Identifying Trajectories and Predictors of Response to Psychotherapy for Post-Traumatic Stress Disorder in Adults: A Systematic Review of Literature

Abstract

Objective: There exists considerable individual variability in the development and progression of pathological stress reactions after experiencing trauma, as well as in individuals’ response to psychological interventions. Yet until recently, such individual differences had not been considered when evaluating the efficacy of therapeutic interventions for post-traumatic stress disorder (PTSD). This systematic review aims to examine the emerging literature on this subject and, specifically, to identify trajectories and predictors of psychotherapeutic response in adults with PTSD. Method: Four databases were searched using specific keywords without date or language restrictions. For each study, independent reviewers systematically evaluated whether it met eligibility criteria and assessed risk of bias. For included studies, reviewers completed data extraction using standard formats. Those examining how subgroups of adults respond to therapy for clinical PTSD using trajectory modeling were deemed eligible. Demographic, PTSD, clinical, and trauma-related factors associated to particular trajectories were also examined. Results: Of the 1,727 papers identified, 11 were included in this analysis. Of these studies, six focused on military-related traumas and five on civilian ones. Although studies found between two and five trajectories, most supported a three-trajectory model of response categorized as responders, nonresponders, and subclinical participants. Over 22 predictors of treatment trajectories were examined. Comorbid depression, anxiety, and alcohol abuse were the strongest predictors of poor therapeutic response. Age, combat exposure, social support, and hyperarousal were moderate predictors. Conclusion: This review provides valuable insight into the treatment of PTSD, as it supports the heterogeneous trajectories of psychotherapeutic responses and provides avenues for the development of interventions that consider individual-level factors in treatment response.

Overcoming Adversity and Stress Injury Support (OASIS): Evaluation of Residential Treatment Outcomes for U.S. Service Members with Posttraumatic Stress Disorder

“…In the current study, we examined treatment outcomes for active duty service members receiving care in OASIS, the DoD's only residential PTSD treatment program for active duty service members. Overall, 32.0% of active duty service members in the OASIS program reported significant reductions in PTSD symptoms over the course of treatment, a finding similar to the 35.5% response rate for PTSD treatment demonstrated in a recent meta-analysis (Dewar et al, 2020). Each week of residential treatment was associated with an additional 0.76-point reduction on the PCL-M, and changes in PTSD symptoms during the OASIS program did not differ across demographic factors.…”

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

“…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 ].…”

Differential Effects of Comorbid Psychiatric Disorders on Treatment Outcome in Posttraumatic Stress Disorder from Childhood Trauma

“…We hypothesized that comorbid MDD and AD would be associated with worse outcomes in terms of reduction in PTSD symptoms for each condition. Although previous studies on AD and MDD produced inconsistent results, recent reviews found these two diagnoses among the strongest predictors of poor therapeutic response [21,22]. Moreover, lower remission rates of PTSD symptoms in patients with MDD and AD were observed in epidemiological studies [5,[13][14][15].…”

“…Finally, in traumatized women treated with either cognitive processing therapy or exposure therapy, a higher level of depression was even associated with a better treatment outcome in both conditions, but there was no differential effect between the two treatments [8]. Two recent systematic reviews aimed to identify trajectories and predictors of psychotherapeutic response in adults with PTSD [21,22]: in the first review comorbid depression, anxiety, and alcohol abuse were the strongest predictors of poor therapeutic response [21], while the other only found that comorbid diagnosis of depression was associated with poor treatment outcome, however only two studies [17,23] were included [22].…”