Information for clinicians

Patients can move through the PTSD Treatment Decision Aid step-by-step or jump to the sections that most interest them. They will be able to

• Read about effective treatments
• Watch videos explaining how different treatments work
• Compare features of the treatments they like best
• Think about next steps
• Create a personalized summary of their choices

The personalized summary includes information about a patient’s symptoms, goals, treatment preferences, and questions. It is important for patients to save or print this summary because any information entered into the decision aid will be deleted once the browser closes. Your patient can bring the summary to their next appointment and use it as a jumping-off point to discuss next steps for treatment.

Anyone can use the PTSD Treatment Decision Aid, but it was designed specifically for people who have or think they might have PTSD. The PTSD Treatment Decision Aid was developed by the National Center for PTSD, part of the Department of Veterans Affairs, but it is not just for Veterans. Some information is specific to Military Service Members and Veterans—for example, information about which treatments are common at VA hospitals—but most information applies to everyone. The PTSD Treatment Decision Aid is for patients who are considering treatment for the first time as well as those who have already tried PTSD treatment. Even if past PTSD treatment was not successful, results may be different the next time around or with a different treatment. Although the decision aid was developed for people with PTSD, family members and clinicians also can benefit from the information in the decision aid.

• Family members or loved ones of someone with PTSD can use the PTSD Treatment Decision Aid to learn more about PTSD treatment options. That way, they will be prepared to help their loved one choose which treatment to receive.
• As a clinician, you can use the decision aid to find current, comprehensive information about evidence-based PTSD treatments. You will be able to see how expert clinicians describe these treatments to patients. You also can download handouts on each of the evidence-based treatments to print and share with your patients.

There are many treatments for PTSD, but the PTSD Treatment Decision Aid focuses on evidence-based PTSD treatments because years of research tell us that these treatments offer the best chance of recovery. The decision aid does provide a list of other treatments that were reviewed in the 2023 VA/DoD PTSD Guideline. If you or your clinic offer PTSD treatment options other than the evidence-based interventions featured in the PTSD Treatment Decision Aid , you can inform patients of these additional options and their risks and benefits. Sometimes people with PTSD may choose to receive a treatment that is not evidence-based, and they may find such treatments helpful.

User testing indicated that it took most people 30 to 40 minutes to work through the PTSD Treatment Decision Aid, though it varied from one person to the next. The PTSD Treatment Decision Aid contains a great deal of text, video, and multimedia content. In many places, users have the option to go deeper and get even more information on a particular topic. If a user were to read all the text and watch all the videos, it would take several hours from start to finish

There are three ways patients can use the PTSD Treatment Decision Aid.

• You and your patient can use the decision aid together. During an appointment, you can navigate through it step-by-step, or you can show your patient certain features of the decision aid that you think will be most helpful, such as the treatment comparison chart.
• Patients can use it on their own, especially if you only have a short time in session for the decision aid. The decision aid is a great place to start learning about evidence-based PTSD treatments. Share the URL and encourage them to spend some time using it at home. You can even pull up the decision aid on your office computer to give your patient a quick tour of the site. Schedule a follow-up appointment to review your patient’s personalized summary and work together to decide on a course of treatment.
• You can use the PTSD Treatment Decision Aid as a general educational tool, as it includes information about all top options for PTSD treatment in one place. Consider keeping brochures for the PTSD Treatment Decision Aid for people to pick up in your clinic space or other locations

There are several evidence-based treatments for PTSD. But there’s no single treatment that works for everyone. That means that people with PTSD have options.

The decision aid can:

1. Help patients learn about and compare evidence-based treatment options.
   Among people with PTSD symptoms, there are many misconceptions about PTSD treatment. Many people do not know which PTSD treatments are effective. They also do not know what to expect from treatment, such as what they will be asked to do or talk about, how long treatment lasts, or how well it works. To educate patients and correct common misconceptions, the PTSD Treatment Decision Aid includes comprehensive information about evidence-based treatment options.
2. Encourage patients to get involved in their treatment decisions. Patients often assume that the clinician is the expert and they should do whatever the clinician recommends. But research shows that when patients are involved in the treatment decision and receive their preferred treatment, they are more likely to benefit from treatment.¹ The decision aid encourages patients to participate in treatment decisions and includes helpful tips on how they can talk with their clinician about PTSD treatment options.

No, it will not. The PTSD Treatment Decision Aid can help patients identify which treatments might be a good fit based on their preferences. Patients then can explore these treatments and identify which treatments they would like to discuss with their clinician. The decision aid does not make treatment recommendations based on patients’ demographic characteristics (age, gender, race/ethnicity) or clinical characteristics (trauma type, symptom severity, comorbidities, etc.). The reason for this is that we know very little about how such characteristics relate to success in particular treatments. It is important to remember that the decision aid serves as a starting point in the decision-making process. Patients will need to work with their clinician to make a final treatment decision.

After your patient uses the PTSD Treatment Decision Aid, meet with your patient to:

• Review your patient’s personal summary;
• Answer any questions listed on their summary and discuss their treatment preferences;
• Check your patient’s treatment knowledge;
• Ask your patient to tell you what they learned from the decision aid and correct any misconceptions;
• Ask if there is any additional information that your patient needs or wants;
• Talk with your patient about treatment cost and availability. The PTSD Treatment Decision Aid does not tell patients how much treatment will cost or which treatments are readily available in their area, so it is important for you to address these topics with each patient.
• Help your patient deliberate. Ask what your patient likes and dislikes about different treatments and explore what matters most to them. Once you and your patient agree on a course of action, make sure your patient knows what to expect in terms of next steps.

