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Treatment - Post-traumatic stress disorder

The main treatments for post-traumatic stress disorder (PTSD) are psychological therapies and medicine.

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's possible for PTSD to be successfully treated many years after the traumatic event or events occurred, which means it's 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. This may be carried out by a GP or specialist.

You can see a GP to start on this process, or you can refer yourself for assessment to a psychological therapy service. You're likely to be offered treatment if you've had symptoms of PTSD for more than 4 weeks or your symptoms are severe.

There are a number of mental health specialists you may see if you have PTSD, such as a psychological therapist, psychologist, community psychiatric nurse or psychiatrist.

Active monitoring

If you have mild symptoms of PTSD, or you've had symptoms for less than 4 weeks, an approach called active monitoring may be recommended.

Active monitoring involves carefully monitoring your symptoms to see whether they improve or get worse.

It's sometimes recommended because 2 in every 3 people who develop problems after a traumatic experience get better within a few weeks without treatment.

If active monitoring is recommended, you should have a follow-up appointment within 1 month.

Psychological therapies

If you have PTSD that requires treatment, psychological therapies are usually recommended first.

A combination of a psychological therapy and medicine may be recommended if you have severe or persistent PTSD.

A GP can refer you to an NHS psychological therapies service (IAPT) or, in some cases, a specialist clinic.

You can also refer yourself directly to an NHS psychological therapies service (IAPT) without a referral from a GP.

There are 3 main types of psychological therapies used to treat people with PTSD.

Cognitive behavioural therapy (CBT)

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

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

For example, your therapist may ask you to face your traumatic memories by describing aspects of your experience in detail.

During this process, your therapist helps you cope with any distress you feel while identifying any beliefs you have about the experience that may be unhelpful.

Your therapist can help you gain control of your fear and distress by reviewing with you any conclusions you have drawn about your experience (for example, feeling you're 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'll usually have 8 to 12 weekly sessions of trauma-focused CBT, although fewer may be needed. Sessions usually last for around 60 to 90 minutes.

Find out more about CBT

Eye movement desensitisation and reprocessing (EMDR)

Eye movement desensitisation and reprocessing (EMDR) is a psychological treatment that's been found to reduce the symptoms of PTSD.

It involves recalling the traumatic incident in detail while making eye movements, usually by following the movement of your therapist's finger. 

Other methods may include the therapist tapping their finger or playing a tone.

It's not clear exactly how EMDR works, but it may help you change the negative way you think about a traumatic experience.

Support and advice

There are a number of charities that provide peer support and advice for PTSD.

For example:

Medicine

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

Of these medicines, only paroxetine and sertraline are licensed specifically for the treatment of PTSD.

But mirtazapine, amitriptyline and phenelzine have also been found to be effective and may be recommended as well.

These medicines will only be used if:

  • you choose not to have trauma-focused psychological treatment
  • psychological treatment would not be effective because there's 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 usually 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 help with sleeping problems.

But they're not usually prescribed for people younger than 18 unless recommended by a specialist.

If medicine for PTSD is effective, it'll usually be continued for a minimum of 12 months before being gradually withdrawn over the course of 4 weeks or longer.

If a medicine is not effective at reducing your symptoms, your dosage may be increased.

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

Withdrawal symptoms are less likely if the medicine is reduced slowly.

Children and young people

Trauma-focused CBT is usually recommended for children and young people with PTSD.

This normally involves a course of 6 to 12 sessions that have been adapted to suit the child's age, circumstances and level of development.

Where appropriate, treatment includes consulting with and involving the child's family.

Children who do not respond to trauma-focused CBT may be offered EMDR.

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.

Visit GOV.UK for more information on PTSD and driving

Page last reviewed: 27 September 2018
Next review due: 27 September 2021