Let's all get on the same page: A commentary on “Defining response and nonresponse to PTSD treatments: A systematic review”.

Larsen, Sadie E.; Sippel, Lauren M.; Schnurr, Paula P.

doi:10.1111/cpsp.12364

Cited by 6 publications

(3 citation statements)

References 5 publications

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“…Additional services with a more central focus on interpersonal functioning across domains, potentially including trauma‐informed dyadic therapy or treatments that target interpersonal skill‐building, may be indicated. Future studies can aim to identify benchmarks of meaningful improvements in interpersonal functioning (Larsen et al., 2021) and determine when more deliberate attention to interpersonal needs is adequate (e.g., via case conceptualization without deviating from fidelity to extant TFPs) versus when adjunctive modules or sequential treatments are needed to help patients reach optimal interpersonal and relational outcomes.…”

Section: Discussionmentioning

confidence: 99%

The impact of trauma‐focused psychotherapy for posttraumatic stress disorder on interpersonal functioning: A systematic review and meta‐analysis of randomized clinical trials

Swerdlow

Baker

Leifker

et al. 2023

Journal of Traumatic Stress

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Interpersonal functioning is a common concern for people with postttraumatic stress disorder (PTSD) but is not a key target of most trauma‐focused psychotherapies (TFPs). We preregistered and undertook a systematic review and meta‐analysis of randomized clinical trials (RCTs) examining the efficacy of TFPs for improving interpersonal functioning. Studies were identified through the PTSD Trials Standardized Data Repository, scholarly databases, and the solicitation of unpublished data from the PTSD research community following current PRISMA guidelines. We used random effects meta‐analysis to estimate within‐group change (i.e., pre‐ to posttreatment) in interpersonal functioning. Meta‐analytic findings yielded a medium total effect of TFP on interpersonal functioning, g = 0.54, 95% CI [0.37, 0.72], with high between‐study heterogeneity. Sensitivity analyses yielded substantively equivalent point estimates when outliers were excluded, g = 0.55, and when only the most well‐established individual TFPs were included, g = 0.57. In contrast, allocation to a control condition was associated with little average change in interpersonal functioning, g = 0.04 [‐0.12, 0.21]. Formal tests did not yield clear evidence of publication bias. Bias‐corrected estimates varied but centered around a medium effect, gs = 0.41–1.11. There was a medium‐to‐large association between change in interpersonal functioning and change in PTSD symptoms, rs = ‐.35–‐.44. The extant literature on TFPs and interpersonal functioning is small and heterogeneous, indicating the need for more focused attention on this outcome. Results suggest that, on average, TFPs are moderately efficacious for improving interpersonal functioning; however, additional treatment may be needed to meet the desired level of improvement

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Section: Discussionmentioning

confidence: 99%

The impact of trauma‐focused psychotherapy for posttraumatic stress disorder on interpersonal functioning: A systematic review and meta‐analysis of randomized clinical trials

Swerdlow

Baker

Leifker

et al. 2023

Journal of Traumatic Stress

Self Cite

View full text Add to dashboard Cite

show abstract

“…Besides allowing us to utilize the full dataset, this approach had the advantage of allowing us to report change in relative terms. Considering that this was a naturalistic study attempting to evaluate treatment response, using a metric that can easily be communicated among clinicians, policymakers, and patients alike, was important to us and the choice for percentage scores was based on recommendations in recent literature (Larsen et al, 2020; Varker et al, 2020).…”

Section: Methodsmentioning

confidence: 99%

Treatment response and treatment response predictors of a multidisciplinary day clinic for police officers with PTSD.

