This article is more than 5 years old. Information may no longer be current.

Patient treatment preference plays role in improving PTSD outcomes

Both prolonged exposure and sertraline showed good short- and long-term efficacy across a range of outcomes among patients with PTSD, according to findings published in American Journal of Psychiatry.

In addition, patients with PTSD who selected their form of treatment — prolonged exposure or sertraline — showed more improvement than those who were prescribed one or the other regardless of preferences.

“PTSD studies have not systematically examined whether patient preference for [cognitive behavioral therapy] or [selective serotonin reuptake inhibitors] affects outcome,” Lori A. Zoellner, PhD, from the department of psychiatry and behavioral sciences, University of Washington, and colleagues wrote. “Prolonged exposure and sertraline are very different treatment options. Given such differences, patients may have clear treatment preferences, and such preferences may influence treatment outcome and adherence.”

The investigators conducted a doubly randomized preference trial to assess whether patient treatment preference affected the differential effectiveness of treatment with prolonged exposure and sertraline in 200 patients with PTSD.

Participants were randomly assigned to receive their preferred treatment, or to no choice group. Those assigned to no choice were then randomized to receive prolonged exposure or sertraline. Zoellner and colleagues measured participants’ PTSD symptoms after 10 weeks of acute treatment and at 3, 6, 12 and 24 months post-treatment via the PTSD Symptom Scale-Interview. They also evaluated participants’ self-reported PTSD severity, depression symptoms, anxiety symptoms and disability.

Overall, patients preferred prolonged exposure over sertraline; however, both prolonged exposure and sertraline conferred benefits in patients with PTSD as measured by interviewer-rated PTSD severity scores (P < .001) that were maintained over 24 months. Patients who received prolonged exposure were significantly more likely than those who received sertraline to achieve loss of PTSD diagnosis. Furthermore, participants’ self-reported PTSD severity, depression and anxiety symptoms and functioning showed improvement (effect sizes = 0.35-0.44).

The results revealed that participants who received their preferred treatment were significantly more likely than those who did not to achieve loss of PTSD diagnosis and responder status. They were also more likely to be adherent to treatment and have lower self-reported PTSD, depression and anxiety symptoms, according to the results.

“These findings have broad real-world applicability, as this trial included patients with common comorbidities, extensive trauma histories, and complicated treatment histories,” Zoellner and colleagues wrote. “Accommodating patient preferences, within the context of empirically supported treatments, 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.” – by Savannah Demko

Disclosure: Zoellner reports no relevant financial disclosures. Please see the study for other authors’ relevant financial disclosures.