Helping yourself

Do

• keep life as normal as possible
• get back to your usual routine
• talk about what happened to someone you trust
• try relaxation exercises
• go back to work
• eat and exercise regularly
• go back to where the traumatic event happened
• take time to be with family and friends
• be careful when driving – your concentration may be poor
• be more careful generally – accidents are more likely at this time
• speak to a doctor
• expect to get better.

Don’t

• beat yourself up about it – PTSD symptoms are not a sign of weakness. They are a normal reaction of a normal person to terrifying experiences.
• bottle up your feelings.  If you have developed PTSD symptoms, don’t keep it to yourself because treatment is usually very successful.  
• avoid talking about it
• expect the memories to go away immediately; they may be with you for quite some time
• expect too much of yourself. Cut yourself a bit of slack while you adjust to what has happened.
• stay away from other people
• drink lots of alcohol or coffee or smoke more
• get overtired
• miss meals
• take holidays on your own.  

What can interfere with getting better?

You may find that other people may:                  

• not let you talk about it
• avoid you
• be angry with you 
• think of you as weak
• blame you.

These are all ways in which other people protect themselves from thinking about gruesome or horrifying events. It won’t help you because it doesn’t give you the chance to talk over what has happened to you. And it is hard to talk about such things.

A traumatic event can put you into a trance-like state which makes the situation seem unreal or bewildering. It is harder to deal with if you can’t remember what happened, can’t put it into words, or can’t make sense of it.

Treatment

Just as there are both psychological and physical aspects to PTSD, so there are both psychological and physical treatments for it.

Psychotherapy

All the effective psychotherapies for PTSD focus on the traumatic experience – or experiences – rather than your past life. You cannot change or forget what has happened. You can learn to think differently about it, about the world, and about your life. 

You need to be able to remember what happened, as fully as possible, without being overwhelmed by fear and distress.

These therapies help you to put your experiences into words. By remembering the event, going over it and making sense of it, your mind can do its normal job of storing the memories away, and moving on to other things.

When you start to feel safer, and more in control of your feelings, you won’t need to avoid the memories as much. You will be able to only think about them when you want to, rather than having them burst into your mind out of the blue.

All these treatments should all be given by PTSD specialists. The sessions should be at least weekly, with the same therapist, for 8-12 weeks.  Although sessions will usually last around an hour, they can sometimes last up to 90 minutes.

Cognitive Behavioural Therapy (CBT) is a talking treatment which can help us to understand how ‘habits of thinking’ can make the PTSD worse – or even cause it. CBT can help you change these ‘extreme’ ways of thinking, which can also help you to feel better and to behave differently.

EMDR (Eye Movement Desensitisation & Reprocessing)

This is a technique which uses eye movements to help the brain to process flashbacks and to make sense of the traumatic experience.  It may sound odd, but it has been shown to work.

Group therapy

This involves meeting with a group of other people who have been through the same, or a similar traumatic event.

It can be easier to talk about what happened if you are with other people who have been through a similar experience.

Medication

SSRI antidepressant tablets may help to reduce the strength of PTSD symptoms and relieve any depression that is also present. They will need to be prescribed by a doctor.

This type of medication should not make you sleepy, although they all have some side-effects in some people. 

They may also produce unpleasant symptoms if stopped too quickly, so the dose should usually be reduced gradually. If they are helpful, you should carry on taking them for around 12 months. Soon after starting an antidepressant, some people may find that they feel more:

• anxious
• restless
• suicidal

These feeling usually pass in a few days, but you should see a doctor regularly.

If these don’t work for you, tricyclic and MAOI antidepressants may still be helpful. 

Occasionally, if someone is so distressed that they cannot sleep or think clearly, anxiety-reducing medication may be necessary.  These tablets should usually not be prescribed for more than 10 days or so.

Body-focussed therapies

These don’t help PTSD directly, but can help to control your distress and hyperarousal, the feeling of being ‘on guard’ all the time. 

These include physiotherapy and osteopathy, but also complementary therapies such as massage, acupuncture, reflexology, yoga, meditation and tai chi. They can help you to develop ways of relaxing and managing stress.

What works best?

At present, there is evidence that EMDR, Cognitive Behavioural Therapy, behaviour therapy and antidepressants are all effective.

There is not enough information for us to show that one of these treatments is better than another. There is not yet any evidence that other forms of psychotherapy or counselling are helpful for PTSD.

Which treatment first?

Guidelines from the National Institute for Health and Care Excellence (NICE) suggest that trauma-focused psychological therapies (CBT or EMDR) should be offered before medication, wherever possible.