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

Abstract

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.

Predicting optimal treatment outcomes in phase‐based treatment and direct trauma‐focused treatment among patients with posttraumatic stress disorder stemming from childhood abuse

“…Another explanation for this difference may be the study design. In contrast to our study, in which the number of trauma‐focused sessions for both conditions was the same, Hoeboer, Oprel, and colleagues (2021) offered fewer trauma‐focused sessions in the phase‐based condition than in the direct trauma‐focused condition. According to our results, the PAI analysis did not show significant differences between the two conditions with the same dose of trauma‐focused treatment or with the addition of STAIR in one of the two conditions.…”

Exposure-based treatments for childhood abuse-related post-traumatic stress disorder in adults: a health-economic evaluation

“…Given the lack of differences in clinical outcomes (Oprel et al, 2021 ) and cost-effectiveness among treatments, as found in the present study, our findings leave room for shared decision making in choosing PTSD treatment, taking into account the preferences of patients and clinicians (Hamblen et al, 2019 ). Despite the lack of differences in clinical outcomes, it was previously found in the current study sample that several clinical predictors could indicate a more optimal treatment choice (Hoeboer et al, 2021 ). As such, personalization offers a promising method by which to assign patients to their optimal treatment (Deisenhofer et al, 2018 ; Keefe et al, 2018 ).…”

What makes inpatient treatment for PTSD effective? Investigating daily therapy process factors

“…Enhancement of these factors during therapy can lead to a more favourable outcome. Although our results require replication in future research, future modular and personalized treatments of PTSD should encompass therapy monitoring tools that allow for a rapid detection of disadvantageous idiographic therapy processes (Brintzinger et al, 2021;Cloitre et al, 2020;Hoeboer et al, 2021;. Furthermore, our results hint at the existence of a subgroup of patients with motivational, mindfulness, and self-care deficits who profit less from inpatient treatment.…”