PTSD Treatment: What Works
Post-traumatic stress disorder (PTSD) is a condition following a traumatic event in which the memory keeps returning as though it were happening now, reminders are avoided, and the body stays on guard for more than a month.
Also called: Post-Traumatic Stress Disorder, Post traumatic stress disorder, Post-traumatic stress.
ICD-10 F43.1 · ICD-11 6B40
The way out goes through the memory.
Everything in PTSD pushes a person to avoid the memory. Avoiding feels like the only safe thing to do. It works for a moment. It is also the main thing keeping PTSD going.
The treatments with the best evidence ask for the opposite. The person goes back to the memory on purpose, with a trained therapist, at a pace they agree together. The aim is to teach the brain two things. The memory is not the danger. And the danger is over.
These are talking therapies, not medication. The guidelines recommend them first.
WHERE TREATMENT STARTS
Trauma-focused therapy first, medication second
NICE, the National Institute for Health and Care Excellence, writes the UK guidelines. It recommends trauma-focused cognitive behavioural therapy (CBT), or eye movement desensitisation and reprocessing (EMDR), as the first treatment for adults with PTSD. A course is usually 8 to 12 sessions, and more after repeated trauma.
The US veterans guideline agrees. It names three therapies with the strongest evidence, prolonged exposure, cognitive processing therapy and EMDR, and recommends them over medication because the improvement is larger and lasts longer.
In the first weeks after a trauma, practical support and checking in are usually the right steps. Formal debriefing, where people are asked to talk through the event straight away, is not recommended. It can make things worse.
THE EXERCISE THAT SOUNDS WRONG
Stay with it.
One of these therapies is called prolonged exposure. In each session the person goes back over the memory out loud, in order, with the therapist beside them. In the example below, that means telling the story of a car crash from the start.
The alarm rises while they tell it. That is expected. The important part is not escaping the moment it rises. That means not changing the subject, not stopping halfway, and not pushing the memory away. Staying lets the brain notice something. The memory is painful, but it is not the crash. Nothing bad is happening in the room.
Here is the thing to watch, because it is not the obvious one. Do not watch how far the fear falls inside a single session. Watch where the NEXT session begins. Studies find that is what predicts recovery. It starts lower every time the person stayed. It starts just as high every time they escaped.
Press and hold to stay with the memory. Let go whenever you want to. Then look at where the next session starts.
Hold to stay with it
Staying with it
Start again
Session
Alarm now
Next session starts at
stayed
let go
6
6
0.84
0.68
0.02
Ready. Press and hold to start the session.
The alarm is rising. Nothing is happening in the room.
This is the peak. It is hard. It is also only a memory.
Still here. The fear is easing, slowly.
You stayed. The brain recorded it. A painful memory, and no danger.
You let go. Relief came at once. The alarm learned nothing new.
Six sessions done. Now look at where each one started.
Look at where each session starts, not how far it falls. After every session you stayed with, the next one started lower. After every session you let go of early, the next one started just as high. That is the whole point. Escaping feels better right now, and it keeps the fear exactly the same size.
When a session is held through, the alarm rises, peaks, and eases a little. The next session then starts lower.
When a session is escaped, the alarm drops at once. The next session starts just as high as this one did.
Over six held sessions, the starting level falls a long way. Over six escaped sessions, it does not move at all.
Real prolonged exposure usually runs weekly, for about 8 to 15 sessions, with practice between them. It is always done with a trained therapist. The person stays in control of the pace throughout. This device shows you the idea. It is not a way to do the therapy alone.
THE OPTIONS
What else has evidence
Several therapies work, in different ways. They all deal with the memory rather than around it.
Cognitive processing therapy
Works on the stuck thoughts trauma leaves behind, like "it was my fault" or "nowhere is safe". Usually about 12 sessions.
EMDR
The person holds the memory in mind while following a moving hand or a tapping rhythm. It works about as well as trauma-focused CBT. Whether the eye movements themselves are needed is still debated.
Cognitive therapy for PTSD
Updates the memory with what the person knows now, like "I survived" and "it is over", and trains them to tell a reminder now apart from the event then.
Medication
Sertraline, paroxetine and venlafaxine help some people. They work less well than trauma-focused therapy, so guidelines offer them second, or when someone does not want therapy.
Why going back does not usually make it worse
This is the most common fear, and it is a fair one. Early sessions are hard, and a small number of people feel worse for a short time. But in trials, that short rise does not stop people getting better. Working with the memory in a planned, safe way helps. Avoiding it is what keeps PTSD in place.
IF YOU START
What actually happens, in order
Most trauma-focused therapy follows the same shape.
An assessment, and a plan agreed together. Nobody is pushed into the memory in the first session.
Learning what PTSD is, and why avoidance keeps it going. This part alone often brings relief.
The work on the memory itself, usually weekly, with practice between sessions.
Many people notice a change within the first few weeks. A full course often takes around three months.
After long or repeated trauma, courses are longer, and may start with skills for handling strong emotions.
OVER TIME
How well it works
Better than most people expect. Not for everyone.
Up to 4 in 10 people with PTSD recover within a year, even before treatment.
Trauma-focused therapies lead to large improvements in trials, and the gains usually hold when people are followed up later.
Results are smaller in military veterans. About two in three who finish these therapies still meet the diagnosis afterwards, even though many are better. That is why research into new treatment continues.
MDMA-assisted therapy was turned down by the US regulator in 2024, and a new application was filed in August 2026. It is not an approved treatment.
COMING OFF
Ending therapy, and stopping medication
Therapy has a planned ending. Medication is reduced slowly.
A course of therapy ends with a plan for what to do if symptoms come back. A few top-up sessions later on are common.
If medication has helped, it is usually continued for several months to a year before stopping is discussed.
Stopping should be done slowly, with a doctor, the same as for depression. Stopping suddenly can cause withdrawal symptoms.