Psychosocial interventions for acute or posttraumatic stress disorder in adults and young people

Trauma-focused psychosocial interventions are effective for both acute stress disorder and posttraumatic stress disorder (PTSD). Start psychosocial interventions, including psychoeducation, in:

• patients with PTSD
• patients with acute stress disorder who are at increased risk of developing PTSD (eg past history of trauma, exposure to additional stressors after the traumatic event).

Psychosocial interventions with the best evidence include:

• trauma-focused cognitive behavioural therapy (CBT). This involves challenging misattributions associated with the patient’s traumatic experience (eg challenging unrealistic expectations of catastrophe), and repeated exposure to associated memories to minimise physiological anxiety responses
• eye movement desensitisation and reprocessing (EMDR) that includes in vivo exposure.

There is also limited evidence for dialectical behaviour therapy, emotion-focused therapy, metacognitive therapy and mindfulness-based cognitive therapy.

If PTSD follows exposure to prolonged or severe traumatic events, teaching emotional regulation skills and a more gradual approach to exposure therapy may be required.

Exposure-based therapies have limited benefit in delayed-expression PTSD; instead, psychosocial interventions that help the patient manage their symptoms (eg anger and anxiety management, stress reduction, relaxation therapy, good sleep practices) are used.