Treatment for PTSD

Post traumatic stress disorder (PTSD) is mainly treated with talking therapies, medication, or a mixture of both.

NICE make recommendation to the NHS about what treatment should be offered to patients for different conditions. 

NICE stands for National Institute for Health and Care Excellence.  

You can read the full NICE guidelines on PTSD here.

A summary of the NICE guidelines

You might have symptoms of PTSD and have experienced oe or more traumatic events in the past month.   

NICE say you should be offered prevention or treatment options from the following. What you are offered will depend on how severe your symptoms are, and what you prefer: 

• Active monitoring
• Trauma-focused cognitive behavioural therapy (CBT), like:
  
  
  • Cognitive processing therapy
  • Narrative exposure therapy (NET)
  • Prolonged exposure therapy
• Eye movement desensitisation and reprocessing (EMDR)
• Supported trauma-focused computerised cognitive behavioural therapy (CBT)
• CBT - to target an issue such as anger or sleeping problems
• Medication - such as antidepressants or antipsychotics 

You can usually refer yourself for NHS talking therapy for free. You can also have private talking therapy if you can afford to.

Read more about talking therapies.

What is active monitoring?

Active monitoring means a medical professional will stay in touch with you to see if your symptoms get worse or better.   If they get worse, they will offer you treatment.

NICE recommend that medical professionals use active monitoring if: 

• you have mild symptoms of PTSD, or
• the trauma has happened within the last four weeks. 

You should have a follow up appointment after one month. 

Active monitoring is used because many people who experience symptoms after a trauma will recover without treatment.  

What is trauma-focused cognitive behavioural therapy (CBT)?

CBT helps you deal with your symptoms by making changes to how you think and act. 

Trauma-focused CBT is a special type of CBT.  It should help you:  

• manage your symptoms and emotions, and
• reactions to trauma. 

What is cognitive processing therapy (CPT)?  

CPT helps people who are ‘stuck’ in their thoughts about a trauma. 

The theory is that PTSD can happen because of a conflict between your pre-trauma and post-trauma outlook.

These conflicts are called ‘stuck points.’ These are looked at through activities such as writing about the traumatic event. 

What is narrative exposure therapy (NET)?  

NET can help to reduce distress caused by complex or multiple traumatic experiences. 

The aim of NET is to put traumatic experiences into context. NET tries to recreate the story of your life and trauma. It fills in any missing or unclear memories and brings in positive events. 

This helps to create a clear story of your life. This can identify when certain thinking and behaviours first started to happen.

What is prolonged exposure therapy?  

Prolonged exposure therapy helps you gradually approach trauma-related memories, feelings, and situations. 

It helps you to learn that the trauma-related memories and reminders are not dangerous. And that you do not need to avoid them.

What is eye movement desensitisation and reprocessing (EMDR)? 

You will be led by the therapist to make eye movements while thinking about the traumatic event. 

Therapists think that this works by making your brain deal with painful memories in a different way.

The therapy uses eye stimulation to process certain memories. Other stimulation methods such as taps or tones can be used.  

This should be used until the memories are no longer distressing.

It can include you learning self-calming techniques and techniques for managing flashbacks.

You can watch this short video from the EMDR Association UK to learn more about the treatment.

What is supported trauma-focused computerised cognitive behavioural therapy (CBT)?

You can get therapy through a computer programme if your PTSD symptoms are not severe.

You may be able to have this therapy if you prefer it to face-to-face trauma-focused CBT or EMDR.

You should be supported by a trained professional. 

Can medication help with PTSD?

If you prefer treatment with medication your doctor might offer you: 

• venlafaxine, or
• a selective serotonin reuptake inhibitor (SSRI), such as sertraline.

You can choose to have this together with talking therapy.

Your doctor should review this treatment regularly. 

You may be offered antipsychotic medication, such as risperidone. But only if you experience psychosis or severe hyperarousal.   

Hyperarousal means when you are always alert and feeling under threat or in danger.

The treatment will need to be reviewed regularly by a specialist.  

Your doctor should inform you about possible side effects, including any possible withdrawal symptoms. Withdrawal symptoms are less likely if the medicine is reduced slowly.

What if I have complex PTSD or additional needs?

NICE guidelines say if you have complex PTSD, or other additional needs, healthcare professionals should. 

• Give you more therapy sessions or give you longer therapy sessions to help build trust. 
• Think about the impact that your personal circumstances will have on the outcome of therapy. Like, your housing situation. 
• Help you to manage any issues that might stop you from being able to take part in therapy.
• Plan any ongoing support that you need after the end of treatment.

What if I have a drug or alcohol issue? 

The NICE guidelines say you should not be excluded from PTSD treatment if you have a drug or alcohol issue. 

Read more about drugs, alcohol and mental health.

I have lived with PTSD for a long time. Can treatment still help?

It is possible to be successfully treated for PTSD a long time after the trauma. So, it is never too late to seek help. 

Some think: 

• traumatic events are thought to change our view of the world as meaningful and safe. And our view of ourselves as worthy, 
• recovery can be about rethinking our worldview using different coping strategies, and 
• recovery can happen when someone has processed their trauma.  They have built a new worldview which includes the trauma.