What you believe is what you want: Modeling PTSD-related treatment preferences for sertraline or prolonged exposure

Abstract

Despite the known efficacy of various psychotherapies and pharmacotherapies for posttraumatic stress disorder (PTSD), we know little about what factors predict treatment preference. In the present study, we first developed exploratory path models of treatment preference for a psychotherapy or pharmacotherapy (n = 273) and then conducted confirmatory analyses of these models in a second sample (n = 324) and in a third generalization sample of trauma-exposed women (n = 105). We examined demographic and psychopathology factors and treatment-related beliefs (i.e., credibility and personal reactions). Across all samples, treatment-related beliefs were the strongest predictors of treatment preference. Further, severity of depression directly reduced the likelihood of choosing psychotherapy, and severity of PTSD directly increased the likelihood of choosing pharmacotherapy. These results underscore the importance of better understanding individual’s beliefs regarding treatments. With a clearer understanding of these factors, we may be able to reduce barriers to treatment and increase access to effective treatments for those with trauma-related symptoms.

Older Adults’ Rating of the Acceptability of Treatments for Generalized Anxiety Disorder

“…It was hypothesized that CBT would be considered as more acceptable than pharmacotherapy. The results support this hypothesis and are consistent with those found in young (Deacon & Abramowitz, 2005;Zoellner et al, 2009) and older adults (Mohlman, 2012). The results concerning CBT and CBT-GSH are mixed.…”

“…Both medication and CBT were generally perceived as acceptable, believable, and effective. Similarly, Zoellner, Feeny, and Bittinger (2009) found that prolonged exposure is preferred over sertraline for posttraumatic stress disorder across adult samples of undergraduate students and trauma-exposed women. This research has also known that treatment history (Deacon & Abramowitz, 2005) and severity of psychopathology (Zoellner et al, 2009) both influence the perception of anxiety treatments.…”

“…Similarly, Zoellner, Feeny, and Bittinger (2009) found that prolonged exposure is preferred over sertraline for posttraumatic stress disorder across adult samples of undergraduate students and trauma-exposed women. This research has also known that treatment history (Deacon & Abramowitz, 2005) and severity of psychopathology (Zoellner et al, 2009) both influence the perception of anxiety treatments. In the only study looking specifically at anxiety in older adults, Mohlman (2012) found that the majority prefer psychotherapy to pharmacotherapy and a combination of both.…”

Reducing Barriers to Mental Health and Social Services for Iraq and Afghanistan Veterans: Outcomes of an Integrated Primary Care Clinic

“…Despite the efficacy of TIDES for older veterans with depression, collaborative care models may need to be modified to be most effective in OEF/OIF veterans. For example, younger and minority combat veterans with anxiety disorders may be reluctant to accept medication and may instead prefer psychotherapy 50,[52][53][54] . Evidence-based psychotherapy for PTSD and other anxiety disorders is typically delivered in specialty mental health settings, but a recent study of OEF/OIF veterans with new PTSD diagnoses in VA healthcare showed that veterans' failed to attend an adequate number of specialty mental health visits required for evidence-based PTSD treatment 55 .…”

Stepped-Care Approaches to Posttraumatic Stress Disorder: Sharpening Tools for the Clinician

“…There is a growing body of literature in support of the notion that outcomes are improved when the PTSD treatment received matches the client's preference for treatment, i.e., the treatment you think is best for you is best for you (Le, Doctor, Zoellner, & Feeney, 2014;Zoellner, Feeny, & Bittinger, 2009). The Department of Veterans Affairs has wisely built into their specialty clinic intake process an orientation group received very positively by veterans that explains psychotherapy and pharmacotherapy treatment options for PTSD (Schumm, Walter, Bartone, & Chard, 2015).…”