Post-traumatic stress disorder (PTSD) - Treatment 

Treating post-traumatic stress disorder (PTSD) 

CBT expert

Professor David Clark explains how cognitive behavioural therapy (CBT) works and who could benefit from it.

Media last reviewed: 24/04/2013

Next review due: 24/04/2015

PTSD and driving

Post-traumatic stress disorder (PTSD) may affect your ability to drive safely, so you should inform the Driver and Vehicle Licensing Agency (DVLA) about your condition.

For more information, see PTSD and driving on the Gov.uk website.

The main treatments for post-traumatic stress disorder (PTSD) are psychotherapy and medication.

Traumatic events can be very difficult to come to terms with, but confronting your feelings and seeking professional help is often the only way of effectively treating PTSD.

It is possible for PTSD to be successfully treated many years after the traumatic event occurred, which means it is never too late to seek help.

Assessment

Before having treatment for PTSD, a detailed assessment of your symptoms will be carried out to ensure treatment is tailored to your individual needs.

Your GP will often carry out an initial assessment, but you will be referred to a mental health specialist for further assessment and treatment if you have had symptoms of PTSD for more than four weeks or your symptoms are severe.

There are a number of mental health specialists you may see if you have PTSD, such as:

  • a psychologist - an expert in how the mind works
  • a community psychiatric nurse - a nurse who specialises in mental healthcare
  • a psychiatrist - a mental health specialist who diagnoses and treats mental health conditions

Watchful waiting

If you have mild symptoms of PTSD, or you have had symptoms for less than four weeks, an approach called watchful waiting may be recommended.

Watchful waiting involves carefully monitoring your symptoms to see whether they improve or get worse. It is sometimes recommended because 2 in every 3 people who develop problems after a traumatic experience will get better without treatment within a few weeks.

If watchful waiting is recommended, you should have a follow-up appointment within one month.

Psychotherapy

If you have PTSD that requires treatment, psychotherapy is usually recommended first. A combination of psychotherapy and medication may be recommended If you have severe or persistent PTSD.

Psychotherapy is a type of therapy often used to treat emotional problems and mental health conditions such as PTSD, depression, anxiety and obsessive compulsive disorder.

The treatment is carried out by trained mental health professionals who will listen to you and help you come up with effective strategies to resolve your problems.

The two main types of psychotherapy used to treat people with PTSD are described below.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a type of therapy that aims to help you manage your problems by changing how you think and act.

Trauma-focused CBT uses a range of psychological treatment techniques to help you come to terms with the traumatic event.

For example, your therapist may ask you to confront your traumatic memories by thinking about your experience in detail. During this process your therapist will help you cope with any distress you feel, while identifying any unhelpful thoughts or misrepresentations you have about the experience.

By doing this, your therapist can help you gain control of your fear and distress by changing the negative way you think about your experience, such as feeling that you are to blame for what happened or fear that it may happen again.

You may also be encouraged to gradually restart any activities you have avoided since your experience, such as driving a car if you had an accident.

You will usually have 8-12 weekly sessions of trauma-focused CBT, although fewer may be needed if the treatment starts within one month of the traumatic event. Sessions where the trauma is discussed will last for around 90 minutes.

Read more about CBT.

Eye movement desensitisation and reprocessing (EMDR)

Eye movement desensitisation and reprocessing (EMDR) is a relatively new treatment that has been found to reduce the symptoms of PTSD.

EMDR involves making side-to-side eye movements, usually by following the movement of your therapist's finger, while recalling the traumatic incident.

It is not clear exactly how EMDR works, but it may help the malfunctioning part of the brain (the hippocampus) to process distressing memories and flashbacks so that their influence over your mind is reduced.

Read more about EMDR.

Medication

Antidepressants such as paroxetine, mirtazapine, amitriptyline or phenelzine are sometimes used to treat PTSD in adults.

Of these medications, paroxetine is the only one licensed specifically for the treatment of PTSD. However, mirtazapine, amitriptyline and phenelzine have also been found to be effective and are often recommended as well.

However, these medications will only be used if:

  • you choose not to have trauma-focused psychological treatment
  • psychological treatment would not be effective because there is an ongoing threat of further trauma (such as domestic violence)
  • you have gained little or no benefit from a course of trauma-focused psychological treatment
  • you have an underlying medical condition, such as severe depression, that significantly affects your ability to benefit from psychological treatment

Amitriptyline or phenelzine will only be used under the supervision of a mental health specialist.

Antidepressants can also be prescribed to reduce any associated symptoms of depression and anxiety and to help with sleeping problems. However, they are not usually prescribed for people younger than 18 unless recommended by a specialist.

If medication for PTSD is effective, it will usually be continued for a minimum of 12 months before being gradually withdrawn over the course of four weeks or longer. If a medication is ineffective at reducing your symptoms, your dosage may be increased.

Before prescribing a medication, your doctor should inform you about possible side effects that you may have while taking it, along with any possible withdrawal symptoms when the medication is withdrawn.

