Friday, October 19, 2018

Giving Patients Choice of PTSD Treatment Yields Significant Benefit, Study Finds

Adults with posttraumatic stress disorder (PTSD) given a choice between sertraline or prolonged exposure therapy opted for prolonged exposure almost two to one; and while both treatments conferred significant benefits, prolonged exposure provided some advantage over sertraline, reports a study published today in AJP in Advance.

The study aimed to determine whether giving patients diagnosed with PTSD their choice of treatment would affect patient outcomes, wrote Lori A. Zoellner, Ph.D., of the Department of Psychology at the University of Washington and colleagues. According to the authors, the study was the first large-scale trial directly comparing the efficacy of sertraline and prolonged exposure therapy for PTSD.

Some 200 patients with PTSD watched videotaped treatment rationales for both treatments and then indicated a preference for either sertraline or prolonged exposure. They were then randomly assigned to having a choice between treatments or to no choice of treatment. Both groups received up to 10 weeks of acute treatment and up to 24 months of follow-up.

Participants showed a strong preference for prolonged exposure therapy over the medication: of 97 participants given a choice of treatment, 63% chose prolonged exposure therapy and 37% chose sertraline. Participants in the prolonged exposure group received 10 weekly, 90- to 120-minute sessions led by a therapist. Responders were offered continued sertraline up to 24 months or up to two prolonged exposure booster sessions during the follow-up period.

The primary outcome measure was interviewer-rated PTSD symptoms, as measured by the PSS-I—a 17-item interview that uses DSM-IV symptom criteria and yields a severity rating (range, 0–51) and a diagnosis (yes/no). Additional measures included several standard self-assessments for depression, anxiety, and disability.

Both treatment groups showed large gains that were maintained during the 24-month follow-up; however, patients treated with prolonged exposure were significantly more likely to lose their PTSD diagnosis.

The authors noted that patients who received their preferred treatment were more likely to complete treatment (73% vs. 49%), and were more likely to lose their PTSD diagnosis, achieve responder status, and have lower self-reported PTSD, depression, and anxiety symptoms.

“Notably, preference effects were as strong as, if not stronger than, treatment modality effects, which suggests that accommodating patients’ preferences in treating PTSD is as important as, if not more so, than the specific choice of an empirically supported treatment,” the researchers wrote. “Accommodating patient preferences … and developing strategies for enhancing patient buy-in are important next steps in facilitating access, initiation, adherence, and completion of empirically supported treatment for PTSD.”

For related information, see the Psychiatric News article “Propranolol Combined With Reactivation Therapy May Reduce PTSD Symptoms.”

(Image: iStock/shironosov)


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