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's possible for PTSD to be successfully treated many years after the traumatic event occurred, which means it's never too late to seek help.
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'll be referred to a mental health specialist for further assessment and treatment if you've 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
If you have mild symptoms of PTSD, or you've 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'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 watchful waiting is recommended, you should have a follow-up appointment within one month.
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 listen to you and help you come up with effective strategies to resolve your problems.
The 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 helps you cope with any distress you feel, while identifying any unhelpful thoughts or misrepresentations you have about the experience.
Your therapist can help you gain control of your fear and distress by changing the negative way you think 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've avoided since your experience, such as driving a car if you had an accident.
You'll usually have 8-12 weekly sessions of trauma-focused CBT, although fewer may be needed. Sessions usually last for around 60-90 minutes.
Eye movement desensitisation and reprocessing (EMDR)
Eye movement desensitisation and reprocessing (EMDR) is a relatively new treatment which has been found to reduce the symptoms of PTSD.
It involves making side-to-side eye movements, usually by following the movement of your therapist's finger, while recalling the traumatic incident. 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 to change the negative way you think about a traumatic experience.
You may also be offered group therapy as some people find it helpful to speak about their experiences with other people who also have PTSD. Group therapy can be used to teach you ways to manage your symptoms and help you understand the condition.
There are also a number of charities which provide counselling and support groups for PTSD. For example:
- Combat Stress – a military charity specialising in helping ex-servicemen and women
- Rape Crisis – a UK charity providing a range of services for women and girls who have experienced abuse, domestic violence and sexual assault
- Victim Support – providing support and information to victims or witnesses of crime
- CRUSE – a UK charity providing support and information for people who have experienced bereavement
Antidepressants such as paroxetine, sertraline, mirtazapine, amitriptyline or phenelzine are sometimes used to treat PTSD in adults.
Of these medications, paroxetine and sertraline are the only ones licensed specifically for the treatment of PTSD. However, mirtazapine, amitriptyline and phenelzine have also been found to be effective and may be recommended as well.
However, these medications will only be used if:
- you choose not to have trauma-focused psychological treatment
- psychological treatment wouldn't be effective because there's an ongoing threat of further trauma (such as domestic violence)
- you've 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 to help with sleeping problems. However, they're not usually prescribed for people younger than 18 unless recommended by a specialist.
If medication for PTSD is effective, it's usually be continued for a minimum of 12 months before being gradually withdrawn over the course of four weeks or longer. If a medication isn't effective at reducing your symptoms, your dosage may be increased.
Before prescribing a medication, your doctor should inform you about possible side effects 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. Withdrawal symptoms are less likely if the medication is reduced slowly.
Children and young people
For children and young people with PTSD, trauma-focused CBT is usually recommended.
This normally involves a course of 8-12 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.
Treatment with medication isn't usually recommended for children and young people with PTSD.