Longer time since trauma linked to larger symptom reductions in PTSD

Longer time since trauma was associated with larger symptom reductions among patients with PTSD, according to study results published in Journal of Clinical Psychiatry.

“Both epidemiologic and treatment literature suggest the likelihood of recovery or treatment response in PTSD may depend in part on the elapsed time since trauma,” Sheila A. M. Rauch, PhD, of the department of psychiatry and behavioral sciences at Emory University School of Medicine in Georgia, and colleagues wrote. “[A recent study] highlighted how chronic PTSD has a neurobiology that should be differentiated from that of acute disorder. The National Comorbidity Survey indicated any mental health treatment was associated with an increased rate of recovery in the first 6 years compared to no treatment, but thereafter more than a third of persons failed to remit regardless of any reported treatment.”

Although multiple psychotherapy trials found longer time since trauma was linked to needing more sessions for response, a meta-analysis of prolonged exposure therapy trials did not show an association between time since trauma and outcomes. In the current study, Rauch and colleagues analyzed predictors of PTSD treatment response in a clinical trial that compared prolonged exposure plus placebo, prolonged exposure plus sertraline and sertraline plus enhanced medication management with predictors that included time since trauma, self-report of pain, alcohol use, baseline symptoms and demographics. They included 196 veterans with combat-related PTSD according to DSM-IV-TR criteria that last 3 months or longer, with recruitment between 2012 and 2016 from four sites that participated in the 24-week PROlonGed ExpoSure and Sertraline clinical trial.

Results across treatment conditions showed longer time since trauma predicted greater week 24 PTSD symptoms improvement (P = .01) after baseline adjustment, higher baseline pain severity predicted smaller symptom improvements (P = .003) and greater improvement among Hispanic patients than among non-Hispanic patients (P = .03). No other baseline characteristics, including alcohol consumption, significantly predicted week 24 improvement. The researchers noted a significant association only in those randomly assigned to the prolonged exposure plus sertraline condition (P = .03) according to a comparison of time since trauma by treatment condition. Further, they observed similar results in longitudinal analyses.

“The current study required recruitment of patients willing to engage in [prolonged exposure] and/or sertraline who were not already taking medication,” Rauch and colleagues wrote. “Replication in a clinical care sample to ensure the findings translate to standard care is warranted. In addition, replication in a larger sample to examine the multifactorial effects of these predictors is needed.”