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High expectancy and early response produce optimal effects in sertraline treatment for post-traumatic stress disorder

  • Belinda Graham (a1), Natalia M. Garcia (a2), Mark S. Burton (a3), Andrew A. Cooper (a4), Peter P. Roy-Byrne (a5), Matig R. Mavissakalian (a6), Norah C. Feeny (a7) and Lori A. Zoellner (a8)...

Abstract

Background

Better indicators of prognosis are needed to personalise post-traumatic stress disorder (PTSD) treatments.

Aims

We aimed to evaluate early symptom reduction as a predictor of better outcome and examine predictors of early response.

Method

Patients with PTSD (N = 134) received sertraline or prolonged exposure in a randomised trial. Early response was defined as 20% PTSD symptom reduction by session two and good end-state functioning defined as non-clinical levels of PTSD, depression and anxiety.

Results

Early response rates were similar in prolonged exposure and sertraline (40 and 42%), but in sertraline only, early responders were four times more likely to achieve good end-state functioning at post-treatment (Number Needed to Treat = 1.8, 95% CI 1.28–3.00) and final follow-up (Number Needed to Treat = 3.1, 95% CI 1.68–16.71). Better outcome expectations of sertraline also predicted higher likelihood of early response.

Conclusions

Higher expectancy of sertraline coupled with early response may produce a cascade-like effect for optimal conditions for long-term symptom reduction. Therefore, assessing expectations and providing clear treatment rationales may optimise sertraline effects.

Declaration of interest:

None.

Copyright

Corresponding author

Correspondence: Belinda Graham, Department of Experimental Psychology, University of Oxford, The Old Rectory, Paradise Square, Oxford OX1 1TW, UK. Email: belinda.graham@psy.ox.ac.uk

