Treatment augmentation for posttraumatic stress disorder: A systematic review

Abstract

This systematic review examined the efficacy of all augmentation approaches for first‐line posttraumatic stress disorder (PTSD) interventions. From 9,890 records, 34 trials were eligible for inclusion, covering 28 different augmentation approaches. Overall, augmentation approaches were ineffective if they targeted a mechanism similar to the first‐line treatment. Augmentation approaches combining two guideline‐recommended treatments were largely ineffective, reflecting ceiling effects. Pharmacological augmentation approaches targeting fear extinction mechanisms were largely ineffective, or worsened outcomes relative to prolonged exposure alone, as these approaches may inadvertently strengthen fear memories. Augmentation approaches targeting general cognitive enhancement showed promise and provided support for augmentation interventions that require little cognitive or emotional work and target mechanisms different than the first‐line treatment.

Defining response and nonresponse to posttraumatic stress disorder treatments: A systematic review.

“…They also can inform which treatment strategies are most helpful and consequently lead to a better understanding of the mechanisms of change and longitudinal course of PTSD. This would not only allow for improvements to treatment response definitions, but also may assist in improving treatment outcomes through augmented treatments specifically targeting residual symptoms (Metcalf et al., 2019).…”

Enhancing outcomes for PTSD treatment: Commentary on "treatment augmentation for posttraumatic stress disorder: A systematic review".

“…Theoretically, when this baseline material is combined with precise information about the treatment itself (duration, intensity, and presence or absence of specific and common factors) and the regular collection of progress data, the effectiveness of treatment will be maximized. Metcalf et al (2020) acknowledge the need for a precision medicine approach (referred to in the paper as “personalized medicine,” p. 18) and note that several of the trials they reviewed found evidence that subgroups of patients appeared to benefit more than others. However, in our view the importance of matching patient characteristics to augmentation approaches (and to the choice of the primary treatment itself) is the critical next step in evidence-based psychotherapy.…”

“…Yet, not everyone responds favorably to these treatments, and as a result, PTSD researchers developed additional treatments as well as explored methods that may improve treatment response to already established treatments. Metcalf et al’s (2020) review of augmentation approaches for the treatment of PTSD provides a valuable overview of some of the methods by which clinical researchers are hoping to improve the treatment of this complex and heterogeneous disorder. The review showcases the variety of approaches that have been tested; however, it also highlights the nascent status of this testing, as virtually all the adjunctive interventions that they examined were evaluated by only a single clinical trial.…”

Four Decades of Military Posttraumatic Stress: Protocol for a Meta-analysis and Systematic Review of Treatment Approaches and Efficacy

“…However, the clear-cut criteria applied in research share little overlap with the complexities of real-life practices and experiences of diagnosing and treating PTSD in military and veteran populations. Treatment providers contend with complexities of patient characteristics (eg, chronicity and type of trauma), clinical characteristics of PTSD (eg, symptom clusters, prior treatment or use of medications, and comorbidities), and treatment characteristics (eg, length of treatment, type of treatment and augmentation [ 13 ], add-on, and adjunctive treatments) when making treatment-related decisions. In addition, treatment planning is often conducted with patient engagement and feedback in mind [ 36 ], and may involve many parallel processes with different health and mental health providers.…”