Psychological treatment should be the first type of treatment offered for posttraumatic stress disorder (PTSD). Pharmacological treatments should be considered first only when psychological treatments are not available or when clients make an informed choice not to participate in them.
Pharmacological treatments may also be considered first when the client is not stable enough for psychological treatments (e.g., the person is suicidal or dissociating). Limited research exists about the effectiveness of combined psychotherapy and pharmacotherapy.
Psychotherapy
Cognitive-behavioural therapy (CBT)
- Individual trauma-focused CBT has been shown to be the most effective treatment for PTSD.
- Trauma-focused CBT is short term and structured.
- CBT focuses on the relationship between emotions, thoughts and behaviours.
- During CBT, the client faces his or her fears with the expectation that anxiety will lessen after repeated exposure.
- Cognitive restructuring during therapy allows the client to identify biased or maladaptive thoughts and beliefs and to reframe them in a more balanced way.
Pharmacotherapy
- Medications are not the first-line treatment for PTSD. They should only be used when the client is:
- unwilling to take part in psychotherapy
- not stable enough to begin psychotherapy
- dissociating
- not benefiting from psychotherapy
- SSRIs are the recommended medication, including sertraline, paroxetine and fluoxetine.
Evidence summary
Ng, L. (2012). Trauma and posttraumatic stress disorder. In A. Khenti, J. Sapag, S. Mohamound & A. Ravindran (Eds.), Collaborative Mental Health: An Advanced Manual for Primary Care Professionals (pp. 251–272). Toronto, ON: Centre for Addiction and Mental Health.
Swinson, R. (2011). The patient who is anxious. In D. Goldbloom & J. Davine (Eds.), Psychiatry in Primary Care: A Concise Canadian Pocket Guide (pp. 45–60). Toronto, ON: Centre for Addiction and Mental Health.
Van Ameringen, M., Mancini, C., Patterson, B. & Boyle, M.H. (2008). Post-traumatic stress disorder in Canada. CNS Neuroscience & Therapeutics, 14(3), 171–181.