Differential treatment response trajectories in individuals with subclinical and clinical PTSD

Abstract

Subclinical presentations of posttraumatic stress disorder (PTSD), wherein patients are one or two symptom criteria short of the full disorder, are prevalent and associated with levels of distress and impaired functioning approximating that of full PTSD. Nonetheless, research examining treatment efficacy for this group is in the nascent stage. The purpose of the present study was to examine whether the subclinical PTSD group would: (1) show a greater reduction in PTSD symptoms at pre and post treatment in response to an exposure based treatment and (2) show a greater rate of change over the course of treatment, when compared to the full criteria PTSD group. We also examined whether differences would emerge when examining PTSD symptom clusters. Consistent with predictions, the subclinical PTSD group demonstrated a greater reduction in PTSD symptoms at post-treatment (29%) than those with a PTSD diagnosis (14%). Further, the groups had different treatment trajectories, with the subclinical PTSD group showing a marginally greater rate of change during the course of treatment. Findings also varied by symptom cluster with the subclinical group showing a greater rate of change in the intrusions, hyper-vigilance, and avoidance symptom clusters. There was not a significant between group difference in the numbing symptom cluster. This study provides preliminary evidence that treating PTSD symptoms at the subclinical level may result in a larger, and more rapid symptom reduction, and thus has implications supporting treatment earlier in the developmental trajectory of the disorder.

Investigating Individual Pre-trauma Susceptibility to a PTSD-Like Phenotype in Animals

“…Searching for new treatments is important because existing treatments are either effective but have a high attrition rate (Resick et al, 2002) or have better compliance but moderate to low efficacy (Cusack et al, 2016). In addition, people exhibiting distinct clusters of symptoms respond differently to different treatment types (Korte et al, 2016). While these considerations underscore the importance of finding new effective treatments, they also highlight the importance of preventing PTSD from developing in the first place.…”

Sex differences in the trauma-related symptoms: A pilot study

“…Better understanding of sex differences in PTSD pathophysiology and symptom-maintenance, in both clinical and sub-clinical population, might assist in developing enhanced, more personalized treatments to address sex-specific neurobiological targets. Treating trauma related symptoms at the subclinical level may result in a larger and more rapid symptom reduction, thus sexspecific interventions applied earlier in the developmental trajectory of the disorder might be highly beneficial (34). However, future studies are needed to examine whether trauma-focused treatments can be tailored in relation to sex and to which extent it might prevent full-blown PTSD.…”

Recovery, Rehabilitation and Positive Psychology for Chronic Post-Traumatic Stress Disorder: Theoretical and Practical Aspects among French Veterans

“…On the one hand, there is little research to indicate which treatments are most effective for which patients. For example, whereas significant research to improve treatment for full criteria PTSD exists [7], the evaluation of treatments targeting subclinical PTSD is still in nascent stages [10]. Furthermore, patient treatment preference may affect the differential effectiveness of standardized treatment [11].…”

“…Do they experience great difficulties to keep it when the disease is established? This lack of information is set in recent current events, bearers of a large number of victims of attacks and other acts of terrorism posing the problem of the socioprofessional future of these victims as a matter of future public health [10]. It seems necessary to think over the dynamics of the PTSD recovery; to make it feasible, it is important to consider two singular points of the PTSD: (i) the learned mental disability context and (ii) the responsiveness to surroundings, including the one in which the rehabilitation interventions are implemented.…”