In this blog, Sandra shares her experience of PTSD (post-traumatic stress disorder) and how treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. with EMDR (eye movement desensitisation and reprocessing) helped, and we include sources of information and support for people with PTSD, plus some recent Cochrane evidenceCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. on treatments for PTSD.
Page originally published: 11 November 2014. Revised and republished: 18 August 2022, retaining Sandra’s personal story, adding NICE guidance and sources of information and support for people with PTSD, and removing the Cochrane ReviewsCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. which have not been updated since the blog was originally published.
Featured image PTSD art 2 from: http://meatandmarrow.blogspot.co.uk.
What is PTSD?
Post-traumatic stress disorder (PTSD) is an anxiety disorder, caused by very stressful, frightening or distressing events. People with PTSD experience heightened arousal (such as sleep disturbances and being easily startled) and intense fear, reliving the trauma they’ve been through, and avoiding reminders of it.
“I was diagnosed with PTSD after enduring the repeated cancellations of diagnostic surgery to determine whether or not I had a cancerous polyp. During a tortuous period of 13 weeks I experienced three devastating “in situ” cancellations. On two occasions I was actually gowned up and physically and emotionally prepared for surgery. Each time I was sent home with no future date for the surgery and the agonizing uncertainty of the nature of the polyp. Was it cancerous? Was it growing or spreading during this extended waiting time? Just 18 months earlier my husband had undergone surgery to remove an aggressive malignant melanoma and my biggest dread was wondering if I would have to tell my adult children that I too had cancer. Thankfully, after receiving wonderful and efficient treatment in the private sector, I received the fantastic news that the polyp was in fact benign.
However, the repeated traumas of cancellation and 13 weeks of intense anxiety had caused me to begin experiencing the debilitating effects of PTSD. I found myself unable to sleep for any length of time and when I did sleep I experienced traumatic dreams related to my experiences. I felt increasingly emotional. I experienced vivid flashbacks and felt in a permanent state of heightened anxiety and distress. I was alarmed by my inability to focus or concentrate. I wanted to avoid social occasions and as such I was unable to return to work as a primary school teacher for six months. I experienced a complete change in my personality and became withdrawn and anxious. Prior to my diagnosis of PTSD I had rarely missed a single day of teaching in the previous two decades!”
“EMDR gave me back my personality and way of life”
For Sandra at least, EMDR has helped her recovery, as she explains here.
“I consider myself very fortunate to have been diagnosed by a very knowledgeable psychiatrist who explained the possible benefits of EMDR therapy in overcoming the symptoms of PTSD. I found a very experienced EMDR practitioner and after an initial assessment we began to work on reprocessing my memories of the traumatic experiences.
EMDR involves using multisensory bilateral stimulation. It sounds complicated but in effect, it required me to follow a light on a computer screen, whilst wearing headphones which made a sound in alternate ears in time with the light. In each hand, I held a buzzer which operated in time with the other two inputs. My psychologist explained that while discussing and visualizing the traumatic events, the sensory input of the EMDR process enables the patient to reprocess the memories from the active memory into the long-term memory and to be stored there without the emotional attachment.
I have found EMDR to be a very effective treatment for the extreme levels of disturbance I was experiencing. It has been a long process, no quick fixes, but so worthwhile and supportive. After over six months of weekly, then fortnightly, sessions of one hour I have finally reached a stage where I am now able to recall and talk about my experiences without becoming distressed and emotional. My sleep pattern is much improved, I am able to concentrate much better and I am no longer anxious and withdrawn. Best of all, I recently returned to work doing the job I love. From my own experience, EMDR has been instrumental in giving me back my personality and my way of life.”
Recommendations for practice – NICE guidance on EMDR
The NICE Guideline Post-traumatic stress disorder (published December 2018) covers recognising, assessing and treating post-traumatic stress disorder (PTSD) in children, young people and adults. It includes EMDR as an option in managing PTSD. For adults, NICE states:
“Consider EMDR for adults with a diagnosis of PTSD or clinically importantClinical significance is the practical importance of an effect (e.g. a reduction in symptoms); whether it has a real genuine, palpable, noticeable effect on daily life. It is not the same as statistical significance. For instance, showing that a drug lowered the heart rate by an average of 1 beat per minute would not be clinically significant, as it is unlikely to be a big enough effect to be important to patients and healthcare providers. 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.
EMDR for adults should:
- be based on a validated manual
- 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
- be delivered in a phased manner and include psychoeducation about reactions to trauma; managing distressing memories and situations; identifying and treating target memories (often visual images), and promoting alternative positive beliefs about the self
- use repeated in-session bilateral stimulation (normally with eye movements but use other methods, including taps and tones, if preferred or more appropriate, such as for people who are visually impaired) for specific target memories until the memories are no longer distressing
- include the teaching of self-calming techniques and techniques for managing flashbacks, for use within and between sessions.”
