mantram repetition (Bormann 2008) and acupuncture (Hollifield 2007).Bormann (2008) found greater improvement in self-reported symptoms (medium to large Cohen’s d effect sizes 0.40 or higher) in older Veterans using mantram repetition relative to controls, but noted a smaller improvement in clinician-assessed symptoms. Satisfaction with mantram repetition was also high, suggesting it may be a potential treatment alternative for older Veterans. However, the results would need to be confirmed in larger, robust RCTs, especially in populations of younger Veterans with recent combat experience.Hollifield (2007) found significant improvement (large Cohen’s d effect sizes .70 or higher) in self-reported symptoms for the use of acupuncture in treating PTSD relative to controls; the effect sizes were similar to that of cognitive behavior therapy and were sustained for at least three months after completion of therapy. Similar improvements in depression symptoms, anxiety symptoms and global impairment scores were also found. Participants were satisfied with both treatment interventions, suggesting a possible role for acupuncture as a treatment option. However, 83% of the study participants suffered their traumatic events in childhood. Confirmation of these results is needed using other controls, interventions, outcome measures and blinded outcome assessment, as well as in a Veteran population with recent combat experience.VATAP identified no controlled studies in the published literature (full text in English) for either Cochrane protocol topic (Reiki or sport/ play-based interventions) that met criteria for inclusion.Given the preliminary nature of the existing evidence and lack of generalizability to a growing Veteran population with recent combat experience in need of treatment for PTSD, VATAP concludes that the current evidence for CAM therapies is insufficient to assess the net benefit of these interventions. Therefore, a USPSTF grade of an (I) statement citing insufficient evidence is warranted (Appendix 2, section 6). If offered, patients should understand the uncertainty about the balance of benefits and harms of these interventions.

Project Status: Completed

URL for project: http://www4.va.gov/VATAP/docs/CAMPTSD2009.pdf

Year Published: 2009

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: VA Technology Assessment Program

Contact Address: Liz Adams, VA Technology Assessment Program, Office of Patient Care Services (11T), VA Boston Healthcare System Room 4D-142, 150 South Huntington Avenue, Boston, MA 02130 USA Tel: +1 617 278 4469; Fax: +1 617 264 6587;

Contact Name: elizabeth.adams@med.va.gov

Contact Email: elizabeth.adams@med.va.gov

Copyright: VA Technology Assessment Program (VATAP)