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Patient characteristics as a moderator of posttraumatic stress disorder treatment outcome: combining symptom burden and strengths

Published online by Cambridge University Press:  02 January 2018

Marylene Cloitre ,
Eva Petkova ,
Zhe Su  and
Brandon J. Weiss
Marylene Cloitre*
Affiliation:
National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA NYU Langone Medical Center, New York, USA
Eva Petkova
Affiliation:
Department of Child & Adolescent Psychiatry, NYU Langone Medical Center; Nathan Kline Institute for Psychiatric Research, New York State Office of Mental Health, New York, New York, USA
Zhe Su
Affiliation:
Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, New York, USA
Brandon J. Weiss
Affiliation:
National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
*
Marylene Cloitre, National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA. Email: [email protected]
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Abstract

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Background

Post-traumatic stress disorder (PTSD) psychotherapy research has failed to identify patient characteristics that consistently predict differential outcome.

Aims

To identify patient characteristics associated with differential outcome via a statistically generated composite moderator among women with childhood abuse-related PTSD in a randomised controlled trial comparing exposure therapy, skills training and their combination.

Method

Six baseline patient characteristics were combined in a composite moderator of treatment effects for PTSD symptoms across the three treatment conditions through a 6-month follow-up.

Results

The optimal moderator was the combined burden of all symptoms and emotion regulation strength. Those with high moderator scores, reflecting high symptom load relative to emotion regulation, did least well in exposure, moderately well in skills and best in the combination.

Conclusions

A clinically meaningful moderator, which combines patient symptom burden and strengths, was identified. Assessment at follow-up may provide a more accurate indicator of variability in outcome than that obtained immediately post-treatment.

Type
Research Article
Information
BJPsych Open , Volume 2 , Issue 2 , March 2016 , pp. 101 - 106
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Copyright
Copyright © The Royal College of Psychiatrists 2016

Footnotes

Declaration of interest

None.