There are also recommendations for EMDR as a possible option for children.
Recent Cochrane evidence on treatments for PTSD
The Cochrane Review looking at Internet‐based cognitive and behavioural therapies for post‐traumatic stress disorder (PTSD) in adults (published May 2021) mentions that EMDR is one of the trauma-focused psychological treatments recommended in several major guidelines. Interventions based on EMDR were excluded from this review. The review authors found a lack of reliable evidence but were encouraged to see that there are many planned or ongoing studies.
The Cochrane Review Pharmacotherapy for post traumatic stress disorder (PTSD) (published March 2022) looked at drug treatments for PTDS. The authors found that selective serotonin reuptake inhibitors (SSRIs) probably improve PTSD symptoms compared to placeboAn intervention that appears to be the same as that which is being assessed but does not have the active component. For example, a placebo could be a tablet made of sugar, compared with a tablet containing a medicine. (pills that look the same but don’t have an active ingredient), and that the medicines mirtazapine and amitriptyline may also improve symptoms of PTSD. More people taking SSRIs dropped out due to side effects than people taking placebo.
The Cochrane Review on Present‐centered therapy (PCT) for post‐traumatic stress disorder (PTSD) in adults (published November 2019) found that this non-trauma based treatment may not be as helpful for people with PTSD as trauma-focused therapies, although it is probable that fewer people drop out of the treatment.
Couple and family therapies
The authors of a Cochrane Review Couple and family therapies for post‐traumatic stress disorder (PTSD) (published in December 2019) found that there isn’t much research on this and what there is doesn’t tell us whether couple and family therapy is helpful, either on its own or added to other treatments.
More information and support
NHS: Post-traumatic stress disorder (PTSD)
- Anna Freud National Centre for Children and Families
- PTSD UK
- Combat Stress (forces veterans, reservists and their families)
- PTSD At Work
- PTSD Resolution (forces veterans, reservists and their families)
- Rethink Mental Illness
- Sole Survivor – PTSD Support
- The Brain Charity
- The Royal British Legion (armed forces community), 0808 802 8080
- The Survivors Trust (survivors of rape, sexual violence and childhood sexual abuse)
- Young Minds – PTSD: a guide for young people
Our thanks to Sandra for sharing her story.
Join in the conversation on Twitter with @CochraneUK or leave a comment on the blog.
Please note, we cannot give specific medical advice and do not publish comments that link to individual pages requesting donations or to commercial sites, or appear to endorse commercial products. We welcome diverse views and encourage discussion but we ask that comments are respectful and reserve the right to not publish any we consider offensive. Cochrane UK does not fact-check – or endorse – readers’ comments, including any treatments mentioned.
Sarah Chapman has nothing to disclose.
I had EMDR prescribed by an NHS pain clinic and the EMDR therapy was conducted by an NHS psychologist. I have a science/engineering background, was very sceptical of the whole idea, but having chronic lower back pain from a serious industrial injury, having severe lower/upper back pain and scoliosis, I am obviously going to give it a try?
So following 25 years of pain, my twelve sessions of EMDR had no perceptible effects on my chronic pain. However, it most certainly did have a profound and lasting effect on my mind.
Following the forth sesssion, I got lost on my way home. I had to wait around 40 min to get my bearings. I still avoid the area near the hospital as I’m uncertain where the back road leads and I don’t want to feel ‘lost’ again.
People who don’t really know me would say I am a quiet/shy person. Those who do, say the opposite. I used to be very reserved with people I don’t know and take a few month before I would be comfortable. I had a strong dislike for being among or meeting strangers. After the EMDR this trait is no longer there. At all. I am far more at ease when in new social situations.
EMDR was like a reset for ones brain. It made me feel renewed in a strange way. It certainly seems to have had a profound in my instance. Maybe give it a go for yourself?
The person featured in the article was fortunate enough to be able to pay their way out of an unplesant episode in her life. I too am now in the financial position to spend on private healthcare to help my multiple health issues. I never would though. Living in a country which has a national health service, it is always going to be the NHS for me. No matter how bad things get (and on three occasions I have been at death’s door), I would never, ever pay to go private. I find the idea of using wealth to jump the cue as abhorrent and against all I hold dear. I know many do not understand why a person would suffer when money can make it go away. It reminds me of a new Rolls Royce car in a showroom without a price sticker: If you need to ask the price, you cannot afford. Well, so you don’t understand why some very wealthy people would never go private?
I think that if you need to ask, then you will never truly understand why some comfortably well-off patients choose not to go private. No matter what.