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A key component of SDM involves empowering patients with information about potential treatment options to promote informed choice and agency in the treatment decision-making process. As part of this step of the SDM Session, the provider identifies potential treatment options and presents verbally and in written form a summary of information about each treatment and what treatment involves, the treatment length and frequency, the risks of treatment, and the effectiveness of treatment.
Patient decision aids and related resources for use during the Educate step of the SDM Session are provided on this page, including:
Treatment Options Grids: Customizable matrices with key information about different treatment options, listed side by side, for a specific condition. The Treatment Options Grid is provided to patients as a visual guide during the discussion of potential treatment options during the Educate step. Treatment Options Grids may be customized for individual patients and local use, including removing or adding EBPs or other treatments based on clinical considerations for specific patients and local treatment availability.
Treatment Fact Sheets: Following each Treatment Options Grid is a list of patient education handouts providing additional information about specific treatment options for patients interested in learning more about specific treatment options after reviewing and discussing the treatments included on the Treatment Options Grid.
Treatment Options Grids
Please note that the Treatment Options Grid will be wider than the available space on the page, so it will be necessary to scroll to the right to see all the columns in the grid. And, if viewing on a small mobile screen, rotating to landscape display will provide better viewing of the grids.
The Treatment Options Grid may be printed from your web browser (File ➤ Print) for providing to patients. You may also click the "Extract Grid" button to open the grid in a pop-up window from which you can print a simplified version of the table or copy/paste the contents into other documents.
Treatment Options for:
Cognitive Behavioral Therapy (CBT)
Acceptance and Commitment Therapy (ACT)
Interpersonal Psychotherapy (IPT)
General Talk Therapy
Medication
How does this treatment work?
CBT works by helping you to change negative ways of thinking about yourself or situations in your life that often contribute to depression.
It also works by helping you plan and do things in your life that give you joy and satisfaction.
ACT works by changing your relationship with your thoughts and feelings so that they no longer hold the power they once did.
It also focuses on clarifying values you hold for what matters most in your life — and then taking actions to live according to those values.
IPT focuses on improving relationship issues that may contribute to depression. This may involve strategies to improve or expand relationships in your life.
General talk therapy involves talking about problems that are on your mind. Unlike the other talk therapies listed here, general talk therapy does not mainly focus on teaching skills for improving thoughts, behaviors, or relationships.
Antidepressant medications help to help reduce symptoms of depression by increasing certain chemicals in the brain that are believed to be related to depression. They are usually taken once a day or as otherwise directed by a prescriber who monitors symptoms and side effects.
Antidepressant medications can be taken in combination with one of the talk therapies.
How long does treatment last?
CBT usually lasts 12-16 sessions, though the actual length is determined by you and your therapist.
ACT usually lasts 12-16 sessions, but the actual length is determined by you and your therapist.
IPT usually lasts 12-16 sessions, but the actual length is determined by you and your therapist.
General talk therapy is less structured and does not have a specific treatment length.
Medication treatment usually about lasts 6 to 12 months. For some people, it is recommended that they continue to take medication for longer periods of time.
What are the risks of this treatment?
You may feel discomfort when talking about difficult issues that you are currently facing in your life.
You may feel discomfort when talking about difficult issues that you are currently facing in your life.
You may feel discomfort when talking about difficult issues that you are currently facing in your life.
You may feel discomfort when talking about difficult issues either those that you are currently facing or that you have faced in the past.
Side effects are generally mild. The most common side effects are nausea, diarrhea, drowsiness, and sexual problems (for some medications). Less common side effects are sweating, sleep problems, and dry mouth. If you choose to receive medication, you can talk with your prescriber about different medication options and specific side effects of each.
How effective is this treatment?
Decades of research have shown CBT to be effective in treating depression, including with Veterans. On average, CBT reduces symptoms of depression by almost half. And it is highly recommended by experts. Because CBT helps people develop skills for changing thoughts and behaviors related to depression, the benefits usually last well beyond the end of treatment.
Although a newer talk therapy, a number of research studies have shown ACT to be effective in treating depression, including with Veterans. Because ACT teaches new skills for managing unpleasant thoughts and emotions related to depression and for focusing on living life according to one's values, the benefits usually last well beyond the end of treatment.
