Predictors of response to cognitive-behavioral therapy in patients with posttraumatic stress disorder: a systematic review

Abstract

Objective Posttraumatic stress disorder (PTSD) is a highly prevalent and disabling disorder. Even when treated with the first-line intervention, cognitive-behavioral therapy (CBT), 45% of the patients continue suffering from this disorder. Therefore, knowing the factors that could foresee who will respond to CBT would be of great value to the treatment of these patients. Thus, we have systematically reviewed the literature to identify the variables that could predict response to CBT in patients suffering from PTSD. Methods Following the PRISMA 2020 guidelines, we searched the electronic databases ISI Web of Science, Scopus, PsycINFO, MEDLINE, and PTSDpubs until November 2021. Two authors have independently conducted study selection and data extraction. Studies that examined possible predictors of response to therapy on a sample of adults (18-65 years), both genders, with and without comorbidities were considered eligible. The characteristics of the studies were synthesized in a table. The risk of bias was assessed by the Cochrane risk of bias quality assessment tool. Results Twenty-eight studies comprising 15 variables were selected. Among those, eight showed a low risk of bias, 19 showed some concerns, and one showed a high potential risk of bias. The therapeutic relationship was the only variable considered to be a predictor of a good response to therapy. All other variables showed conflicting results. Conclusions The most promising variable, although scientifically weak, is the therapeutic relationship. Additional randomized clinical trials should be conducted to clarify the role of this variable as a predictor of response to CBT in patients with PTSD.

A Precision Treatment Model for Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression Among University Students

“…The finding that physical disorders were associated with optimality of guided i-CBT is consistent with the suggestion in previous i-CBT trials that a human coach is useful in addressing interference related to psychosomatic distress . The associations of psychiatric comorbidities with HTE expand on prior studies finding mixed evidence for psychiatric comorbidities predicting i-CBT response . The important associations of bullying with HTE highlight the importance of institutionally embedded antibullying policies and the value of guided i-CBT in facilitating stress management efforts related to this salient student stressor .…”

“…[31][32][33] The associations of psychiatric comorbidities with HTE expand on prior studies finding mixed evidence for psychiatric comorbidities predicting i-CBT response. [34][35][36] The important associations of bullying with HTE highlight the importance of institutionally embedded antibullying policies and the value of guided i-CBT in facilitating stress management efforts related to this salient student stressor. 37 The fact that baseline anxiety and depression severity were not important predictors of HTE adds caution to evidence from prior studies that anxiety and depression symptom severity predict reduced likelihood of being optimized by guided i-CBT 38,39 ; however, our failure to find these variables to be important occurred among a sample in which students with serious suicidality were excluded.…”

Terapias Cognitiva, Comportamental e Cognitivo-Comportamental no tratamento do Transtorno do Estresse Pós-Traumático.

“…A amostra ser composta por adultos com diagnóstico de TEPT, tratados com Terapias Cognitiva, Comportamental e Cognitivo-Comportamental em pesquisas publicadas nos últimos cinco anos, indexados e publicados em inglês, português e espanhol, e que estivessem disponíveis na íntegra para leitura. Além disto, para corresponder a amostra adulta, utilizou-se como referencial teórico a autora Papalia 11 . Não respeitados os presentes critérios, os materiais foram excluídos.…”