PTSD: A Multi-Faceted Educational Approach

Introduction

“Post-traumatic stress disorder (PTSD) is a chronic mental disorder resulting in a reduced quality of life” (Ghazi, Ziyad, Reijnders, Nijs, & Eijssen, 2023). When talking about PTSD, one of the first things that come to mind for most people might be military personnel that have been to war. While this is undoubtedly true, it is estimated that “approximately 70% of the world’s population have been exposed to a traumatic life event” (Global prevalence of stress and trauma-related disorders, 2023). While not all exposures to a traumatic event will develop into PTSD, for the people who develop PTSD, it is a mental handicap that they must learn to live with. As instructional designers, we can apply learning engagement principles to help make living with this disorder easier.

Meaningful Knowledge

Many people who seek help with PTSD do so because they want to improve their current way of life. Usually, they seek out knowledge on how to improve their lives. This usually begins by setting an emotional goal that when achieved helps them feel good about themselves and gives them new opportunities to enjoy friendly interactions with other people. (Reiser, 2017). People can learn to achieve these emotional goals through cognitive behavioral therapy (CBT). The principles behind CBT are evidential based and have been proven to give learners the meaningful knowledge they seek. CBT’s learning objectives are: “Psychological problems are based in part on faulty thinking. Psychological problems are based in part on learned patterns of unhelpful behavior. People suffering from psychological problems can learn better ways of coping with them…” (Psychology, 2017). CBT aims to take these distorted thoughts (s) and “reevaluate them in the light of reality” (Psychology, 2017). The following is an example of how I sought help and learned to use CBT to reevaluate one of my thoughts, which provided me with the meaningful knowledge I sought.

I previously thought when I was deployed that, I let myself get too close to the patients that I was treating. I felt I should have kept a professional barrier in place to prevent myself from getting emotionally attached and “caring too much” for my patients. That thought pattern was unhealthy, and I had to learn how to train my brain by “rephrasing” that thought into something accurate. Through CBT, I learned to rephrase that thought: “I was emotionally invested in every single one of my patients, and that characteristic helped me provide outstanding care to everyone I treated.” Rephrasing that one thought gave me meaningful knowledge that helped me achieve my emotional goal.

CBT is one cognitive tool that people with PTSD can use to gain knowledge and apply it to make their lives better. While this thought restructuring process effectively reshapes someone’s perspective of the trauma, this approach fails to teach people with PTSD the day-to-day life skills needed to function and deal with life’s stressors. To deal with these life stressors, another learning strategy that a person with PTSD needs to learn is mastering the task.

Mastering the Task

Learning how to master one’s emotions is another objective that people with PTSD need to learn. The basis behind teaching how to master one’s thoughts is teaching those with PTSD to believe that they might not have control over a situation but do have control over their emotions. To help them master this task of learning is something called DBT (Dialectical Behavioral Therapy). DBT is based on four pillars that strive to lessen the emotional responses that people with PTSD feel and are prone to. The first pillar is distress tolerance. This technique helps people with PTSD learn how to build resiliency to reduce the emotional response when exposed to certain triggering events (Traffic, loud noises, smells, etc.) (McKay, Wood, & Brantley, 2019). The second pillar is mindfulness, which aims to teach patients how to live and focus on the present instead of reliving the past (McKay, Wood, & Brantley, 2019). The third pillar is teaching patients how to regulate their emotions by being present in them without letting them swing out of control (McKay, Wood, & Brantley, 2019). Finally, the fourth pillar is interpersonal effectiveness, which teaches patients how to express feelings and emotions while respecting others (McKay, Wood, & Brantley, 2019).

While CBT provides learners with insightful knowledge, and DBT teaches people how to master their emotions, those tools are sometimes insufficient. Another way to teach people how to teach people living with PTSD is by providing them with the belief that they can succeed in their endeavor to overcome it.

Believe to Succeed

Sometimes learners may not believe they can succeed in the task they have set out to learn or overcome. One way to teach people with PTSD that they can succeed is by making them believe that “they can look the dragon square in the eye.” The dragon they need to believe they can succeed in living with is their trauma. A way to help people with PTSD believe they can succeed is through Virtual Reality Exposure Therapy (VRET). VRET is a treatment tool that teaches people new responses to previously feared stimuli (Rizzo & Shilling, 2017). The first time this therapy was applied to military populations was in “1997 when researchers at Georgia Tech and Emory University began testing the Virtual Vietnam VR scenario with Vietnam veterans diagnosed with PTSD” (Rizzo & Shilling, 2017). This initial treatment modality has undergone several iterations and has evolved into an effective treatment not only for people with PTSD, but for other mental health conditions as well.

People who undergo care using VRE attempt to “process the emotions associated with the trauma and de-condition the learning cycle via a habituation/extinction process” (medvr.ict.usc.edu/projects/bravemind.html, 2023). The theory behind VRE is that it uses simulations as close to the patient’s original trauma, bringing about an emotional response from the individual controlled by the clinician, that customizes the pace and relevance of exposure to the individual patient (Rizzo & Shilling, 2017). By experiencing the tailored VR experience over and over again, the patient learns how to process the emotions of the trauma; “they learn how to become desensitized to the stimuli of the trauma, so those stimuli stop causing fear, as well as any method capable of activating the fear structure” (Rizzo & Shilling, 2017). After therapy, patients reported a significant decrease in PTSD symptoms after learning to process their traumas successfully.

IDT and PTSD

Applying the learning principles above, in conjunction with a program like adobe captivate, a PTSD learning module can be created using instructional design principles. The target audience of this module would be low-income people who would like to seek PTSD treatment but cannot afford to do so or an individual who does not want to see a provider face-to-face. The learning objectives of this module would be “Identify thoughts and feelings associated with the trauma,” “Identify thoughts that are harmful or untrue,” and “Reformulate harmful or intrusive thoughts into something more accurate.” Besides being accessible to a learner, this module would also need to be accessible by a mental health provider or intern. A professional would be required to monitor the patient so they could guide them through the trauma processing, provide them with feedback, and encourage them to complete the process. An interactive format we use in Fullsail is one example of how this could be accomplished. As the module went through iteration after iteration, eventually the goal would be to decrease the dependence of a mental health professional, which could be achieved through AI.

Conclusion

Learning takes on many shapes and forms and can be accomplished in many ways. I used PTSD as one example, but the overall formula of how we design learning experiences does not depend on the subject. It starts with identifying the objectives we want the learner to achieve. We need to establish how we are going to get the learner to achieve those objectives. Identify how we will engage the learner throughout the learning process and “measure” if learning was achieved. If learning is not achieved, we need to redesign how we get the learner to the objectives. If learning is achieved, it is on to the next iteration to continually make our learning platforms a little bit better.

References

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