H. Patient Education

OBJECTIVE

Help trauma survivors cope with ASD/PTSD by providing information that may help them manage their symptoms and benefit from treatment.

BACKGROUND

Education of the trauma survivor is a core part of all PTSD treatment. Survivors need to better understand what they are experiencing, how to cope with reactions or symptoms, and what happens in treatment. It is also helpful to provide this information to family members or to the patient’s significant others so that they can more effectively support the patient’s recovery.

RECOMMENDATIONS

1. Trauma survivors should be educated about PTSD symptoms, other potential consequences of exposure to traumatic stress, practical ways of coping with traumatic stress symptoms, processes of recovery from ASD/PTSD, and the nature of treatments.

DISCUSSION

PTSD education involves teaching the survivor to label, recognize, and understand PTSD symptoms (and other trauma-related problems) that he or she is experiencing, providing simple advice regarding coping, explaining what he or she can do to facilitate recovery, and describing treatment options. Education can help make symptoms more understandable and predictable, decrease fear of symptoms, increase social support and lessen feelings of isolation, increase awareness of coping options and reduce maladaptive coping, and help survivors decide whether to seek treatment or learn how to better participate in treatment.

Education should be one of the first steps of PTSD treatment. It can help establish the credibility of the treatment provider, make treatment seem immediately helpful to the patient, and help prepare the patient for next steps in treatment. In fact, education should continue throughout PTSD treatment, sometimes in brief discussions when the patient has questions and sometimes more systematically as a formal helping activity. It can be delivered to individuals or to groups. Because those with PTSD often have difficulties with concentration and memory, repetition of educational information and provision of written information are important.

The content of PTSD-related education can include the following topics:

1. Nature of PTSD symptoms: It is often useful to help the survivor identify and label the reactions that he or she may be experiencing, recognize that emotional and physical reactions are very common (and not dangerous), and understand that anxiety and distress are often “triggered” by reminders of the traumatic experience that can include sights, sounds, or smells associated with the trauma, physical sensations (e.g., heart pounding), or behaviors of other people.
2. Practical steps to cope with trauma-related problems: Survivors can also be educated about ways of coping with their PTSD symptoms in order to minimize their impact on functioning and quality of life. While education about coping is not a substitute for more systematic coping skills training, simple information can also be useful. Survivors can be helped to distinguish between positive and negative coping actions. Positive coping includes actions that help to reduce anxiety, lessen other distressing reactions, and improve the situation: relaxation methods, exercise in moderation, talking to another person for support, positive distracting activities, and active participation in treatment. Negative coping methods may help to perpetuate problems and can include continual avoidance of thinking about the trauma, use of alcohol or drugs, social isolation, and aggressive or violent actions.
3. Nature of the recovery process and PTSD treatment: Survivors will sometimes have unrealistic or inaccurate expectations of recovery, and may benefit from understanding that recovery is an ongoing daily gradual process (i.e., it doesn’t happen through sudden insight or “cure”) and that healing doesn’t mean forgetting about the trauma or having no emotional pain when thinking about it. Education about what happens in treatment is also important. This can help build motivation to participate or persist in treatment.

Despite the ubiquity of education in PTSD treatment, and a strong clinical consensus as to the importance of such education, there is little evidence bearing on its impact on chronic PTSD. Education has usually been a component of empirically-supported treatments, but it has not been evaluated as a “stand alone” treatment (nor is it intended to be delivered in the absence of other treatment elements).