Post-traumatic stress disorder (PTSD)

Explains what post-traumatic stress disorder (PTSD) is, including possible causes and how you can access treatment and support. Includes tips for helping yourself, and guidance for friends and family.

This page is also available in Welsh.

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What treatments are available?

This page covers:

Watchful waiting

If you have had PTSD symptoms for less than four weeks or they are relatively mild, your GP might suggest an approach called 'watchful waiting' before offering you any treatment. This involves monitoring your symptoms yourself to see if things improve. In this case you should be offered a follow-up appointment within one month.

Talking treatments for PTSD

The National Institute for Health and Care Excellence (NICE) – the organisation that produces guidelines on best practice in health care – currently recommends two types of talking treatment for PTSD:

Trauma-focused cognitive behavioural therapy (TF-CBT). This is a form of cognitive behavioural therapy (CBT) specifically adapted for PTSD. NICE recommends that you are offered 8–12 regular sessions of around 60–90 minutes, seeing the same therapist at least once a week. See our pages on CBT for more information about this therapy.
Eye movement desensitisation and reprocessing (EMDR). This is a fairly new treatment that can reduce PTSD symptoms such as being easily startled. It involves making rhythmic eye movements while recalling the traumatic event. The rapid eye movements are intended to create a similar effect to the way your brain processes memories and experiences while you're sleeping. EMDR Association UK - a professional association of EMDR clinicians and researchers - provides lots more information about EMDR on its website. They also have a search function to find EMDR-accredited therapists in your area.

NICE may recommend other talking treatments in future if they are found to help with PTSD, but more research is needed.

"One of the most disturbing things has been the feelings of aggression and anger towards anyone who looks like the person who attacked me... EMDR therapy has been massively helpful."

What if I don't feel better?

If the talking treatment you try doesn't seem to be helping, NICE suggests that you:

tell your doctor or therapist you were expecting to feel differently
ask if you need more treatment, or a different type of treatment.

Your doctor or therapist should offer you a second course of treatment or a follow-up appointment. You can read the full guidelines for PTSD treatment in English or Welsh on the NICE website.

Medication for PTSD

People experiencing PTSD aren't routinely prescribed medication. However, you might be offered medication if:

you also have depression
you have sleep problems caused by PTSD
you are unable or do not want to try talking treatments.

If you are offered medication for PTSD, this will usually be an antidepressant. While PTSD is not the same as depression, this type of medication has been found to help. NICE recommends four antidepressants in particular:

paroxetine – can be prescribed by a GP
mirtazapine – can be prescribed by a GP
amitriptyline – must be prescribed by a specialist
phenelzine – must be prescribed by a specialist.

NICE recommends venlafaxine or a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs), such as sertraline. See our pages on antidepressants for more information about this kind of medication.

If you also experience symptoms of psychosis or severe hyperarousal (constantly feeling on high alert), and other medications have not helped you, you may be offered an antipsychotic to treat these symptoms. Antipsychotic treatment should be reviewed regularly by a specialist such as a psychiatrist. See our pages on antipsychotics for more information about this kind of medication.

Before you take any medication

Before you decide to take any medication, you should make sure you have all the facts you need to feel confident about your decision. For guidance on what you might want to know about any drug before you take it, see our pages on:

Other treatment options

Some people with PTSD say they have found other treatments helpful in managing their condition, such as group therapy, arts therapies or dialectical behaviour therapy (DBT).

Trauma can affect the body physically as well as psychologically and there is growing evidence to show that body-based therapy can help people experiencing PTSD to ground themselves and regulate emotions. You can find out more about body-based therapy and find a therapist via the Body Psychotherapy Network.

However, the NICE guidelines recommend that treatments that have not been designed or properly tested for people who have experienced trauma should not be used on their own.

Pre-trial therapy for prosecution witnesses

The Crown Prosecution Service (CPS) guidelines for vulnerable witnesses, which includes anyone giving evidence about rape or sexual assault, say that some forms of therapy can "present problems" if someone has them before giving evidence which may be used in a trial.

For information about this you can speak to Victim Support, which is a charity in England and Wales that aims to help victims and witnesses of any crime, or you could talk to an Independent Sexual Violence Advisor (ISVA) – The Survivors Trust has a list of ISVAs on their website.

Accessing treatment

Here are some ways you could access treatment:

Your GP. To get treatment on the NHS, you could visit your GP. For advice on preparing for a GP appointment, see our page on talking to your GP.
Free NHS therapy services. You might be able to directly contact Improving Access to Psychological Therapies (IAPT) services in your area, if you live in England. You can search for these on the NHS website.
Specialist organisations. See our useful contacts page for organisations that may offer therapy or be able to put you in touch with local services.
Local trauma services. Some organisations offer free or low-cost trauma therapy. Your local Mind on Mind's Infoline may have information about services in your area.
Private therapists. Finding a private therapist is another option some people choose to explore.