Is it worth it to personalize the treatment of PTSD? - A variance-ratio meta-analysis and estimation of treatment effect heterogeneity in RCTs of PTSD

Abstract

Several evidence-based treatments for posttraumatic stress disorder (PTSD) are recommended by international guidelines (e.g., APA, NICE). While their average effects are in general high, non-response rates indicate differential treatment effects. Here, we used a large database of RCTs on psychotherapy for PTSD to determine a reliable estimate of this heterogeneity in treatment effects by (1) applying Bayesian variance ratio meta-analysis, and (2) estimating the treatment effect heterogeneity (TEH). In total, 66 studies with a total of 8,803 patients were included in our study. TEH was found for all psychological treatments, with varying degrees of certainty, only slight differences between psychological treatments, and active control groups yielding a smaller variance ratio compared to waiting list control groups. Across all psychological treatment and control group types, the estimate for the intercept was 0.12, indicating a 12% higher variance of endpoint values in the intervention groups after controlling for the endpoint ratio. This study is the first to determine the extent of increase in treatment effects of psychological treatments for PTSD by personalization. The results indicate that there is sufficient heterogeneity in treatment effects across all psychological treatment and control groups, which in turn allow personalizing psychological treatments by using treatment selection approaches.