How is PTSD treated?

PTSD is mainly treated with talking therapies, medication or a mixture of both.

What are NICE guidelines?

NICE stands for National Institute for Health and Care Excellence. They make recommendation to the NHS about what treatment should be offered to patients for the condition they’re living with. NICE have made the following recommendations to treat PTSD.

You might have clinical symptoms of PTSD and have experienced 1 or more traumatic events in the past month. NICE say you should be offered the following treatment options as prevention of, or treatment for PTSD:

• Trauma-focused cognitive behavioural therapy (CBT), such as:
  
  • 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 to manage some of the symptoms of PTSD

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

You can find more information about ‘Talking therapies’ by clicking here.

What is active monitoring?

Active monitoring or ‘watchful waiting’ may be suggested if you have mild symptoms of PTSD. Or the trauma has happened within the last 4 weeks. This means that your symptoms should be monitored, and you should have a follow up appointment in 1 month.

Active monitoring is used because 2 in every 3 people who experience 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.

Your therapy should help manage symptoms and reaction to trauma and help you deal with related emotions.

Sometimes CBT can be aimed at specific symptoms of PTSD such as sleep problems or anger.

What is cognitive processing therapy (CPT)?

CPT is focused on helping people who are ‘stuck’ in their thoughts about a trauma. It is based on the idea that PTSD symptoms happen because of conflict between pre-trauma and post-trauma beliefs.

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

What is narrative exposure therapy (NET)?

NET can help to reduce distress resulting from complex or multiple traumatic experiences.

The aim of NET is to put traumatic experiences into context. NET helps you to create and express a clear narrative of your life. Mainly focusing on the trauma. But also bringing in some positive events.

What is prolonged exposure therapy?

Prolonged exposure helps you gradually approach trauma-related memories, feelings, and situations. It helps you to learn that the trauma-related memories and reminders aren’t dangerous and that you don’t need to avoid them.

What is eye movement desensitisation and reprocessing (EMDR)?

You’ll 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, or other stimulation methods such as ‘taps’ or ‘tones’, to process certain memories. This should be used until the memories are no longer distressing.

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

You can therapy through a computer programme if you’re PTSD symptoms aren’t severe.

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

Can medication help with PTSD?

Your doctor might offer you medication to treat PTSD. You can choose to have this together with talking therapy.

You might be offered venlafaxine or a selective serotonin reuptake inhibitor (SSRI) such as sertraline.

You may be offered antipsychotic medication, such as risperidone. This may be offered if you experience psychosis or severe hyperarousal. The treatment will need to be reviewed regularly by a specialist.

The antidepressants mirtazapine, amitriptyline, and phenelzine may be recommended. 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, or
• you have an underlying condition, such as severe depression, that affects your ability to benefit from psychological treatment.

Amitriptyline or phenelzine will usually only be used under the supervision of a mental health 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.

You can find out more about:

• Antidepressants by clicking here.
• Antipsychotics by clicking here.
• Psychosis by clicking here.
• Depression by clicking here.
• Drugs, alcohol, and mental health by clicking here.
• Medication - Choice and managing problems by clicking here.

What is the treatment for complex PTSD?

You may respond to trauma-focused therapies if you have complex PTSD.

There is some overlap of symptoms between complex PTSD and borderline personality disorder (BPD). If you have complex PTSD you may benefit from certain treatments that help people with BPD.

You can find more information about 'Borderline personality disorder (BPD)' by clicking here.

What if I have complex needs like complex PTSD or a drug or alcohol issue?

You should not be excluded from treatment because if have a drug or alcohol issue. If you have complex PTSD or a drug or alcohol issue your health professional 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, for example your housing situation,
• help you to manage any issues that might stop you from being able to engage with trauma-focused therapies. Such as substance misuse, dissociation or problems controlling your emotions, and
• plan any ongoing support that you need after the end of treatment, such as managing other mental health conditions.

You can find more information about 'Drugs, alcohol and mental health' by clicking here.

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

It is possible to be successfully treated from PTSD years after the trauma, so it’s never too late to seek help.

Some think:

• traumatic events are thought to ‘shatter’ our view of the world as meaningful, safe, and our view of ourselves as worthy,
• recovery can be about reconstructing our worldview using different coping strategies, and
• recovery can occur when someone has processed their trauma and has built a new worldview which includes the trauma.

What can I do if I’m not happy with my treatment?

If you aren’t happy with your treatment you can:

• talk to your doctor about your treatment options,
• ask for a second opinion,
• get an advocate to help you speak to your doctor,
• contact Patient Advice and Liaison Service (PALS), or
• make a complaint.

There is more information about these options below.

How can I speak to my doctor about my treatment options?

You can speak to your doctor about your treatment. Explain why you aren’t happy with it. You could ask what other treatments you could try.

Tell your doctor if there is a type of treatment that you would like to try. Doctors should listen to your preference. If you aren’t given this treatment, ask your doctor to explain why it isn’t suitable for you.

What’s a second opinion?

A second opinion means that you would like a different doctor to give their opinion about what treatment you should have. You can also ask for a second opinion if you disagree with your diagnosis.

You don’t have a right to a second opinion. But your doctor should listen to your reason for wanting a second opinion.

What is advocacy?

An advocate is independent from the mental health service. They are free to use. They can be useful if you find it difficult to get your views heard.

There are different types of advocates available. Community advocates can support you to get a health professional to listen to your concerns. And help you to get the treatment that you would like. NHS complaints advocates can help you if you want to complain about the NHS.

You can search online to search for a local advocacy service.

What is the Patient Advice and Liaison Service (PALS)?

PALS is part of the NHS. They give information and support to patients and a good place to start if you’re not happy with any aspect of the NHS.

You can find your local PALS’ details through this website link:
www.nhs.uk/Service-Search/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363

How can I complain?

You can complain about your treatment or any other aspect of the NHS verbally or in writing. See our information on ‘Complaining about the NHS or social services’ for more information.

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