The National Institute for Health and Clinical Excellence (NICE) recommends psychotherapy as the first treatment to try for post-traumatic stress disorder (PTSD). In some cases, medication may also be used.
PTSD can develop days, weeks, months or even years after a person experiences a traumatic event.
Such 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.
Treatment plan
Treatment for PTSD usually begins with a detailed assessment of your symptoms before drawing up a treatment plan that is tailored to your individual needs.
Your GP should discuss your treatment plan with you, and any decisions regarding your treatment should be clearly explained to you.
Your GP may feel that you would benefit from seeing a mental health specialist, such as a:
- psychologist: an expert in how the mind works
- community psychiatric nurse: a nurse who specialises in mental healthcare
- psychiatrist: a mental health specialist who diagnoses and treats mental health conditions
If you are referred to a mental health specialist, they should always treat you with sensitivity and understanding.
Watchful waiting
Watchful waiting involves carefully monitoring your symptoms to see whether they improve or get worse.
It may be recommended in cases of PTSD where the symptoms are mild or have been present for less than four weeks after the traumatic event.
If watchful waiting is recommended, you should have a follow-up appointment within one month.
Psychotherapy
Psychotherapy is a type of therapy that is often used to treat emotional problems and mental health conditions, such as PTSD, depression, anxiety and obsessive compulsive disorder.
A psychotherapist is a trained mental health professional. They will listen to your problems and suggest strategies to help you resolve them.
If you have severe or persistent PTSD, a combination of psychotherapy and medication may be recommended.
Read more about psychotherapy.
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, replacing negative thoughts associated with the traumatic event with positive ones. The aim is to help you work through the trauma and gain control of your fear and distress. You may be offered trauma-focused CBT if:
- Your symptoms of PTSD are severe and develop within one month of a traumatic event.
- You still have PTSD symptoms within three months of a traumatic event.
You will 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 while recalling the traumatic incident. It works by helping 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
NICE recommends that paroxetine or mirtazapine should be considered for treating PTSD in adults.
However, these antidepressants will only be used if you:
- choose not to have trauma-focused psychological treatment
- cannot start psychological treatment due to a high risk of further trauma
- have gained little or no benefit from a course of trauma-focused psychological treatment
- have severe depression or hypersensitivity that significantly affects your ability to benefit from psychological treatment
Amitriptyline or phenelzine may also be used under the supervision of a mental health specialist. The same criteria as above apply.
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:
Possible withdrawal symptoms that are associated with paroxetine include sleep disturbances, intense dreams, anxiety and irritability.
Read more about the possible side effects and withdrawal symptoms of paroxetine.
Children and young people
NICE recommends that trauma-focused CBT should be used to treat older children with severe symptoms of PTSD in the first month after a traumatic event.
Three months after the trauma has occurred, the following treatment is recommended:
- A course of trauma-focused CBT that is adapted to suit the child’s age, circumstances and level of development.
- A course of 8-12 trauma-focused sessions for children and young people who have chronic (long-term) PTSD following a traumatic event.
- The psychological treatment should be regular and continuous (at least one session a week) and should be delivered by the same person.
- Where appropriate, the child and their family should be involved in the treatment plan.
- Where appropriate, the child’s parents or guardians should be informed that trauma-focused psychological treatment has proved to be an effective method of treating PTSD. They should also be made aware that there is no evidence to show that other forms of therapy, such as play therapy, art therapy or family therapy are effective.
The NICE guidelines contain more detailed information about how post-traumatic stress disorder is treated.
