Keyan, D., Garland, N., Choi-Christou, J., Tran, J., O’Donnell, M., & Bryant, R. A. (2024). A systematic review and meta-analysis of predictors of response to trauma-focused psychotherapy for posttraumatic stress disorder.Psychological Bulletin, 150(7), 767–797.https://doi.org/10.1037/bul0000438
Key TakeawaysThe primary methods of predicting response to trauma-focused psychotherapy (T-F psychotherapy) for posttraumatic stress disorder (PTSD) include examining baseline factors related to fear biology, other clinical factors, demographic characteristics, trauma-related characteristics, and psychiatric comorbidities.Factors like greater activation in fear-related brain regions, higher psychophysiological reactivity to fear provocation, better executive functioning, higher social support, being female, and being Caucasian significantly predict better response to T-F psychotherapy for PTSD.Factors like carrying risk alleles for genes modulating fear expression, higher levels of depression, cognitive distortions, anger, pretreatment PTSD severity, childhood trauma exposure, combat exposure, service-related disability, pain, sleep difficulties, poor quality of life, alcohol use, and problematic personality traits significantly predict poorer response to T-F psychotherapy for PTSD.Limitations include the arbitrary grouping of predictors into categories, exclusion of mediation and dropout studies, mixed risk of bias across studies, and lack of consensus on defining treatment response.This comprehensive meta-analysis of predictors of T-F psychotherapy response for PTSD has important implications for improving treatment outcomes and developing more personalized, process-based approaches to PTSD treatment.
Key Takeaways
Rationale
Thissystematic reviewandmeta-analysiswas conducted to comprehensively examine baseline factors that predict response to trauma-focused psychotherapy (T-F psychotherapy) for posttraumatic stress disorder (PTSD). The rationale for this study stems from several key points in the existing literature:
What we know:
What’s the next step:
Given the limited success of current augmentation strategies and the diverse range of factors potentially influencing treatment response, a data-driven approach examining the relative importance of various predictors was needed. This meta-analysis aimed to:
Method
The study followed PRISMA guidelines for systematic reviews and meta-analyses. The protocol was preregistered with PROSPERO (CRD42020162112).
Results
Fear Biology Factors:
Other Clinical Factors:
Demographic Characteristics:
Trauma-Related Characteristics:
Psychiatric Comorbidities:
Moderator Analyses:
Insight
This comprehensive meta-analysis provides several key insights into predicting response to T-F psychotherapy for PTSD:
Future research directions include:
Strengths
Limitations
Clinical Implications
The results of this meta-analysis have significant implications for clinical psychology practice and PTSD treatment:
Variables influencing results include study design characteristics, sample demographics, and trauma types. The consistent effects across diverse samples and methodologies, however, suggest broad applicability of the findings.
References
Primary reference
Other references
Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005). A multidimensional meta-analysis of psychotherapy for PTSD.American Journal of Psychiatry, 162(2), 214-227.
Fonzo, G. A., Federchenco, V., & Lara, A. (2020). Predicting and managing treatment non-response in posttraumatic stress disorder.Current Treatment Options in Psychiatry, 7(2), 70-87.
Kline, A. C., Panza, K. E., Lyons, R., Kehle-Forbes, S. M., Hien, D. A., & Norman, S. B. (2023). Trauma-focused treatment for comorbid post-traumatic stress and substance use disorder.Nature Reviews Psychology, 2(1), 24-39.
Loerinc, A. G., Meuret, A. E., Twohig, M. P., Rosenfield, D., Bluett, E. J., & Craske, M. G. (2015). Response rates for CBT for anxiety disorders: Need for standardized criteria.Clinical Psychology Review, 42, 72-82.
Mataix-Cols, D., Fernández de la Cruz, L., Monzani, B., Rosenfield, D., Andersson, E., Pérez-Vigil, A., … & DCS Anxiety Consortium. (2017). D-cycloserine augmentation of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders: a systematic review and meta-analysis of individual participant data.JAMA Psychiatry, 74(5), 501-510.
Ressler, K. J., Berretta, S., Bolshakov, V. Y., Rosso, I. M., Meloni, E. G., Rauch, S. L., & Carlezon Jr, W. A. (2022). Post-traumatic stress disorder: clinical and translational neuroscience from cells to circuits.Nature Reviews Neurology, 18(5), 273-288.
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Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
