A systematic review of factors associated with outcome of psychological treatments for post-traumatic stress disorder

Barawi, Kali; Lewis, Catrin; Simon, Natalie; Bisson, Jonathan I.

doi:10.1080/20008198.2020.1774240

Cited by 33 publications

(30 citation statements)

References 176 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Predictors of the exposure conditions correspond to previously identified predictors of PTSD treatment in general. There is considerable evidence for the relationship between more severe depressive symptoms and worse treatment outcomes and between less social support and worse treatment outcomes of PTSD treatment [ 50 , 51 ]. Predictors of STAIR+PE have not been frequently investigated, but the finding that more emotion regulation difficulties predicted worse treatment outcomes in this condition seems to contradict a previous study finding that more emotion regulation difficulties relative to symptom burden were related to better outcomes in STAIR+PE, compared to PE [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Personalization of Treatment for Patients with Childhood-Abuse-Related Posttraumatic Stress Disorder

Hoeboer

Oprel

Kleine

et al. 2021

JCM

View full text Add to dashboard Cite

Background: Differences in effectiveness among treatments for posttraumatic stress disorder (PTSD) are typically small. Given the variation between patients in treatment response, personalization offers a new way to improve treatment outcomes. The aim of this study was to identify predictors of psychotherapy outcome in PTSD and to combine these into a personalized advantage index (PAI). Methods: We used data from a recent randomized controlled trial comparing prolonged exposure (PE; n = 48), intensified PE (iPE; n = 51), and skills training (STAIR), followed by PE (n = 50) in 149 patients with childhood-abuse-related PTSD (CA-PTSD). Outcome measures were clinician-assessed and self-reported PTSD symptoms. Predictors were identified in the exposure therapies (PE and iPE) and STAIR+PE separately using random forests and subsequent bootstrap procedures. Next, these predictors were used to calculate PAI and to retrospectively determine optimal and suboptimal treatment in a leave-one-out cross-validation approach. Results: More depressive symptoms, less social support, more axis-1 diagnoses, and higher severity of childhood sexual abuse were predictors of worse treatment outcomes in PE and iPE. More emotion regulation difficulties, lower general health status, and higher baseline PTSD symptoms were predictors of worse treatment outcomes in STAIR+PE. Randomization to optimal treatment based on these predictors resulted in more improvement than suboptimal treatment in clinician assessed (Cohens’ d = 0.55) and self-reported PTSD symptoms (Cohens’ d = 0.47). Conclusion: Personalization based on PAI is a promising tool to improve therapy outcomes in patients with CA-PTSD. Further studies are needed to replicate findings in prospective studies.

show abstract

Section: Discussionmentioning

confidence: 99%

Personalization of Treatment for Patients with Childhood-Abuse-Related Posttraumatic Stress Disorder

Hoeboer

Oprel

Kleine

et al. 2021

JCM

View full text Add to dashboard Cite

show abstract

“…Then, we conducted a systematic search in the databases PsycINFO and Medline for the period between 1 January 2013 and 22 September 2020. Finally, we reviewed the relevant meta-analyses on the efficacy of psychological interventions for adult PTSD published since 2013 (Asmundson et al, 2019 ; Barawi, Lewis, Simon, & Bisson, 2020 ; Bisson, van Gelderen, Roberts, & Lewis, 2020 ; Carpenter et al, 2018 ; Cipriani et al, 2018 ; Coventry et al, 2020 ; Cusack et al, 2016 ; Gallegos, Crean, Pigeon, & Heffner, 2017 ; Gerger et al, 2014 ; Grasser & Javanbakht, 2019 ; Hegberg, Hayes, & Hayes, 2019 ; Hopwood & Schutte, 2017 ; Karatzias et al, 2019 ; Khan et al, 2018 ; Kline, Cooper, Rytwinksi, & Feeny, 2018 ; Kuester, Niemeyer, & Knaevelsrud, 2016 ; Lenz, Haktanir, & Callender, 2017 ; Lewis, Roberts, Andrew, Starling, & Bisson, 2020a ; Lewis, Roberts, Bethell, Robertson, & Bisson, 2018 ; Lewis, Roberts, Gibson, & Bisson, 2020b ; Mahoney, Karatzias, & Hutton, 2019 ; Mavranezouli et al, 2020 ; Montero-Marin, Garcia-Campayo, López-Montoyo, Zabaleta-Del-Olmo, & Cuijpers, 2018 ; Morina, Malek, Nickerson, & Bryant, 2017a ; Niles et al, 2018 ; Schwartze, Barkowski, Strauss, Knaevelsrud, & Rosendahl, 2019 ; Springer, Levy, & Tolin, 2018 ; Tran & Gregor, 2016 ; Van Dis et al, 2020 ; Wilson et al, 2018 ). Inclusion criteria for the meta-analysis were: (1) RCT, (2) treatment targets primarily chronic PTSD, (3) participants older than 17 years, (4) at least ten participants per condition at post-assessment, and (5) at least 70% of the sample was diagnosed with PTSD by means of a structured interview (Bisson et al, 2013 ).…”