Martinmäki¹,

Aa²,

Nijdam³

et al. 2023

Psychological Trauma: Theory, Research, Practice, and Policy

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Objective: Police officers typically face multiple potentially traumatic events and consequently have a higher conditional probability of developing PTSD. Although most police officers with PTSD benefit from first-line treatment, it is unknown whether recommended intensification of treatment for low responders is effective and which factors contribute to response. This study aimed to examine the treatment response of a day clinic for police officers with PTSD and identify predictors of treatment response. Method: Between 2009 and 2019, routine outcome monitoring measurements consisting of PTSD symptom severity and general psychological distress were administered at two timepoints among 102 patients undergoing a day clinic treatment consisting of trauma-focused therapy, sociotherapy, and psychomotor therapy. Hierarchical regression was used to assess whether change in PTSD symptom severity was associated with baseline PTSD and depression severity, gender, age, and eligibility for a recognition procedure. Results: Significant improvements in PTSD symptom severity were found over the course of the treatment (d = .59), with 47% of patients showing statistically reliable improvement in their symptoms. The only significant predictor of treatment response was eligibility for a recognition procedure, with the total model explaining approximately 10% of the variation in treatment response. Conclusions: Intensifying treatment for police officers with PTSD who do not respond to previous trauma-focused treatment appears beneficial for a substantial number of patients. However, eligibility for a recognition procedure may negatively impact treatment response. Clinical Impact StatementPolice officers are frequently exposed to traumatic experiences and consequently may develop PTSD. Most police officers with PTSD benefit from first-line trauma-focused treatment but some need additional treatment. This study showed that about 50% of police officers who did not benefit from previous trauma-focused treatment, do benefit from participation in a trauma-focused day clinic. However, those eligible for or involved in procedures for obtaining recognition of PTSD as an occupational disorder during treatment may benefit less. In conclusion, it appears worthwhile to offer intensive treatment to police officers with PTSD who fail to benefit from first-line treatment.

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“…There are no standard criteria for defining response or non-optimal response to PTSD treatment (Beck, 2020 ; Fonzo et al, 2020 ; Larsen et al, 2020 ; Varker et al, 2020 ). As one of the goals for the present study was to lay the foundation for future work examining subsequent treatment for non-optimal responders, we decided to use relatively strict criteria that were based on endpoint symptom severity.…”

Section: Methodsmentioning

confidence: 99%

Examining trauma cognition change trajectories among initial PTSD treatment non-optimal responders: a potential avenue to guide subsequent treatment selection

Held

Splaine

Smith

et al. 2023

European Journal of Psychotraumatology

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Background: Despite their general effectiveness, 14-50% of individuals do not fully respond to evidence-based treatments for posttraumatic stress disorder (PTSD). Although changes in negative posttrauma cognitions (NPCs) are considered a likely PTSD treatment mechanism, less is known about how NPCs change among individuals who continue to be symptomatic following treatment (non-optimal responders). Objective: The objective of this study was to examine NPC change trajectories among individuals who were determined to be non-optimally responsive to intensive PTSD treatment. Method: Using a 3-week Cognitive Processing Therapy-based intensive PTSD treatment sample (ITP; N = 243), the present study examined the number of distinct NPC change trajectories among non-optimal responders via Group Based Trajectory Modeling and assessed predictors of non-optimal responders’ NPC change trajectory membership. Analyses were replicated in a separate 2-week ITP sample ( N = 215). Results: In both non-optimal responder samples, two trajectories emerged; a no NPC change group which represented those with an overall lack of NPC change throughout treatment and an NPC change group which represented those with an overall reduction of NPCs occurring primarily later in treatment. Changes in PTSD symptom severity during treatment was the only consistent predictor of NPC change trajectory group membership among treatment non-optimal responders across ITPs. Conclusions: Findings suggest NPC change among non-optimal responders is nuanced and may inform subsequent intervention selection, resulting in testable hypotheses for future research.

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Let's all get on the same page: A commentary on “Defining response and nonresponse to PTSD treatments: A systematic review”.

Cited by 6 publications

References 5 publications

The impact of trauma‐focused psychotherapy for posttraumatic stress disorder on interpersonal functioning: A systematic review and meta‐analysis of randomized clinical trials

The impact of trauma‐focused psychotherapy for posttraumatic stress disorder on interpersonal functioning: A systematic review and meta‐analysis of randomized clinical trials

Treatment response and treatment response predictors of a multidisciplinary day clinic for police officers with PTSD.

Examining trauma cognition change trajectories among initial PTSD treatment non-optimal responders: a potential avenue to guide subsequent treatment selection

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