PTSD (Post-Traumatic Stress Disorder)

PTSD is a trauma-related diagnosis recognised across DSM-5-TR and ICD-11. The diagnostic criteria require exposure to a traumatic event followed by symptoms across four clusters persisting beyond one month: re-experiencing (intrusive memories, flashbacks, nightmares), avoidance (of trauma reminders), negative alterations in cognitions and mood (persistent shame, guilt, distorted self-blame), and alterations in arousal and reactivity (hypervigilance, sleep disruption, irritability).

First-line treatments per VA/DoD, WHO, and APA guidelines: EMDR and trauma-focused CBT (including Cognitive Processing Therapy and Prolonged Exposure). Effect sizes are large. 8 to 12 sessions typically reduce PTSD diagnoses to subclinical levels for single-incident trauma.

Body-based and complementary approaches with strong evidence:

• Trauma-informed yoga: 2014 van der Kolk RCT showed effect sizes comparable to EMDR for chronic PTSD
• Neurofeedback: 2018 van der Kolk RCT showed effect sizes comparable to other established trauma treatments
• Somatic experiencing: particularly suited to pre-verbal trauma and presentations with high dissociation
• EFT: growing evidence base, shorter course (6 to 8 sessions for single-incident PTSD)

For complex PTSD (sustained or repeated traumatic exposure), see the dedicated definition. The phase-based approach combining body-based stabilisation, trauma processing, and identity-level integration consistently outperforms single-modality approaches.

Combined approaches: pairing EMDR or trauma-focused CBT with body-based work (yoga, somatic experiencing, EFT) consistently outperforms either alone for the substantial subgroup of patients who respond partially to first-line treatment.

Psychedelic-assisted therapy: MDMA-assisted therapy showed strong RCT effects for PTSD in Phase 3 trials. Psilocybin shows promise for treatment-resistant depression. Both remain in clinical trial pathways in most countries.

Severe acute PTSD with suicide risk requires immediate clinical intervention regardless of modality preference.