For example, common side effects of paroxetine include feeling sick, blurred vision, constipation and diarrhoea. Possible withdrawal symptoms associated with paroxetine include sleep disturbances, intense dreams, anxiety and irritability.

See depression medicines information for more information about the medications used to treat PTSD.

Children and young people

For children and young people with PTSD, trauma-focused CBT is usually recommended.

This will normally involve a course of 8-12 sessions that have been adapted to suit the child’s age, circumstances and level of development. Where appropriate, treatment will include consulting with and involving the child's family.

Treatment with medication is not usually recommended for children and young people with PTSD.




Page last reviewed: 24/09/2013

Next review due: 24/09/2015

Ratings

How helpful is this page?

Average rating

Based on 92 ratings

All ratings

Add your rating

Comments

The 5 comments posted are personal views. Any information they give has not been checked and may not be accurate.

HWood said on 20 February 2014

I had to push and push to find a GP that would take PTSD seriously, but I'm glad I got the help I needed before I felt completly helpless. I was witness to a horrific fatal car crash in 2007, and did not get positive help from a GP until 2010. I am someone who likes to get realistic help rather than just take tablets alone to help with mental health.

I had EMDR therapy and it has changed my life! The reason I finally got help for PTSD was because I had moved from one area to another. I was told at the time EMDR is not available through many NHS trusts and this makes me feel sick for the amount of people who will have to keep pushing and pushing for help they may never recieve. I very well may have ended up in a suicidal state if I had not recieved the help when I did and am very grateful I was one of the lucky ones who was offered this treamtment thorugh the NHS.

Report this content as offensive or unsuitable

Leyla2 said on 20 February 2014

Many people with a diagnosis of Borderline Personality disorder have a history of extremely complex trauma, especially extreme childhood sexual abuse. But instead of recognizing this as complex trauma psychiatry is so quick to diagnose a personality disorder, completely disregarding the underlying symptoms of PTSD - the main symptoms which are PTSD and once you have a diagnosis of Borderline personality disorder it is on your medical records for life. I do not have a personality disorder - I was sexually abused, lived daily in far of my life and was raped and tortured for the entire of my childhood. Of course as an adult it has had a profound emotional impact and causes intense personal suffering, flashbacks, hyper-vigilance, re-living of events. There seems to be so little recognition of complex childhood related trauma as part of PTSD - yet it is so common to so many people diagnosed with personality disorder instead, so many of us are just really traumatized. An understandable reaction to the terrible things that have happened to us. I believe it is time to get rid of the personality disorder label, which is incredibly stigmatized and stays on your records for life and to call it what it is - complex trauma. If it was called complex trauma people would understand, be compassionate and they would know what the problem is. Call it BPD and it makes people scared, it has so much negative judgement and connotations. It makes getting treatment so difficult. Yet the experiences are the same - I have been deeply, deeply traumatized. I believe the NHS should start linking BPD to complex PTSD and start to really understand the devastating impact childhood sexual abuse can have on an individuals life.

Report this content as offensive or unsuitable

marhug said on 07 October 2013

I am astonished and horrified to find that NICE is willing to allow EMDR on the NHS. This technique is totally unproven. Only those treatments that have been shown to be effective by proper scientific methods should be allowed to be used or recommended by the NHS. Such "treatments" as EMDR are no more than hocus-pocus and cannot withstand scientific scrutiny.
I was also upset to find out that my local GP offers acupuncture, which is another totally unproven alternative procedure which is based on completely false premises about a supposed "life force" in the body flowing along meridian lines. It is complete bunk and could not perform under controlled scientific testing.
NICE should only approve properly investigated therapies which will stand up to scientific scrutiny. If alternative therapies such as EMDR and acupuncture are to be allowed on the NHS perhaps African witch doctors should also be made available.

Report this content as offensive or unsuitable

twiggay said on 28 March 2013

It's funny how they mention all these things about a month after the event. Maybe if they spotted the disorder within the first month instead of nearly 3 years later this would work. There is a lack of detail here and it needs to be sorted. People shouldn't have to go to more unreliable sites to get the medical terms.

Report this content as offensive or unsuitable

pansy1 said on 16 February 2013

Am horrified at the description of CBT being, in part about "replacing negative thoughts associated with the traumatic event with positive ones.' And this is not a blog or forum but an official NHS website. CBT replaces extreme, distorted, subjective interpretations with more balanced and objectively accurate thoughts which tend to end up being neutral rather than valenced in any direction. If Professor Clark endorsed this 'turn that frown upside down' view of CBT for PTSD, then that's an abomination and no wonder that critics are able to represent CBT as simplistic and solution-focused regardless of the reality and complexity of presentations

Report this content as offensive or unsuitable

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is a type of problem-solving therapy – find out more here

'I run to boost my mood'

Liz Gardiner talks about her depression and how medication, CBT and exercise have all helped