Decades of research have shown IPT to be effective in treating depression, including with Veterans. On average, IPT reduces symptoms of depression by almost half. And it is highly recommended by experts. Because IPT helps to improve relationship issues related to depression and learn effective relationship skills, the benefits usually last well beyond the end treatment.
General talk therapy can be helpful for some people, particularly those who are more interested in learning about themselves or receiving general support. Because it does not focus on teaching specific skills for addressing problems related to depression, the benefits, for some, may not always last well beyond the end of treatment.
Antidepressant medications have been shown in research studies to be effective in reducing symptoms of depression. Some research suggests that medication is not as effective over the long-term. For some people, medication combined with talk therapy can be helpful and more effective that either treatment alone.
CBT for Insomnia teaches proven strategies for re-training the brain for sleep. It also teaches thinking and relaxation skills to calm both the mind and body at night.
Sleep hygiene education consists of information to help you better understand behaviors and lifestyle habits that interfere with sleep. It also provides steps you can take to improve sleep. It generally does not involve ongoing support and coaching by a therapist. Sleep hygiene education is one part of CBT for Insomnia treatment that is sometimes provided separately, mainly for those with more mild sleep problems.
Relaxation training involves teaching effective skills for relaxing both the mind and body. These skills usually include deep breathing, relaxing different muscle groups, and imagining calming and peaceful scenes. Relaxation training is one part of CBT for Insomnia treatment that is sometimes provided separately, mainly for those with more mild sleep problems.
Sleep medications are medications that increase sleepiness and are usually taken a short time before bed. Sleep medications are provided by a prescriber who monitors symptoms and side effects.
How long does treatment last?
Treatment generally lasts only 6 or less.
Sleep hygiene education is usually provided in 1-2 visits sessions.
Relaxation can be taught in one session, although it is usually best to return for several sessions to practice and get feedback from your provider.
Medication treatment typically lasts 6 to 12 months.
What are the risks of this treatment?
There are few risks associated with CBT for Insomnia. Although initially, you may feel a temporary increase in sleepiness as you learn new skills to help you sleep better.
There are few risks associated with sleep hygiene education.
There are few risks associated with relaxation training.
The most common side effects of sleep medications are daytime drowsiness, dizziness, mental slowing, and unusual dreams. In some cases, people develop a tolerance to sleep medications, meaning the effects wear off or require a higher dose to have effect.
How effective is this treatment?
Many years of research have shown CBT for insomnia to be very effective in treating insomnia. About 2 out of 3 Veterans who receive this treatment sleep much better within 6 weeks. And it is highly recommended by experts. Because CBT teaches new skills for sleeping longer and better, the benefits usually last.
Sleep hygiene education can provide helpful tips for improving sleep habits, mostly for people with more mild sleep problems. Sleep hygiene education, which is included as one part of CBT for Insomnia, is not as effective as overall CBT for Insomnia treatment.
Relaxation training is effective for some people in helping to quiet the mind and body for sleep. Relaxation training, which is included as one part of CBT for Insomnia, is not as effective as full CBT for Insomnia treatment, especially for people with more than mild sleep problems.
Sleep medications are effective in increasing sleepiness and in helping people fall asleep. They tend to be less effective in improving the quality of sleep. They also must be taken in order to provide benefit. For this reason, CBT for Insomnia has been shown to more effective than sleep medications over the long-term.
Cognitive Behavioral Therapy for Substance Use Disorders (CBT-SUD)
Motivational Enhancement Therapy (MET)
Behavioral Couples Therapy for Alcohol Use Disorders (BCT)
Contingency Management (CM)
Community Reinforcement Approach (CRA)
General Talk Therapy
12-Step Facilitation
Medication
How does this treatment work?
CBT-SUD works by teaching you how to change negative thoughts and behaviors that lead to substance use, including: (1) skills for managing urges to use, (2) skills for refusing alcohol or other drugs, and (3) skills for addressing problems related to substance use, like managing negative emotions, solving problems, and improving social support. You may invite a significant other to join a few sessions to talk about how they can best support you.
MET is a very brief approach that focuses on your motivation for making changes in substance use. It helps you explore your reasons for wanting to make changes. You will answer some questions on paper and your therapist will provide you with personalized feedback based on your responses.
BCT is a couples-based therapy that helps you make changes in substance use while also working to improve your relationship satisfaction. During treatment, you commit to daily goals and your partner commits to supporting you in achieving your goals. You and your partner will also work together to increase the number of activities you do together.
