PTSD
Post-traumatic stress disorder (PTSD) can follow a frightening or traumatic event. Most people who go through one recover without it. If it does develop, several treatments work well. There are also options for when those treatments aren’t available, or don’t feel right yet.
What PTSD is
PTSD involves the memory coming back uninvited, avoiding reminders, and feeling constantly on guard or easily startled. For many people it also brings a heavy, negative view of themselves or the world. They may blame themselves or others, lose interest in things, and feel cut off from people.
A diagnosis needs these difficulties to have lasted at least a month. Somewhere between 5% and 10% of people have PTSD at some point in their lives.
How likely it is depends on what happened. It’s generally highest after trauma involving other people, such as sexual assault, and lowest after natural disasters.
Only a proper assessment can say whether it’s PTSD, and whatever it’s called, it can be treated.
In the first weeks
Most people exposed to a traumatic event recover without developing PTSD. Being shaken, on edge or unable to stop thinking about it for a while is common.
For the first weeks, Australia’s trauma guidelines suggest information, emotional support and practical help (Phoenix Australia, 2020–21).
They advise against going over the event in detail in a one-off debriefing session.
For people still having symptoms in the first three months, the guidelines recommend care matched to how much help each person needs. Rather than waiting to see, they suggest trauma-focused Cognitive behavioural therapy (CBT) A structured, practical form of talking therapy. It's built on a simple idea: what you think affects how you feel, and both affect what you do. More in the jargon decoder (CBT), or a short course of eye movement desensitisation and reprocessing (EMDR (eye movement desensitisation and reprocessing) A structured therapy for memories that still feel raw. You bring a painful memory to mind for short stretches while your attention is split, usually by following your therapist's hand as it moves from side to side. The aim is for the memory to become less upsetting. More in the jargon decoder ).
For children and teenagers, they recommend approaches designed for young people, often with a parent or carer involved.
What helps
The guidelines give their strongest recommendation to five therapies: cognitive processing therapy, cognitive therapy for PTSD, prolonged Exposure (facing things in steps) Facing what you've been avoiding, a bit at a time, and staying long enough for the alarm to settle. For fear and anxiety, it's often the part of therapy that does most of the work. More in the jargon decoder , Trauma-focused CBT A family of talking therapies that work directly on the memory of something that happened, using the ideas of CBT. More in the jargon decoder more broadly, and EMDR. They don’t rank them. All of them work on the trauma directly.
A large review found EMDR and trauma-focused CBT did best, with no clear difference between them (Mavranezouli and colleagues). Counselling that didn’t focus on the trauma helped too, but less. EMDR and talk therapy compared sets out what each one involves, and EMDR has its own page.
Whichever of them you end up doing, the guidelines treat a strong working relationship with the therapist as the basis for trauma treatment.
If trauma-focused therapy isn’t possible or right for you yet
Trauma-focused therapy Therapies that work directly on the memory of what happened, rather than only on how you're coping now. Trauma-focused CBT is the family name for several of them. More in the jargon decoder isn’t always available, and it doesn’t always feel right yet. There are other options with evidence behind them. If you’re still somewhere you’re not safe, safety comes first, and it’s reasonable to put trauma work on hold until you are.
For adults with PTSD where trauma-focused therapy isn’t available, or isn’t acceptable to them, the guidelines suggest:
- Guided online trauma-focused CBT, worked through online with support from a clinician. - Present-centred therapy, which works on current problems and how PTSD affects everyday life, without going over the trauma. - Stress inoculation training, which teaches skills for handling stress and anxiety, and practises them. - Trauma-focused CBT in a group, which group therapy covers in more detail.
For PTSD after war, torture, political detention or being forced from home, the guidelines suggest narrative exposure therapy. It works through the story of a whole life, including the traumatic events, in order.
The guidelines suggest these rather than recommend them. The evidence behind them is less strong, so they’re options rather than first choices.
The guidelines also cover medication, including for when someone’s circumstances aren’t stable enough to start trauma-focused therapy. Therapy and medication covers what’s known about the two together.
When it’s been going on a long time
If the trauma was repeated, went on for years, or happened in childhood, complex PTSD describes that pattern and what helps with it.
Finding help and paying for it
When you’re looking for someone, ask what trauma training they have, and how much of their work is with trauma. Both matter.
How you pay shapes what’s available. Paying the full fee has no session limit, and that includes seeing a Counsellor Someone trained to help people talk through and work on difficulties. The title isn't protected in Australia, so it's worth checking a counsellor's training and registration. Medicare doesn't give a rebate for counsellors. More in the jargon decoder or Psychotherapist Someone trained in therapy, often for longer-standing patterns. Like counsellor, the title isn't protected in Australia, and Medicare doesn't give a rebate for psychotherapists. More in the jargon decoder , whom Medicare Australia's public health insurance scheme. For mental health, it gives rebates on sessions with psychologists and some other professionals, usually through a Mental Health Treatment Plan. More in the jargon decoder doesn’t cover. Workplace programs usually offer three to six sessions. Community health services tend to have a set number too. headspace A national youth mental health service for anyone aged 12 to 25, with centres around Australia and support online and by phone. It's free or close to it, you don't need a referral or a parent, and you can book it yourself. More in the jargon decoder offers free or low-cost support for people aged 12 to 25. A group usually costs less per session.
A Mental Health Treatment Plan A document your GP writes with you. It makes you eligible for a Medicare rebate on up to ten individual sessions a calendar year: six, then a review with your GP, then the remaining four. The plan itself isn't therapy. More in the jargon decoder from your GP (general practitioner) For most people, where getting help starts. A GP can write a Mental Health Treatment Plan, prescribe medication and refer you on, and some are trained to deliver a small number of structured therapy sessions themselves. More in the jargon decoder gives you a Medicare Rebate The amount Medicare pays back towards a session. It comes back to you after you've paid, so what you pay yourself is the fee minus the rebate. More in the jargon decoder on ten sessions a calendar year. Ten sessions a calendar year is a funding limit, not a judgement about how much therapy anyone needs. Free and low-cost options covers other ways to keep costs down.
If you’re experiencing family, domestic or sexual violence, 1800RESPECT is on 1800 737 732. 13YARN, on 13 92 76, is crisis support for Aboriginal and Torres Strait Islander people.
If you’ve served in the Australian Defence Force, or you’re family of someone who has, Open Arms offers free counselling on 1800 011 046, 24 hours a day. The Blue Knot Helpline, on 1300 657 380, is for adults who went through trauma or abuse as children, from 9am to 5pm eastern time, seven days. Blue Knot isn’t a crisis line.
If things are difficult right now, Lifeline is on 13 11 14, the Suicide Call Back Service is on 1300 659 467, and Kids Helpline is on 1800 55 1800 for anyone aged 5 to 25. In an emergency, call 000. Crisis and emergency support has the full list.
Where next
However good the treatment, how well you and your therapist work together matters a great deal. Why who you see matters more than what they do explains why.