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For providers who work with PTSD patients, an important part of their job involves providing education about PTSD treatment options and helping patients decide on a course of treatment.   But, it can be hard to know exactly how to approach treatment decisions with patients.  For example, how much should providers involve patients in these decisions? What are the most important pieces of treatment information to share?  
We thought the best way to answer these questions would be to ask people with PTSD for their opinions.  Our research team at the National Center for PTSD conducted an online survey of 301 adults (half were Veterans) with PTSD symptoms.  All respondents had experienced at least one trauma and screened positive for PTSD on the Primary Care PTSD Screen. 

Preferences for Involvement in Decisions

We started by asking respondents how involved they would want to be in PTSD treatment decisions. 
Similar to prior studies, almost all respondents (97%) wanted to be involved in decision-making. What was surprising, though, is how much control respondents wanted over treatment decisions. Research on patients with other medical conditions, such as cancer (Singh et al., 2010), shows that most patients prefer a collaborative approach where the patient and provider contribute equally to decision-making.  
But this was not the case in our study. 
We found that most participants preferred to be in the driver’s seat when it came to treatment decisions, wanting more control over decisions than their provider.  Although we are not sure why patients want this level of control, one possibility is that characteristic features of PTSD, such as mistrust of others or a need to be in control of situations, may result in a preference for control over treatment decisions.

Preferences for Treatment Information

Next, respondents imagined they were picking a PTSD treatment.  We asked what they would need to know about each treatment option to make a good decision.  
Respondents were most interested in learning about (1) treatment effectiveness (2) potential side effects and (3) how long treatment benefits last.  They were less interested in learning about the amount of homework involved or whether they would need to talk about their trauma in treatment. 
These results suggest that it is important for providers to tell patients how well treatments work—maybe even more important than explaining the exact tasks or techniques used in the treatments.

Preferences for Timing

Finally, we asked respondents how much time they would need to think about their options before making a decision.   Most (80%) wanted at least 1-3 days to consider their choices, and roughly 60% wanted to take the time to involve a family member or friend in the decision-making process.   
In many care settings, patients may be assigned to a particular PTSD treatment during their initial intake session.  Our findings show that this approach may rush patients, pushing them to make a decision before they have had enough time to consider options or get input from loved ones.
Overall, results of this study show that the vast majority of people who screen positive for PTSD want to be involved in treatment decisions.  Providers can do their part in promoting patient-centered decision-making by encouraging patient involvement (to the extent each patient prefers), providing information about treatment effectiveness, and offering patients additional time to consider their choices. 

Reference Article

Harik, J. M., Hundt, N. E., Bernardy, N. C., Norman, S. B., & Hamblen, J. L. (in press). Desired involvement in treatment decisions among adults with PTSD symptoms. Journal of Traumatic Stress.

Discussion Questions:

  1. How might you collaboratively engage your patients in PTSD treatment decision-making? Do these results suggest any changes you might make?  
  2. Given that patients want information on treatment effectiveness, how will you communicate effectiveness in ways that your patients can understand? What resources might you use to help you describe treatment effectiveness?

Author Biographies

Juliette M. Harik
is a research psychologist at the National Center for PTSD-Executive Division and Assistant Professor at Geisel School of Medicine at Dartmouth.  Her works focuses on improving the quality of PTSD treatment decisions.  She is currently developing an online PTSD Decision Aid for the National Center for PTSD website.
Jessica L. Hamblen
is the Deputy for Education at the National Center for PTSD and Associate Professor at Geisel School of Medicine at Dartmouth.  Dr. Hamblen's interests are in developing, disseminating, and evaluating cognitive behavioral treatments for PTSD and related conditions. 
Natalie E. Hundt
is a research psychologist with the Houston VA and Assistant Professor at Baylor College of Medicine. Her work focuses on engaging patients in PTSD care and understanding the factors related to poor engagement.


Singh, J. A., Sloan, J. A., Atherton, P. J., Smith, T., Hack, T. F., Huschka, M. M., ... & Degner, L. F. (2010). Preferred roles in treatment decision making among patients with cancer: a pooled analysis of studies using the Control Preferences Scale. The American Journal of Managed Care, 16, 688.