[Treatment of posttraumatic stress disorder-The updated S3 guidelines]

The S3 guidelines on posttraumatic stress disorder (PTSD) have been updated and expanded under the leadership of the German-speaking Society for Psychotraumatology (DeGPT). Given the high prevalence of trauma exposure, traumatic experiences should be assessed during all clinical evaluations and history taking. Trauma-focused psychotherapy remains the first-line treatment and should also be offered in cases of complex PTSD (cPTSD) with comorbid disorders, in older people, refugees and individuals with mild to moderate intellectual disabilities. Strong evidence is now available for a broader range of interventions, particularly cognitive behavioral therapy (CBT). Trauma-focused interventions can be delivered online and at higher intensity (several sessions per week). For children and adolescents, trauma-focused CBT also remains the treatment of choice. Pharmacotherapy is the second-line treatment and is not recommended for children or adolescents. Benzodiazepines and Z‑drugs should generally be avoided. Among adjuvant forms of treatment the strongest evidence is available for exercise and physical activity. An important treatment principle involves the establishment of trauma-informed basic principles (trauma-informed care) as a standard approach in institutions of the healthcare system.