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

Abstract

Research over the last few decades has demonstrated the effectiveness of various treatments for posttraumatic stress disorder (PTSD). However, the question of which treatment works best remains, especially for patients with PTSD stemming from childhood abuse. Using the Personalized Advantage Index (PAI), we explored which patients benefit more from phase‐based treatment and which benefit more from direct trauma‐focused treatment. Data were obtained from a multicenter randomized controlled trial (RCT) comparing a phase‐based treatment condition (i.e., eye‐movement desensitization and reprocessing [EMDR] therapy preceded by Skills Training in Affect and Interpersonal Regulation [STAIR]; n = 57) and a direct trauma‐focused treatment (EMDR only; n = 64) among individuals with PTSD related to childhood abuse. Machine learning techniques were used to examine all pretreatment variables included in the trial as potential predictors and moderators, with selected variables combined to build the PAI model. The utility of the PAI was tested by comparing actual posttreatment outcomes of individuals who received PAI‐indicated treatment with those allocated to a non–PAI‐indicated treatment. Although eight pretreatment variables between PTSD treatment outcome and treatment condition were selected as moderators, there was no significant difference between participants assigned to their PAI‐indicated treatment and those randomized to a non–PAI‐indicated treatment, d = 0.25, p = .213. Hence, the results of this study do not support the need for personalized medicine for patients with PTSD and a history of childhood abuse. Further research with larger sample sizes and external validation is warranted.

Predictors and moderators of treatment outcomes in phase-based treatment and trauma-focused treatments in patients with childhood abuse-related post-traumatic stress disorder

“…In addition, suicidal and self-injurious behaviours were only measured by single items, which also limited the conclusions. One noteworthy aspect for discussion pertains to the source of these findings, which were derived from a dataset originating from an RCT that has been used for various analyses, including one based on the personalized advantage index, PAI (Bremer et al, 2023 ). However, an essential distinction lies in the fact that the present study aimed to assess the actual predictive value of a wide variety of variables, previously assumed to have a differential impact on treatment outcomes.…”