A personalized index to inform selection of a trauma-focused or non-trauma-focused treatment for PTSD.

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Publisher: Elsevier Science Publishers
Document Type: Report
Length: 519 words

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Keywords PTSD; Evidence-based psychotherapy; Treatment selection Highlights * A prognostic index was generated for each patient enrolled in PCT or PE for PTSD. * PE resulted in better patient outcomes than PCT for patients in the top 63rd percentile for best prognoses. * For those with worse prognoses, outcomes did not differ by treatment. Abstract PTSD treatment guidelines recommend several treatments with extensive empirical support, including Prolonged Exposure (PE), a trauma-focused treatment and Present-Centered Therapy (PCT), a non-trauma-focused therapy. Research to inform treatment selection has yielded inconsistent findings with single prognostic variables that are difficult to integrate into clinical decision-making. We examined whether a combination of prognostic factors can predict different benefits in a trauma-focused vs. a non-trauma-focused psychotherapy. We applied a multi-method variable selection procedure and developed a prognostic index (PI) with a sample of 267 female veterans and active-duty service members (mean age 45; SD = 9.37; 53% White) with current PTSD who began treatment in a randomized clinical trial comparing PE and PCT. We conducted linear regressions predicting outcomes (Clinician-Administered PTSD Scale score) with treatment condition, the PI, and the interaction between the PI and treatment condition. The interaction between treatment type and PI moderated treatment response, moderated post-treatment symptom severity, b = 0.30, SE.sub.b = 0.15 [95% CI: 0.01, 0.60], p = .049. For the 64% of participants with the best prognoses, PE resulted in better post-treatment outcomes; for the remainder, there was no difference. Use of a PI may lead to optimized patient outcomes and greater confidence when selecting trauma-focused treatments. Author Affiliation: (a) National Center for PTSD and Stanford University, United States (b) National Center for PTSD and University of California, Los Angeles, United States (c) National Center for PTSD, United States (d) University of Pennsylvania, United States (e) School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia (f) National Center for PTSD and Geisel School of Medicine at Dartmouth, United States * Corresponding author. Article History: Received 7 July 2020; Revised 24 March 2021; Accepted 19 April 2021 (footnote)[white star] Author Note: This study was conducted with grant Cooperative Studies Program (CSP) #494 from the VA Cooperative Studies Program and support from the Department of Defense for CSP #494. However, the views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the Department of Defense, or any US government agency. Trial registration information for CSP #494: Clinicaltrials.gov Identifier NCT00032617. Zachary D. Cohen and Robert J. DeRubeis are supported in part by a grant from MQ: Transforming mental health MQ14PM_27. The opinions and assertions contained in this article should not be construed as reflecting the views of the sponsors. Data reported were presented at the Annual Meeting of the and the Annual Meeting of the American Psychological Association, August 2018. We extend our thanks to Jiyoung Song and Clara Johnson for their assistance with manuscript preparation. Byline: Shannon Wiltsey Stirman [sws1@stanford.edu] (a,*), Zachary D. Cohen (b), Carole A. Lunney (c), Robert J. DeRubeis (d), Joshua F. Wiley (e), Paula P. Schnurr (f)

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Gale Document Number: GALE|A664259797