References

1 Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62: 593–602.Google Scholar
2 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). APA, 2013.Google Scholar
3 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.Google Scholar
4 Rodriguez, P, Holowka, DW, Marx, BP. Assessment of posttraumatic stress disorder-related functional impairment: a review. J Rehabil Res Dev 2012; 49: 649–65.Google Scholar
5 Schnurr, PP, Lunney, CA, Bovin, MJ, Marx, BP. Posttraumatic stress disorder and quality of life: extension of findings to veterans of the wars in Iraq and Afghanistan. Clin Psychol Rev 2009; 29: 727–35.Google Scholar
6 Australian Centre for Posttraumatic Mental Health. Australian Guidelines for the Treatment of Acute Stress Disorder and Post-traumatic Stress Disorder. ACPMH, 2013 (http://phoenixaustralia.org/wp-content/uploads/2015/03/Phoenix-ASD-PTSD-Guidelines.pdf).Google Scholar
7 National Institute for Clinical Excellence. Post-Traumatic Stress Disorder (PTSD): The Management of PTSD in Adults and Children in Primary and Secondary Care (Clinical Guideline 26). NICE, 2005.Google Scholar
8 Kessler, RC, Sonnega, A, Bromet, E, Hughes, M, Nelson, CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995; 52: 1048–60.Google Scholar
9 Bradley, R, Greene, J, Russ, E, Dutra, L, Westen, D. A multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry 2005; 162: 214–27.Google Scholar
10 Schottenbauer, MA, Glass, CR, Arnkoff, DB, Tendick, V, Gray, SH. Nonresponse and dropout rates in outcome studies on PTSD: review and methodological considerations. Psychiatry 2008; 71: 134–68.Google Scholar
11 Kraemer, HC, Wilson, GT, Fairburn, CG, Agras, WS. Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry 2002; 59: 877–83.Google Scholar
12 Institute of Medicine. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease. The National Academies Press, 2011.Google Scholar
13 Cloitre, M, Courtois, CA, Ford, JD, Green, BL, Alexander, P, Briere, J, et al. The ISTSS Expert Consensus Treatment Guidelines for Complex PTSD in Adults. International Society for Traumatic Stress Studies, 2012.Google Scholar
14 Karam, EG, Friedman, MJ, Hill, ED, Kessler, RC, McLaughlin, KA, Petukhova, M, et al. Cumulative traumas and risk thresholds: 12-month PTSD in the World Mental Health (WMH) surveys. Depress Anxiety 2014; 31: 130–42.Google Scholar
15 Taylor, S, Fedoroff, IC, Koch, WJ, Thordarson, DS, Fecteau, G, Nicki, RM. Posttraumatic stress disorder arising after road traffic collisions: patterns of response to cognitive-behavior therapy. J Consult Clin Psychol 2001; 69: 541–51.Google Scholar
16 Hagenaars, MA, Van Minnen, A, Hoogduin, KA. The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD. Behav Res Ther 2010; 48: 19–27.Google Scholar
17 Van Minnen, A, Arntz, A, Keijsers, GP. Prolonged exposure in patients with chronic PTSD: predictors of treatment outcome and dropout. Behav Res Ther 2002; 40: 439–57.Google Scholar
18 Rizvi, SL, Vogt, DS, Resick, PA. Cognitive and affective predictors of treatment outcome in Cognitive Processing Therapy and Prolonged Exposure for posttraumatic stress disorder. Behav Res Ther 2009; 47: 737–43.Google Scholar
19 Hembree, EA, Street, GP, Riggs, DS, Foa, EB. Do assault-related variables predict response to cognitive behavioral treatment for PTSD? J Consult Clin Psychol 2004; 72: 531–4.Google Scholar
20 Resick, PA, Suvak, MK, Wells, SY. The impact of childhood abuse among women with assault-related PTSD receiving short-term cognitive-behavioral therapy. J Trauma Stress 2014; 27: 558–67.Google Scholar
21 Van Minnen, A, Harned, MS, Zoellner, L, Mills, K. Examining potential contraindications for prolonged exposure therapy for PTSD. Eur J Psychotraumatol 2012; 3: 1–241.Google Scholar
22 Bisson, JI, Roberts, NP, Andrew, M, Cooper, R, Lewis, C. Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev 2013; 12: CD003388.Google Scholar
23 Wallace, ML, Frank, E, Kraemer, HC. A novel approach for developing and interpreting treatment moderator profiles in randomized clinical trials. JAMA Psychiatry 2013; 70: 1241–7.Google Scholar
24 French, B, Joo, J, Geller, NL, Kimmel, SE, Rosenberg, Y, Anderson, JL, et al. Statistical design of personalized medicine interventions: the Clarification of Optimal Anticoagulation through Genetics (COAG) trial. Trials 2010; 11: 108.Google Scholar
25 Murphy, SA. Optimal dynamic treatment regimes. J Roy Stat Soc B 2003; 58: 331–66.Google Scholar
26 Petkova, E, Su, Z. Modeling strategies for developing treatment responses indices. (Session IPS021). In Proceedings of the 59th ISI World Statistics Conference, 25–30 August 2013, Hong Kong: 121–5. Avaialable at http://www.statistics.gov.hk/wsc/IPS012-P3-S.pdf (accessed 28 Jan 2016).Google Scholar
27 Cloitre, M, Stovall-McClough, KC, Nooner, K, Zorbas, P, Cherry, S, Jackson, CL, et al. Treatment for PTSD related to childhood abuse: a randomized controlled trial. Am J Psychiatry 2010; 167: 915–24.Google Scholar
28 Weathers, FW, Keane, TM, Davidson, JR. Clinician-administered PTSD scale: a review of the first ten years of research. Depress Anxiety 2001; 13: 132–56.Google Scholar
29 Beck, AT, Steer, RA, Brown, GK. Manuel for the Beck Depression Inventory-II. Psychological Corporation, 1996.Google Scholar
30 Briere, J. Trauma Symptom Inventory Professional Manual. Psychological Assessment Resources, 1995.Google Scholar
31 Horowitz, LM, Rosenberg, SE, Baer, BA, Ureño, G, Villaseñor, VS. Inventory of interpersonal problems: psychometric properties and clinical applications. J Consult Clin Psychol 1988; 56: 885–92.Google Scholar
32 Spielberger, C. State-Trait Anger Expression Inventory Manual. Psychological Assessment Resources, 1991.Google Scholar
33 Catanzaro, SJ, Mearns, J. Measuring generalized expectancies for negative mood regulation: initial scale development and implications. J Pers Assess 1990; 54: 546–63.Google Scholar
34 Diggle, PJ, Heagerty, P, Liang, K-Y, Zeger, SL. Analysis of Longitudinal Data (2nd edn). Oxford University Press, 2002.Google Scholar
35 R Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, 2013.Google Scholar
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