Stirman Shannon Wiltsey, Cohen Zachary D, Lunney Carole A, DeRubeis Robert J, Wiley Joshua F, Schnurr Paula P
National Center for PTSD and Stanford University, United States.
National Center for PTSD and University of California, Los Angeles, United States.
Behav Res Ther. 2021 Jul;142:103872. doi: 10.1016/j.brat.2021.103872. Epub 2021 Apr 26.
PTSD treatment guidelines recommend several treatments with extensive empirical support, including Prolonged Exposure (PE), a trauma-focused treatment and Present-Centered Therapy (PCT), a non-trauma-focused therapy. Research to inform treatment selection has yielded inconsistent findings with single prognostic variables that are difficult to integrate into clinical decision-making. We examined whether a combination of prognostic factors can predict different benefits in a trauma-focused vs. a non-trauma-focused psychotherapy. We applied a multi-method variable selection procedure and developed a prognostic index (PI) with a sample of 267 female veterans and active-duty service members (mean age 45; SD = 9.37; 53% White) with current PTSD who began treatment in a randomized clinical trial comparing PE and PCT. We conducted linear regressions predicting outcomes (Clinician-Administered PTSD Scale score) with treatment condition, the PI, and the interaction between the PI and treatment condition. The interaction between treatment type and PI moderated treatment response, moderated post-treatment symptom severity, b = 0.30, SE = 0.15 [95% CI: 0.01, 0.60], p = .049. For the 64% of participants with the best prognoses, PE resulted in better post-treatment outcomes; for the remainder, there was no difference. Use of a PI may lead to optimized patient outcomes and greater confidence when selecting trauma-focused treatments.
创伤后应激障碍（PTSD）治疗指南推荐了几种有大量实证支持的治疗方法，包括以创伤为重点的延长暴露疗法（PE）和不以创伤为重点的以当下为中心疗法（PCT）。为治疗选择提供依据的研究在单一预后变量方面得出了不一致的结果，这些变量难以纳入临床决策。我们研究了预后因素的组合是否能预测在以创伤为重点的心理治疗与不以创伤为重点的心理治疗中不同的疗效。我们应用了一种多方法变量选择程序，并以267名患有当前PTSD的女性退伍军人和现役军人（平均年龄45岁；标准差=9.37；53%为白人）为样本，开发了一个预后指数（PI），这些人在一项比较PE和PCT的随机临床试验中开始接受治疗。我们进行了线性回归，以治疗条件、PI以及PI与治疗条件之间的相互作用来预测结果（临床医生评定的PTSD量表得分）。治疗类型与PI之间的相互作用调节了治疗反应，调节了治疗后症状严重程度，b = 0.30，标准误 = 0.15 [95%置信区间：0.01，0.60]，p = 0.049。对于64%预后最佳的参与者，PE导致了更好的治疗后结果；对于其余参与者，则没有差异。使用PI可能会带来优化的患者结果，并在选择以创伤为重点的治疗方法时增强信心。
