Synopsis
Select trauma-focused psychological treatment using age, symptom burden, elapsed time and trauma context, while preserving safety, consent and appropriate therapeutic pacing.
- Do not routinely require a detailed trauma narrative in an initial general clinical consultation; establish needs, safety and willingness to discuss the event.
- For adults with acute stress disorder or clinically important PTSD symptoms within the first month, NICE recommends individual trauma-focused CBT.
- Offer individual trauma-focused CBT to adults with PTSD or clinically important symptoms presenting more than one month after trauma.
- Consider EMDR at one to three months after non-combat trauma if the adult prefers it, and offer EMDR beyond three months after non-combat trauma.
- Adult trauma-focused CBT and EMDR usually involve eight to twelve sessions; more may be needed after multiple traumas.
- For children aged seven to seventeen, consider EMDR beyond three months only if they do not respond to or engage with trauma-focused CBT.
- Do not offer psychologically focused debriefing to prevent or treat PTSD.
Key red flags
Disclosure of ongoing violence or an immediate threat to a child or vulnerable adult requires an appropriate safeguarding response alongside trauma treatment.
Investigation priorities
Establish clinically important symptoms, functional impact and relevant event timing.
Management branches
An adult reports PTSD or clinically important post-traumatic symptoms after assessment of immediate needs.
- Offer trauma-focused CBT for acute stress disorder or clinically important symptoms within one month, and for PTSD or clinically important symptoms presenting beyond one month.
- For non-combat trauma, discuss EMDR as a consideration at one to three months when preferred and as an offered option beyond three months.
- Arrange treatment with a trained supervised practitioner using a validated manual, usually over eight to twelve sessions and longer when the formulation indicates additional need.