Doubly Randomized Preference Trial of Prolonged Exposure Versus Sertraline for Treatment of PTSD

Abstract

The authors examined the effect of patient treatment preference on the differential effectiveness of prolonged exposure and sertraline for the treatment of posttraumatic stress disorder (PTSD).Method: In a doubly randomized preference trial, 200 patients with PTSD viewed standardized treatment rationales prior to randomization. Patients were first randomized to choice of treatment or no choice. Those assigned to no choice were then randomized to prolonged exposure or sertraline. Acute treatment was 10 weeks, with 24-month follow-up. Interviewer-rated PTSD symptom severity was the main outcome measure, and depression, anxiety, and functioning were assessed as additional outcomes.Results: Patients preferred prolonged exposure over sertraline (number needed to benefit [NNTB]=4.5). Using intentto-treat analyses (N=200), both prolonged exposure and sertraline showed large gains that were maintained over 24 months. Although no differential effect was observed on interviewer-rated PTSD severity, there was a significant benefit of prolonged exposure over sertraline on interviewrated loss of PTSD diagnosis (NNTB=7.0), responder status (NNTB=5.7), and self-reported PTSD, depression, and anxiety symptoms and functioning (effect sizes, 0.35-0.44). Patients who received their preferred treatment were more likely to be adherent, lose their PTSD diagnosis (NNTB=3.4), achieve responder status (NNTB=3.4), and have lower self-reported PTSD, depression, and anxiety symptoms (effect sizes, 0.40-0.72).Conclusions: Prolonged exposure and sertraline confer significant benefits for PTSD, with some evidence of an advantage for prolonged exposure. Giving patients with PTSD their preferred treatment also confers important benefits, including enhancing adherence.

Comparative Efficacy and Acceptability of Pharmaceutical Management for Adults With Post-Traumatic Stress Disorder: A Systematic Review and Meta-Analysis

“…The clinician should consider fully the individual factors for the choice of drugs rather than fixed use of a drug to treat, such as the severity of symptom, different populations, or some critical sub-symptoms. Clinicians may use our results to find a preliminary drug selection strategy and should consider a patient's own preferences (A. McHugh et al, 2013;Zoellner et al, 2019). Especially for veterans, common drugs may not be suitable for patients who are resistant to common psychotropic substances, such as SSRIs.…”

Interactive Motion-Assisted Exposure Therapy for Veterans with Treatment-Resistant Posttraumatic Stress Disorder: A Randomized Controlled Trial

“…Blinding of patients for treatment condition was not possible. Being assigned to receive this innovative treatment could have positively affected treatment expectancies and this in itself could have improved PTSD symptomatology [61]. However, the continued symptom decrease after treatment argues against this being the exclusive effect.…”

Advances in PTSD Treatment Delivery: Review of Findings and Clinical Considerations for the Use of Telehealth Interventions for PTSD

“…Overall, the findings from these two studies suggest that veterans with PTSD are as likely to prefer homebased telehealth as in-person care. Matching patients with their preferred treatment type has been shown to improve clinical outcomes [45]. Future research should examine whether matching individuals with their preferred treatment modality could improve both treatment attendance and outcomes.…”