Ideally, every patient with PTSD would have access to all evidence-based treatment options. But in reality, it may be difficult for patients to access certain interventions. Most clinicians are not trained to deliver all evidence-based treatments. And because it takes intensive training and supervision to become skilled in the delivery of an evidence-based psychotherapy, many clinicians are proficient in some but not all of these protocols. A patient who uses the PTSD Treatment Decision Aid may become interested in a particular evidence-based treatment that is not offered by their local mental health clinician or clinic.

If your patient requests a treatment that you do not offer, you can inform the patient of the treatments you do offer and ask whether they would like a referral to a clinician who does offer the preferred treatment. You can then help the patient deliberate between these options. The patient might decide that it is most important to stay with their current clinician/clinic, even if it means not getting a first-choice treatment. Or, the patient may decide that they are willing to work with a different clinician or even travel long distances to find a preferred treatment. Giving patients information about all evidence-based treatments for PTSD (even those treatments that may be hard to find) allows them to understand the full menu of options that exist. Survey research tells us that people with PTSD symptoms are interested in learning about all evidence-based treatments, not just those that are readily available.²

Some patients who use the PTSD Treatment Decision Aid may decide that none of the evidence-based treatments featured in the decision aid are right for them. They may prefer an alternative treatment, or they may choose not to engage in treatment at all. In both cases, you and your patient can discuss the risks and benefits of these choices. While more improvement is associated with those treatments included in the PTSD Treatment Decision Aid , it is important that patients understand that people can get better even if they do not engage with one of these evidence-based treatments.

The PTSD Treatment Decision Aid does not include information about treatments for conditions other than PTSD. However, you can still use this decision aid with patients who have other diagnoses or problems in addition to PTSD. Several research trials have shown that patients with PTSD and co-occurring mental health disorders (such as substance use, depression, or psychotic disorders) can benefit from evidence-based PTSD treatments. In some cases, symptoms of these co-occurring disorders improve with successful PTSD treatment.

Shared decision-making (SDM) is a way to decide collaboratively with patients the treatment approach that may be best for them. Basically, it involves five steps that can unfold in a non-linear conversation. These are outlined below, with some sample wording.

1. Letting the patient know that there is a decision to make (i.e., which PTSD treatment will fit for them) and that you would like them to be part of the process. “Today, I’d like to talk through the different options we have for treating PTSD. I’d like to make this a collaborative discussion, rather than me telling you what treatment to do. I can share what I know about treatment options, like how effective they are and what your involvement would look like. But I also want to know what matters to you in a treatment, and what you think would work best for you.”
2. Sharing your knowledge about treatment options, including the pros and cons of each of those options. This is the step where the decision aid can help you to comprehensively and objectively discuss available options. “Let’s look at the PTSD Treatment Decision Aid to help us walk through the pros and cons of each of the treatment options ...”
3. Eliciting patient preferences and goals for treatment. What matters to them? How do they want to approach treatment? What is feasible for them? The decision aid assesses some preferences, which should be supplemented by clinical conversation. “As we think about what treatments might work best for you, what are the most important factors to take into account? Are there any things in your life that might make some options challenging? Any other preferences I should know about?”
4. Integrating the knowledge gained to decide together on a treatment approach. “So it sounds like, based on our discussion, what’s most important to you is X. Do you have a sense so far of which treatment might be the best fit for you?”
5. Once that approach is initiated, continuing to check in on how it is going and whether the treatment is meeting their goals. “As we move forward with this treatment, I’ll want to keep checking with you about how it’s going to make sure it’s meeting your needs. One way we do this is by having you complete some symptom checklists so that we can see whether your symptoms are improving. If we don’t see improvement, we’ll talk about how to make treatment more effective or whether to try a different treatment.”

As you can see, SDM is larger than a decision aid, but a decision aid can be helpful in Steps 2 and 3 of SDM, since it includes information about treatments and a quiz to assess patient preferences.

SDM is encouraged because it is related to increased patient engagement, adherence, and improved clinical outcomes.^3,4,5 It might involve a slight shift in practice, because it involves covering all treatment options, even if you don’t offer them yourself. SDM does not mean only using a decision aid, only informing patients about a single treatment, only providing a menu of options, simply doing what your patient wants, or forcing a patient to be involved in the decision if they do not want to be.

For more information about SDM, here are some further resources:

• One hour courses on SDM
  • For VA providers, several courses in TMS:
    • VA 38085 “Shared Decision Making”
    • VA 33813 “Shared Decision-Making for PTSD”
    • VA 131006195 “Ethical Considerations in Shared Decision Making for PTSD”
  • For non-VA providers:
    • In Train: Shared Decision Making: Evidence-Based Psychotherapy (EBP) - VHA TRAIN - an affiliate of the TRAIN Learning Network powered by the Public Health Foundation
    • https://www.ptsd.va.gov/professional/continuing_ed/shared_decision_making.asp
    • https://www.ptsd.va.gov/professional/continuing_ed/ethical_considerations_sdm.asp
• For an in-depth written toolkit, EBP_SDM_Toolkit_for_MH_Providers.pdf (va.gov)
• For more information about discussing PTSD treatment options with patients, check out Hooyer at al. (2024) and Larsen et al (2023).^6,7

It can be challenging for patients to feel comfortable with power dynamics within a treatment relationship, especially for patients who have identities that are marginalized by society because of race/ethnicity, gender, or sexual orientation. Patients may have felt unheard by clinicians in the past, or may have experienced discrimination, including by people who looked like their current clinician (e.g., same gender, race/ethnicity, etc). It may help to be more conscious of potential negative past experiences, be extra sure that you elicit a patient’s perspectives on what they want in treatment, and do your best to make clear that you want them to have a say in their treatment.

If you are a clinician who treats Veterans and you have additional questions about the PTSD Treatment Decision Aid or about PTSD treatment in general, contact the PTSD Consultation Program for free consultation, education, and information.