CM works by rewarding you for specific behaviors you engage in that help you meet your recovery goals. The rewards often consist of money or vouchers that can be exchanged for items. You will receive rewards at certain times, such as when you have a negative drug screen or breathalyzer, or when you attend your treatment appointments.
CRA works by using family, social, recreational, or occupational events to support you in changing your substance use. It helps you develop a substance-free lifestyle that you find more rewarding than a lifestyle that involves alcohol or other drugs. Involvement of a significant other is encouraged.
General Talk Therapy involves talking about problems that are on your mind. Unlike the other talk therapies listed here, General Talk Therapy focuses on providing general support and does not usually focus on teaching specific skills for improving thoughts, behaviors, or relationships.
12-Step facilitation focuses on connecting you with mutual help groups like Alcoholics Anonymous. Your therapist helps you to address three areas that fit with the 12-step approach. First is an acceptance of the power that a substance has had over you. Second is to surrender to a higher power while becoming and seeking help as part of a fellowship. Third is active involvement in meetings.
There are medications designed to help people with different kinds of symptoms. Some medications help you with urges and cravings to use, while others help with managing symptoms related to substance use withdrawal.
How long does treatment last?
CBT-SUD usually lasts 12 sessions, though the actual length is determined by you and your therapist.
MET usually lasts 2-4 sessions, though the actual length is determined by you and your therapist.
BCT usually lasts 12-20 sessions, though the actual length is determined by you and your therapist.
The length of CM varies from person to person and is determined by you and your therapist.
CRA usually lasts 12-16 sessions, though the actual length is determined by you and your therapist.
General Talk Therapy is less structured than other talk therapies and does not have a specific treatment length.
The length of 12-Step Facilitation treatment varies from person to person.
The amount of time someone takes medication varies from person to person. Some people might take it for a short time to help reduce cravings while others might continue to take medication without a specific end point.
What are the risks of this treatment?
You may feel discomfort when talking about difficult issues that you are currently facing in your life.
You may feel discomfort when talking about difficult issues that you are currently facing in your life.
You may feel discomfort when talking about difficult issues that you are currently facing in your life.
You may feel discomfort when talking about difficult issues that you are currently facing in your life.
You may feel discomfort when talking about difficult issues that you are currently facing in your life.
You may feel discomfort when talking about difficult issues — either those that you are currently facing or that you have faced in the past.
You may feel discomfort when talking about difficult issues that you are currently facing in your life. In group meetings, you may feel uneasy, particularly early on, sharing or hearing others' personal information.
The person who prescribes your medications will discuss potential sides effects with you and will monitor you for side effects. It's possible that one medication will work better for you than another.
How effective is this treatment?
Many years of research have shown CBT-SUD to be effective in treating alcohol, stimulant, and cannabis use disorders. And, it is recommended by experts.
Consistent research has shown MET to be effective in increasing motivation to change alcohol and cannabis use, as well as in increasing motivation for treatment.
Consistent research has shown BCT to be effective in reducing use of alcohol and other drugs and improving relationship satisfaction.
Research has shown CM to be effective in improving outcomes for some people when used with other types of treatment. For many people, CM increases participation in treatment and abstinence.
More than three decades of research has shown CRA to be effective for many individuals with alcohol use disorders. Research has also found it to be an effective treatment for stimulant use disorders. For many people, it leads to a reduction in substance use, as well as improvements in other areas of life, such as employment.
General Talk Therapy can be helpful for some people, particularly those who are interested in learning about themselves or receiving general support. Because it does not focus on teaching skills for addressing substance use, the benefits are usually not as great, or last as long, as other treatments. For this reason, experts usually recommend one of the other treatments listed first here for most people.
Increasing research in recent years has shown that mutual support groups are effective for many people with alcohol use disorders. The research on those with other drug-related problems is less but promising. Research has shown that 12-Step Facilitation is associated with greater participation in mutual support groups and better outcomes.
Research has shown certain medications to be effective in reducing cravings and urges for some substances. Other medications are effective in helping to manage withdrawal symptoms. There are medications that can help some individuals with substance use disorders stop using. For opiate use disorders, medication is very effective for many individuals. Medications can be taken in combination with one of the talk therapies. The combination of medication and talk therapy is often more effective than either of them alone.
Substance Use Disorder Treatment Fact Sheets for Patients