References

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1Watts, BV, Schnurr, PP, Mayo, L, Young-Xu, Y, Weeks, WB, Friedman, MJ. Meta-analysis of the efficacy of treatments for posttraumatic stress disorder. J Clin Psychiatry 2013; 74(6): e54150.
2Cusack, K, Jonas, DE, Forneris, CA, Wines, C, Sonis, J, Middleton, JC, et al. Psychological treatments for adults with posttraumatic stress disorder: a systematic review and meta-analysis. Clin Psychol Rev 2016; 43: 128–41.
3Lewis, CC, Simons, AD, Kim, HK. The role of early symptom trajectories and pretreatment variables in predicting treatment response to cognitive behavioral therapy. J Consult Clin Psychol 2012; 80(4): 525–34.
4Szegedi, A, Jansen, WT, van Willigenburg, AP, van der Meulen, E, Stassen, H, Thase, ME. Early improvement in the first 2 weeks as a predictor of treatment outcome in patients with major depressive disorder: a meta-analysis including 6562 patients. J Clin Psychiatry 2009; 70(3): 344–53.
5Tadić, A, Helmreich, I, Mergl, R, Hautzinger, M, Kohnen, R, Henkel, V, et al. Early improvement is a predictor of treatment outcome in patients with mild major, minor or subsyndromal depression. J Affect Disord 2010; 120(1–3): 8693.
6Taylor, MJ, Freemantle, N, Bhagwagar, Z, Geddes, JR. Early onset of selective serotonin reuptake inhibitor antidepressant action: systematic review and meta-analysis. Arch Gen Psychiatry 2006; 63(11): 1217–23.
7Hayes, AM, Feldman, GC, Beevers, CG, Laurenceau, J-P, Cardaciotto, L, Lewis-Smith, J. Discontinuities and cognitive changes in an exposure-based cognitive therapy for depression. J Consult Clin Psychol 2007; 75(3): 409–21.
8Haas, E, Hill, RD, Lambert, MJ, Morrell, B. Do early responders to psychotherapy maintain treatment gains? J Clin Psychol 2002; 58(9): 1157–72.
9Whipple, JL, Lambert, MJ, Vermeersch, DA, Smart, DW, Nielsen, SL, Hawkins, EJ. Improving the effects of psychotherapy: the use of early identification of treatment and problem-solving strategies in routine practice. J Couns Psychol 2003; 50(1): 5968.
10Tang, TZ, DeRubeis, RJ. Reconsidering rapid early response in cognitive behavioral therapy for depression. Clin Psychol Sci Pract 1999; 6(3): 283–8.
11Nordberg, SS, Castonguay, LG, Fisher, AJ, Boswell, JF, Kraus, D. Validating the rapid responder construct within a Practice Research Network. J Clin Psychol 2014; 70(9): 886903.
12Westra HA, AJ, Marcus, M. Expectancy, homework compliance, and initial change in cognitive-behavioral therapy for anxiety. J Consult Clin Psychol 2007; 75(3): 363–73.
13Snyder, C, Ingram, RE. Handbook of Psychological Change: Psychotherapy Processes & Practices for the 21st Century. vol. xvi. John Wiley & Sons, 2000.
14American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text Revision). APA, 2000.
15Marshall, RD, Beebe, KL, Oldham, M, Zaninelli, R. Efficacy and safety of paroxetine treatment for chronic PTSD: a fixed-dose, placebo-controlled study. Am J Psychiatry 2001; 158(12): 1982–8.
16Foa, E, Hembree, E, Rothbaum, BO. Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences (Treatments That Work). Oxford University Press, 2007.
17Foa, EB, Riggs, DS, Dancu, CV, Rothbaum, BO. Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Trauma Stress 1993; 6(4): 459–73.
18First, M, Spitzer, R, Gibbon, M, Williams, J. Structured Clinical Interview for DSM-IV. New York State Psychiatric Institute, 1995.
19Lobbestael, J, Leurgans, M, Arntz, A. Inter-rater reliability of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) and Axis II Disorders (SCID II). Clin Psychol Psychother 2011; 18(1): 75–9.
20Beck, AT, Ward, C, Mendelsohn, M. Beck Depression Inventory (BDI). Arch Gen Psychiatry 1961; 4(6): 561–71.
21Beck, AT, Epstein, N, Brown, G, Steer, RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988; 56(6): 893–7.
22Spielberger, CD, Gorsuch, RL, Lushene, PR, Vagg, PR, Jacobs, AG. Manual for the State-Trait Anxiety Inventory (Form Y). Consulting Psychologists Press, 1983.
23Foa, EB, Rothbaum, BO, Riggs, DS, Murdock, TB. Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counseling. J Consult Clin Psychol 1991; 59(5): 715–23.
24Resick, PA, Nishith, P, Weaver, TL, Astin, MC, Feuer, CA. A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. J Consult Clin Psychol 2002; 70(4): 867–79.
25Feeny, NC, Zoellner, LA, Mavissakalian, MR, Roy-Byrne, PP. What would you choose? Sertraline or prolonged exposure in community and PTSD treatment seeking women. Depress Anxiety 2009; 26(8): 724–31.
26Foa, EB, Dancu, CV, Hembree, EA, Jaycox, LH, Meadows, EA, Street, GP. A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. J Consult Clin Psychol 1999; 67(2): 194200.
27Hayes, AF, Matthes, J. Computational procedures for probing interactions in OLS and logistic regression: SPSS and SAS implementations. Behav Res Methods 2009; 41(3): 924–36.
28Hayes, AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. Guilford Press, 2013.
29Machado-Vieira, R, Salvadore, G, Luckenbaugh, DA, Manji, HK, Zarate, CA. Rapid onset of antidepressant action: a new paradigm in the research and treatment of major depression. J Clin Psychiatry 2008; 69(6): 946–58.
30Quitkin, FM, Rabkin, JG, Ross, D, McGrath, PJ. Duration of antidepressant drug treatment: what is an adequate trial? Arch Gen Psychiatry 1984; 41(3): 238–45.
31Peciña, M, Zubieta, J-K. Molecular mechanisms of placebo responses in humans. Mol Psychiatry 2015; 20(4): 416–23.
32Rutherford, BR, Wall, MM, Brown, PJ, Choo, T-H, Wager, TD, Peterson, BS, et al. Patient expectancy as a mediator of placebo effects in antidepressant clinical trials. Am J Psychiatry 2017; 174(2): 135–42.
33Powers, MB, Halpern, JM, Ferenschak, MP, Gillihan, SJ, Foa, EB. A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clin Psychol Rev 2010; 30(6): 635–41.
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High expectancy and early response produce optimal effects in sertraline treatment for post-traumatic stress disorder

  • Belinda Graham (a1), Natalia M. Garcia (a2), Mark S. Burton (a3), Andrew A. Cooper (a4), Peter P. Roy-Byrne (a5), Matig R. Mavissakalian (a6), Norah C. Feeny (a7) and Lori A. Zoellner (a8)...
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