Mathersul Danielle C, Zeitzer Jamie M, Schulz-Heik R Jay, Avery Timothy J, Bayley Peter J
School of Psychology, Murdoch University, Murdoch, WA, Australia.
Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, WA, Australia.
Front Psychiatry. 2024 Feb 8;15:1331569. doi: 10.3389/fpsyt.2024.1331569. eCollection 2024.
High variability in response and retention rates for posttraumatic stress disorder (PTSD) treatment highlights the need to identify "personalized" or "precision" medicine factors that can inform optimal intervention selection before an individual commences treatment. In secondary analyses from a non-inferiority randomized controlled trial, behavioral and physiological emotion regulation were examined as non-specific predictors (that identify which individuals are more likely to respond to treatment, regardless of treatment type) and treatment moderators (that identify which treatment works best for whom) of PTSD outcome.
There were 85 US Veterans with clinically significant PTSD symptoms randomized to 6 weeks of either cognitive processing therapy (CPT; n = 44) or a breathing-based yoga practice (Sudarshan kriya yoga; SKY; n = 41). Baseline self-reported emotion regulation (Difficulties in Emotion Regulation Scale) and heart rate variability (HRV) were assessed prior to treatment, and self-reported PTSD symptoms were assessed at baseline, end-of-treatment, 1-month follow-up, and 1-year follow-up.
Greater baseline deficit in self-reported emotional awareness (similar to alexithymia) predicted better overall PTSD improvement in both the short- and long-term, following either CPT or SKY. High self-reported levels of emotional response non-acceptance were associated with better PTSD treatment response with CPT than with SKY. However, all significant HRV indices were stronger moderators than all self-reported emotion regulation scales, both in the short- and long-term. Veterans with lower baseline HRV had better PTSD treatment response with SKY, whereas Veterans with higher or average-to-high baseline HRV had better PTSD treatment response with CPT.
To our knowledge, this is the first study to examine both self-reported emotion regulation and HRV, within the same study, as both non-specific predictors and moderators of PTSD treatment outcome. Veterans with poorer autonomic regulation prior to treatment had better PTSD outcome with a yoga-based intervention, whereas those with better autonomic regulation did better with a trauma-focused psychological therapy. Findings show potential for the use of HRV in clinical practice to personalize PTSD treatment.
ClinicalTrials.gov identifier, NCT02366403.
创伤后应激障碍（PTSD）治疗的反应率和保留率存在高度变异性，这凸显了识别“个性化”或“精准”医学因素的必要性，这些因素可在个体开始治疗前为最佳干预选择提供依据。在一项非劣效性随机对照试验的二次分析中，行为和生理情绪调节被作为PTSD结果的非特异性预测因素（识别哪些个体更可能对治疗产生反应，无论治疗类型如何）和治疗调节因素（识别哪种治疗对谁效果最佳）进行了研究。
85名有临床显著PTSD症状的美国退伍军人被随机分为两组，分别接受为期6周的认知加工疗法（CPT；n = 44）或基于呼吸的瑜伽练习（苏达山克里亚瑜伽；SKY；n = 41）。在治疗前评估基线时自我报告的情绪调节（情绪调节困难量表）和心率变异性（HRV），并在基线、治疗结束时、1个月随访和1年随访时评估自我报告的PTSD症状。
无论是CPT还是SKY，基线时自我报告的情绪意识（类似于述情障碍）方面更大的缺陷预示着短期和长期内PTSD的总体改善更好。自我报告的情绪反应不接受程度较高与CPT治疗PTSD的反应优于SKY有关。然而，无论是短期还是长期，所有显著的HRV指标都是比所有自我报告的情绪调节量表更强的调节因素。基线HRV较低的退伍军人接受SKY治疗PTSD的反应更好，而基线HRV较高或处于平均至高范围的退伍军人接受CPT治疗PTSD的反应更好。
据我们所知，这是第一项在同一研究中同时将自我报告的情绪调节和HRV作为PTSD治疗结果的非特异性预测因素和调节因素进行研究的。治疗前自主调节较差的退伍军人接受基于瑜伽的干预后PTSD结果更好，而自主调节较好的退伍军人接受以创伤为重点的心理治疗效果更好。研究结果表明在临床实践中使用HRV来个性化PTSD治疗具有潜力。
ClinicalTrials.gov标识符，NCT02366403。
