treatment not drugs for people with post-traumatic stress disorder,
by Angela Hussain
People diagnosed with post-traumatic stress disorder should be offered
psychological treatment rather than drug treatment, a guideline
for the NHS in England and Wales has recommended.
National Institute for Clinical Excellence guideline says that up
to 30% of people who experience an exceptionally threatening or
catastrophic event may develop the disorder.
guideline says that trauma focused psychological therapy should
be used as a routine first line treatment for adults in preference
to drug treatments.
facilitator of the guideline's development, Stephen Pilling, a clinical
psychologist and coordinator of London's National Collaborating
Centre for Mental Health, said:
"We were not able to find very convincing evidence for efficacy
of drug treatment in PTSD.
in contrast to US guidelines, which recommend use of SSRI [selective
serotonin reuptake inhibitor] antidepressants as first line treatment,
we advised against this."
reviewing evidence, including unpublished data from drug trials,
the group that developed the guideline also advised that people
who experience a traumatic event should not be given brief, single-session
interventions, often termed debriefing.
Pilling said: "We found little evidence of benefit from a single
psychological intervention in people with PTSD [post-traumatic stress
disorder], and some evidence of harm."
said that debriefing may not allow enough time for people to work
adequately through the traumatic event and associated emotional
and psychological feelings.
"PTSD is associated with incomplete processing of a traumatic
event, so effective therapy needs to allow a person to fully process
what happened," he said.
guideline, issued last week, recommends that all people diagnosed
with post-traumatic stress disorder be offered several sessions
of psychological treatment-either cognitive behaviour therapy or
eye movement desensitisation and reprocessing (a technique in which
the therapist guides the patient to move his or her eyes in a random
way while the patient talks about the trauma).
Pilling told bmj.com: "The key factor that makes these treatments
effective is that they are structured psychological treatments that
focus specifically on the traumatic event, in contrast to other
more general therapies, such as counselling."
guideline also emphasises the need to improve the detection and
management of the disorder in children, because the effects could
be very long lasting. It said that detection of the disorder could
be improved by asking children directly about their experiences.
and young people with the disorder, including those who have been
sexually abused, should be offered a course of trauma focused cognitive
behaviour therapy, adapted as needed to suit their age, circumstances,
and level of development.
National Institute for Clinical
Excellence guidance on post-traumatic stress disorder (pdf)
does have benefits
Ceylon Marable, third year mental health student nurse, Oxford Brookes
April 11, 2005
I have worked on a placement that works especially with people with
clients did have CBT-based therapy work, but they also found SSRI
medication helpful to treat sypmtoms of PTSD, for example panic
I agree with the NICE guidelines that more psychological treatments
should be used to help this client group, I also feel that low doses
of medication should help treat the symptoms as well. And as the
person grows to understand the traumatic event, the SSRIs can be
do you think? Email your comments on the above
article to the editor using the form below. Selected comments will
© 2001-7 Psychminded Limited. All
about this article