CBT in post-traumatic stress disorder

Last edited 01/2019

The perception of life as unpredictable and uncontrollable are the main cognitive defects in PTSD.

Exposure to feared memories and prevention of avoidance behaviour are important methods.

NICE suggests that regarding adult management:

• offer an individual trauma-focused CBT intervention to adults with a diagnosis of PTSD or clinically important symptoms of PTSD who have presented more than 1 month after a traumatic event.
  • these interventions include:
    • cognitive processing therapy
    • cognitive therapy for PTSD
    • narrative exposure therapy
    • prolonged exposure therapy

Notes:

• typically be provided over 8 to 12 sessions, but more if clinically indicated, for example if they have experienced multiple traumas
• be delivered by trained practitioners with ongoing supervision
• include psychoeducation about reactions to trauma, strategies for managing arousal and flashbacks, and safety planning
• involve elaboration and processing of the trauma memories
• involve processing trauma-related emotions, including shame, guilt, loss and anger
• involve restructuring trauma-related meanings for the individual provide help to overcome avoidance
• have a focus on re-establishing adaptive functioning, for example work and social relationships
• prepare them for the end of treatment include planning booster sessions if needed, particularly in relation to significant dates (for example trauma anniversaries).

Eye movement desensitisation and reprocessing

• consider EMDR for adults with a diagnosis of PTSD or clinically important symptoms of PTSD who have presented between 1 and 3 months after a non-combat-related trauma if the person has a preference for EMDR
• offer EMDR to adults with a diagnosis of PTSD or clinically important symptoms of PTSD who have presented more than 3 months after a non-combat-related trauma

Supported trauma-focused computerised cognitive behavioural therapy

Supported trauma-focused computerised CBT should be considered for adults with a diagnosis of PTSD or clinically important symptoms of PTSD who have presented more than 3 months after a traumatic event if they prefer it to face-to-face trauma-focused CBT or EMDR as long as:

• they do not have severe PTSD symptoms, in particular dissociative symptoms and
• they are not at risk of harm to themselves or others

Cognitive behavioural therapy for specific symptoms

Consider CBT interventions targeted at specific symptoms such as sleep disturbance or anger, for adults with a diagnosis of PTSD or clinically important symptoms of PTSD who have presented more than 3 months after a traumatic event only if the person:

• is unable or unwilling to engage in a trauma-focused intervention or
• has residual symptoms after a trauma-focused intervention

Do not offer psychologically-focused debriefing for the prevention or treatment of PTS

Do not offer psychologically-focused debriefing for the prevention or treatment of PTSD

For full details then consult NICE guideline (1).

Reference:

1. NICE (December 2018).Post-traumatic stress disorder (NG116)