Treating post-traumatic stress disorder (PTSD)

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

Traumaticevents 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 besuccessfully treated many years after the traumatic event occurred, which means it's never too late to seek help.

Assessment

Before having treatment forPTSD, 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 treatmentifyou'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, a community psychiatric nurse or a psychiatrist

Watchful waiting

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'ssometimes recommended because 2 in every 3 people whodevelop 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.

Psychotherapy

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

Psychotherapyis a type of therapy oftenused totreat emotional problems and mental health conditions such as PTSD, depression , anxiety and obsessive compulsive disorder .

The treatmentis carried out bytrained mental health professionals who listen to you and helpyou come upwith effective strategies to resolve your problems.

Find psychotherapy services near you .

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 youfeel, whileidentifying 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,feelingyou'reto 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 have8-12 weekly sessions of trauma-focused CBT, although fewer may be needed. Sessions usually last for around 60-90 minutes.

It involves making side-to-side eye movements, usually by following the movement of your therapist's finger, while recalling the traumatic incident.Other methodsmay includethe therapist tapping their finger or playing a tone.

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

Group therapy

You may also be offered group therapy as some people find it helpfulto speak about their experiences with other peoplewho 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 charitieswhich providecounselling 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

Medication

Antidepressants such asparoxetine, sertraline, mirtazapine, amitriptyline or phenelzineare 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 berecommended as well.

However, thesemedications 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.

Antidepressantscan also be prescribed to reduce any associated symptoms of depression and anxiety and to help with sleeping problems. However,they're not usually prescribedfor people younger than18 unless recommended by a specialist.

If medication for PTSD is effective, it willusually be continued for a minimum of 12 months before being gradually withdrawn over the course of four weeks or longer. If a medicationisn'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, commonside 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

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

This normally involvesa course of 8-12 sessions that have been adapted to suit the childs age, circumstances and level of development. Where appropriate, treatment includes consulting with and involving the child'sfamily.

Treatment with medication isn't usually recommended for children and young people with PTSD.