NICE Guideline NG116: Post-Traumatic Stress Disorder (2018, updated 2025)

Definitions

Planning Treatment (1.6.1-1.6.3)

• Use a holistic approach - consider all contributing factors, past treatment history, and patient preferences.
• Provide information and support to enable informed choice.
• Where there is significant risk of harm to self or others, establish a risk management and safety plan (involving family/carers where appropriate) as part of initial treatment planning.

Within the First Month After Trauma

Active Monitoring (1.6.4)

• Consider active monitoring (watchful waiting) for adults with subthreshold PTSD symptoms within 1 month of trauma.
• Arrange follow-up within 1 month.

Do NOT offer (1.6.5)

• Do not offer psychologically-focused debriefing (e.g. Critical Incident Stress Debriefing) for prevention or treatment of PTSD - evidence shows it is ineffective and potentially harmful.

Adults with ASD or Clinically Important PTSD Symptoms within 1 Month (1.6.15)

• Offer individual trauma-focused CBT (TF-CBT) - this is the recommended first-line intervention. Specific modalities include:
  • Cognitive processing therapy
  • Cognitive therapy for PTSD
  • Narrative exposure therapy
  • Prolonged exposure therapy

Drug Treatment in the First Month (1.6.24)

• Do not offer drug treatments, including benzodiazepines, to prevent PTSD in adults.

Established PTSD (>1 month, or >3 months for EMDR)

Psychological Treatments - Adults (1.6.16-1.6.20)

• Offer individual TF-CBT to adults with PTSD or clinically important symptoms.
• Typically 8-12 sessions (more if multiple traumas).
• Delivered by trained practitioners with ongoing supervision.
• Must include:
  • Psychoeducation about trauma reactions
  • Strategies for managing arousal and flashbacks
  • Safety planning
  • Elaboration and processing of trauma memories
  • Processing trauma-related emotions (shame, guilt, loss)
  • Addressing trauma-related meanings for the individual
  • Help to overcome avoidance
  • Planning booster sessions (e.g. around trauma anniversaries)

• Offer EMDR to adults with PTSD who have presented more than 3 months after a non-combat-related trauma.
• Typically 8-12 sessions (more for multiple traumas).
• Must be based on a validated manual, delivered by trained practitioners.
• Delivered in a phased manner including: psychoeducation, managing distressing memories, identifying and treating target memories (often visual images), and promoting alternative positive beliefs.

Psychological Treatments - Children and Young People (1.6.6-1.6.13)

• Within 1 month of trauma: consider active monitoring or individual TF-CBT for those under 18 with ASD or clinically important symptoms.
• Group TF-CBT (1.6.7): consider for children aged 7-17 following large-scale shared trauma within the last month.
• Established PTSD in children (>3 months): offer TF-CBT as first-line (12 sessions for single event; longer for chronic/recurrent trauma).
• EMDR (1.6.13): consider for children aged 7-17 only if they do not respond to or engage with TF-CBT.

Drug Treatments - Adults (1.6.24-1.6.26)

Drug Treatments - Children and Young People (1.6.14)

• Pharmacotherapy is not recommended for PTSD in children and young people (very limited evidence).
• If comorbid disorders (depression, anxiety) require treatment, drugs may be considered to target those conditions specifically.

Key Practical Points

• Do not delay or withhold treatment because of ongoing court proceedings or compensation claims.
• Transitions between services: the referring team should not discharge the patient before a care plan is agreed in the new service.
• Involve family members and carers where appropriate, both to support the patient and to address their own needs as carers.
• Actively promote access to services - particularly for migrants, asylum seekers, and people with language or literacy needs.
• PTSD can occur after a wide range of traumatic events (road traffic accidents, assault, childbirth, natural disasters, combat, etc.). Assessment should be thorough and consider all trauma history.

Summary Table