Section: Methodsmentioning

confidence: 99%

Study quality and efficacy of psychological interventions for posttraumatic stress disorder: a meta-analysis of randomized controlled trials

2021

View full text Add to dashboard Cite

Background Research indicates that higher study quality may be associated with smaller treatment effects. Yet, knowledge about the association between study quality and treatment efficacy for posttraumatic stress disorder (PTSD) is limited. We aimed at evaluating the efficacy of psychological interventions for adult PTSD and the association between study quality and treatment effects. Methods We conducted a systematic search to identify randomized controlled trials (RCTs) that examined the efficacy of psychological interventions for chronic PTSD symptoms in adult samples with at least 70% of patients being diagnosed with PTSD by means of a structured interview. We assessed study quality using the following eight criteria from prior research: N ⩾ 50, all patients met criteria for PTSD, a treatment manual was used, therapists were trained, treatment integrity was checked, intent-to-treat analyses were applied, randomization was conducted by an independent party, and treatment outcome was conducted by blind assessors. Results The search resulted in 136 RCTs with 8978 patients. Active treatment conditions were largely effective in reducing PTSD symptoms at posttreatment and follow-up (Hedges' g = 1.09 and 0.81, respectively) when compared to passive control conditions. The comparison to active control conditions at posttreatment and follow-up resulted in medium effect sizes. A total of 14 trials met all study quality criteria and these trials produced large effect sizes when compared to passive control conditions at posttreatment and follow-up. Conclusions Overall, study quality was not significantly associated with effect size. The findings indicate that psychological interventions can effectively reduce PTSD symptoms irrespective of study quality.

show abstract

“…Patients with PTSD vary substantially in their response to trauma-focused treatments [ 140 ]. More insight into factors associated with treatment outcome in PTSD is therefore needed.…”

Section: Methodsmentioning

confidence: 99%

The effect of twice-weekly versus once-weekly sessions of either imagery rescripting or eye movement desensitization and reprocessing for adults with PTSD from childhood trauma (IREM-Freq): a study protocol for an international randomized clinical trial

Wibbelink

Lee

Bachrach

et al. 2021

Trials

View full text Add to dashboard Cite

Background Trauma-focused treatments for posttraumatic stress disorder (PTSD) are commonly delivered either once or twice a week. Initial evidence suggests that session frequency affects treatment response, but very few trials have investigated the effect of session frequency. The present study’s aim is to compare treatment outcomes of twice-weekly versus once-weekly sessions of two treatments for PTSD related to childhood trauma, imagery rescripting (ImRs) and eye movement desensitization and reprocessing (EMDR). We hypothesize that both treatments will be more effective when delivered twice than once a week. How session frequency impacts treatment response, whether treatment type moderates the frequency effect, and which treatment type and frequency works best for whom will also be investigated. Methods The IREM-Freq trial is an international multicenter randomized clinical trial conducted in mental healthcare centers across Australia, Germany, and the Netherlands. We aim to recruit 220 participants, who will be randomized to one of four conditions: (1) EMDR once a week, (2) EMDR twice a week, (3) ImRs once a week, or (4) ImRs twice a week. Treatment consists of 12 sessions. Data are collected at baseline until one-year follow-up. The primary outcome measure is clinician-rated PTSD symptom severity. Secondary outcome measures include self-reported PTSD symptom severity, complex PTSD symptoms, trauma-related cognitions and emotions, depressive symptoms, dissociation, quality of life, and functioning. Process measures include memory, learning, therapeutic alliance, motivation, reluctance, and avoidance. Additional investigations will focus on predictors of treatment outcome and PTSD severity, change mechanisms of EMDR and ImRs, the role of emotions, cognitions, and memory, the optimization of treatment selection, learned helplessness, perspectives of patients and therapists, the network structure of PTSD symptoms, and sudden treatment gains. Discussion This study will extend our knowledge on trauma-focused treatments for PTSD related to childhood trauma and, more specifically, the importance of session frequency. More insight into the optimal session frequency could lead to improved treatment outcomes and less dropout, and in turn, to a reduction of healthcare costs. Moreover, the additional investigations will broaden our understanding of how the treatments work and variables that affect treatment outcome. Trial registration Netherlands Trial Register NL6965, registered 25/04/2018.

show abstract

A systematic review of factors associated with outcome of psychological treatments for post-traumatic stress disorder

Cited by 33 publications

References 176 publications

Personalization of Treatment for Patients with Childhood-Abuse-Related Posttraumatic Stress Disorder

Personalization of Treatment for Patients with Childhood-Abuse-Related Posttraumatic Stress Disorder

Study quality and efficacy of psychological interventions for posttraumatic stress disorder: a meta-analysis of randomized controlled trials

The effect of twice-weekly versus once-weekly sessions of either imagery rescripting or eye movement desensitization and reprocessing for adults with PTSD from childhood trauma (IREM-Freq): a study protocol for an international randomized clinical trial

Contact Info

Product

Resources

About