Trauma-focused treatment for comorbid post-traumatic stress and substance use disorder

Kline, Alexander C.; Panza, Kaitlyn E.; Lyons, Robert; Kehle‐Forbes, Shannon M.; Hien, Denise A.; Norman, Sonya B.

doi:10.1038/s44159-022-00129-w

Cited by 6 publications

(2 citation statements)

References 167 publications

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“…In short, while fear biology factors did play an important role in predicting treatment response, there were comparable contributions of other factors that may not be directly related to fear. These findings align with recent narrative reviews of the extant literature relating to predictors of treatment response (Fonzo et al, 2020; Kline et al, 2023), and they importantly highlight a role for nonfear-related factors in driving response to first line interventions (Alpert et al, 2023) for PTSD.…”

Section: Discussionsupporting

confidence: 83%

“…In this sense, the risk for poor outcome posed by comorbidity may be related to the association of different trauma types and earlier exposure to trauma on poor treatment response. It is worth noting that some applications of T-F psychotherapy have specifically attempted to address comorbid issues, including physical health comorbidity, pain, anxiety, sleep, and concurrent alcohol use (Cloitre et al, 2010; Hien et al, 2017; Kline et al, 2023). In this context, it is worth mentioning that increasing attention is being given to complex PTSD, which is characterized by a form of PTSD that is compounded by significant problems in emotion regulation, relationships, and self-identity (Brewin et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

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A systematic review and meta-analysis of predictors of response to trauma-focused psychotherapy for posttraumatic stress disorder.

Keyan,

Garland,

Choi-Christou

et al. 2024

Psychological Bulletin

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Although trauma-focused psychotherapy (T-F psychotherapy) is the treatment of choice for posttraumatic stress disorder (PTSD), up to one half of patients do not respond to this treatment. Attempts to improve response to T-F psychotherapy have focused on augmenting fear extinction-based factors. Here, a systematic and meta-analytic review of predictors of T-F psychotherapy outcome was conducted with the goal of using an aggregate data-driven approach to elucidate baseline factors associated with treatment outcome. There were 114 studies that met inclusion criteria (N = 61, 970; Mage = 40.1 years; 40.1% female). There were 237 effect sizes across 24 meta-analytic categories. Poorer treatment response is associated with lower pretreatment levels of activation of fear-related brain regions, psychophysiological reactivity to fear provocation, trauma-related cognitions, anger, depression, high-risk alleles of genes linked to fear, lower levels of executive control, and social support. A range of other factors also predicted poorer responses including being male, non-Caucasian, older in age, early trauma occurrence, more trauma experience, history of combat trauma, as well as comorbid sleep, pain, poor quality life, and alcohol abuse difficulties. This review provides one potential explanation for the limited success of T-F psychotherapy augmentation strategies that have focused only on fear circuity mechanisms at the exclusion of other factors. Here, poor response relating to predictors of early trauma onset and comorbidity are consistent with clinical presentations of complex PTSD, which may suggest T-F psychotherapy is less effective for this condition. This collective evidence suggests that clinicians should consider a tailored approach that targets potential barriers to successful treatment response.

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Section: Discussionsupporting

confidence: 83%