Psychiatry Referral
A patient with post-traumatic stress disorder should be referred to psychiatry (or mental health services with trauma-focused psychotherapy capabilities), not physiotherapy. PTSD is a psychiatric disorder requiring specialized mental health treatment, specifically trauma-focused psychotherapy as first-line intervention 1.
Why Psychiatry/Mental Health Services
PTSD requires evidence-based psychological interventions that only mental health professionals can provide:
First-Line Treatment Recommendations
Trauma-focused psychotherapy is the primary treatment with strong evidence supporting:
- Prolonged Exposure (PE)
- Cognitive Processing Therapy (CPT)
- Eye Movement Desensitization and Reprocessing (EMDR)
These manualized psychotherapies demonstrate large effect sizes (Cohen's d ~-1.0 or greater) and achieve loss of PTSD diagnosis with numbers needed to treat <4 1, 2, 3.
The 2023 VA/DoD guidelines specifically recommend trauma-focused psychotherapy over pharmacotherapy as the preferred initial approach 1. When medication is indicated, SSRIs (paroxetine, sertraline) or venlafaxine are recommended, which only psychiatrists or appropriately trained physicians can prescribe 1, 4.
What Physiotherapy Cannot Provide
Physiotherapy addresses musculoskeletal and physical rehabilitation concerns. PTSD requires:
- Direct processing of traumatic memories through imaginal exposure
- Cognitive restructuring of trauma-related beliefs
- Management of reexperiencing, avoidance, and hyperarousal symptoms
- Treatment of emotion dysregulation and dissociative symptoms
None of these core PTSD interventions fall within physiotherapy scope of practice.
Clinical Pathway
The appropriate referral pathway is:
- Refer to psychiatry or specialized trauma services for diagnostic assessment and treatment planning
- Initiate trauma-focused psychotherapy (CPT, PE, or EMDR) as first-line treatment 1
- Consider pharmacotherapy (SSRIs/venlafaxine) if psychotherapy alone is insufficient or patient preference 1, 4
- Avoid benzodiazepines and cannabis products - these are specifically recommended against 1
Important Caveat
Even patients with complex PTSD (cPTSD) with severe comorbidities, childhood abuse histories, or dissociative symptoms benefit from direct trauma-focused treatment without requiring prolonged stabilization phases 5. The evidence does not support delaying trauma-focused therapy for a stabilization phase, as this may inadvertently communicate to patients they cannot handle their traumatic memories, potentially reducing treatment motivation 5.
Physiotherapy has no role in PTSD treatment unless there are separate, concurrent musculoskeletal conditions requiring physical rehabilitation.