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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)...



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


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


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.


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.


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:



Corresponding author

Correspondence: Belinda Graham, Department of Experimental Psychology, University of Oxford, The Old Rectory, Paradise Square, Oxford OX1 1TW, UK. Email:


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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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