Post-traumatic stress disorder (PTSD) can develop following a stressful event or situation of an exceptionally threatening or catastrophic nature. Evidence suggests that around 25—30% of people experiencing a traumatic event may go on to develop PTSD.

The symptoms of PTSD include re-experiencing the traumatic event, avoidance of reminders of the event, hyperarousal, and emotional numbing. Symptoms usually start immediately after the event, but in less than 15 of individuals symptoms are delayed

The National Institute of Clinical Excellence (NICE) guidelines (2005) suggest that individuals who have experienced a traumatic event should not routinely be offered debriefing (brief, single-session interventions that focus on the traumatic incident) nor should counselling be the treatment of choice.

Where symptoms are mild and have been present for less than 4 weeks after the trauma, “watchful waiting”, rather than formal psychotherapeutic treatment, is recommended. Trauma-focused cognitive behavioural therapy or eye movement desensitisation and reprocessing (EMDR) should be offered to those with moderate or severe post-traumatic symptoms, regardless of the amount of time that has elapsed since the traumatic incident. The duration of trauma-focused cognitive behavioural therapy should normally be 8—12 sessions, but if the treatment starts in the first month after the event, fewer sessions (about 5) may be sufficient. More than 12 sessions may be offered if several problems need to be addressed in the treatment of PTSD sufferers, particularly after multiple traumatic events, traumatic bereavement, or where chronic disability resulting from the trauma, significant comorbid disorders or social problems are present. Treatment should be regular and continuous (usually at least once a week) and should be delivered by the same person.

The guidelines suggest that children with PTSD should be offered 8—12 sessions of traumafocused CBT when the PTSD results from a single event.

For patients who present with both PTSD and depression, the PTSD should be treated first, as the depression often improves with successful treatment of the PTSD. However, if the depression is so severe that psychological treatment of PTSD would not be possible (i.e.

inactivity, lack of concentration or energy) the depression should be treated first.

References:

The National Institute of Clinical Excellence. 2005. Post„traumatic stress disorder (PTSD):

The management of PTSD in adults and children in primary and secondary care.

www.nice.org.uk Accessed March 2009