Treatment augmentation for posttraumatic stress disorder: A systematic review.

Metcalf, Olivia; Stone, Caleb; Hinton, Mark; O’Donnell, Meaghan; Hopwood, Malcolm; McFarlane, Alexander C.; Forbes, David; Kartal, Dzenana; Watson, Loretta; Freijah, Isabella; Varker, Tracey

doi:10.1037/h0101758

Cited by 7 publications

(9 citation statements)

References 45 publications

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“…Certain sets of depressive symptoms may show greater HTE than others. Future studies should also consider studying HTE for methods designed to augment the effects of psychotherapy, as authors from this field argue that they may only work for certain subgroups of patients (Metcalf et al, 2020, p. 18).…”

Section: Discussionmentioning

confidence: 99%

Heterogeneity of treatment effects in trials on psychotherapy of depression.

Kaiser¹,

Volkmann²,

Volkmann³

et al. 2022

Clinical Psychology: Science and Practice

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Practitioners and researchers alike assume that there is individual variability in the effects of treatments for mental disorders. However, for psychotherapy, up to now this assumption has never been empirically tested. Using a large database of randomized-controlled trials on psychotherapy of depression in adults (306 trials including a total of 51,853 patients), we performed a Bayesian variance ratio metaregression. For the entire sample, we found a 9% higher variance in the intervention groups compared with the control groups. Depending on the depression scale used, this corresponds to a standard deviation of the individual treatment effect of 3 to 4 points. Subgroup analyses revealed that the effect variability of some types of therapy is larger than others. Our results are the first to indicate that patients do benefit differently from psychotherapy. We conclude that there is a sound basis for the paradigm of personalized psychotherapy, which brings about implications for both research and clinical practice. Public Health Significance StatementIn recent years, studies with high methodological quality have pointed out that the efficacy of psychotherapy in the treatment of depression is less satisfactory than previous research suggested. To optimize psychotherapy for non-responders, the paradigm of personalized therapy is coming into the research focus. In this study, we show for the first time that the effects of psychological interventions vary more than those of control conditions. This shows that differential response to treatments is inherent to intervention effects. Thus, it could indeed be beneficial to better tailor psychotherapy to individual patients. In practice, session-by-session outcome monitoring should be used to detect non-responding cases in ongoing treatments. Statistical methods guiding the selection of treatment components capitalize on the heterogeneity of treatment effects and are thus likely to improve outcomes. These findings pave the way for broad research and implementation of approaches that support personalization (e.g., monitoring and feedback systems) as well as a new shaping of training beyond the traditional schools of thought in psychotherapy.

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Section: Discussionmentioning

confidence: 99%

Heterogeneity of treatment effects in trials on psychotherapy of depression.

Kaiser¹,

Volkmann²,

Volkmann³

et al. 2022

Clinical Psychology: Science and Practice

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“…They also can inform which treatment strategies are most helpful and consequently lead to a better understanding of the mechanisms of change and longitudinal course of PTSD. This would not only allow for improvements to treatment response definitions, but also may assist in improving treatment outcomes through augmented treatments specifically targeting residual symptoms (Metcalf et al, 2019).…”

Section: | Discussionmentioning

confidence: 99%

Defining response and nonresponse to posttraumatic stress disorder treatments: A systematic review.

Varker

Kartal

Watson

et al. 2020

Clinical Psychology: Science and Practice

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Posttraumatic stress disorder (PTSD) is precipitated by exposure to traumatic events and consists of symptoms of intrusion, avoidance, arousal, negative cognitions, and negative mood (American Psychiatric Association; APA, 2013). PTSD affects approximately 6.8%-9.2% of adults during their lifetime (Kessler et al., 2005;McEvoy, Grove, & Slade, 2011). However, lifetime prevalence estimates are much higher for interpersonal trauma (e.g., rape or torture), as well as combat and military-related trauma (Breslau, Peterson, Poisson, Schultz, & Lucia, 2004;Goldberg et al., 2016). PTSD is also associated with significant mental and physical distress, impairments in functioning, and reduced quality of life (Nemeroff et al., 2006;Olatunji, Cisler, & Tolin, 2007;Rodriguez, Holowka, & Marx, 2012).Multiple international guidelines for the treatment of PTSD recommend trauma-focused cognitive behavioral therapies as first-line interventions (Forbes et al., 2010). Overall, trauma-focused treatments have demonstrated effectiveness

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“…Such results are attributed to greater symptom severity, deficits in emotional processes, reluctance to discuss the trauma via (imaginal) exposure, and discomfort with therapists (Hoge et al, 2014). Existing augmentations proposed for PTSD EBPs have demonstrated modest incremental effectiveness (Metcalf et al, 2019), but have not adequately addressed all of these barriers.…”

Section: Access and Barriers To Carementioning

confidence: 99%

Processing of Positive Memories Technique among Clients Reporting Traumatic Experiences: A Case Series

Fondren

Banducci

Cox

et al. 2021

Clinical Case Studies

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Many current treatments for posttraumatic stress disorder (PTSD) emphasize processing and engaging with trauma memories as the key mechanism of therapeutic change. However, promising emerging research indicates links between PTSD symptoms and positive memories. Processing positive memories, to therapeutically impact health outcomes for trauma-exposed individuals, may have several benefits, including (a) increasing access to positive coping mechanisms via activating positive affect and thoughts; (b) addressing avoidance of positive affect and thoughts; and (c) honing skills that will aid in the eventual processing of trauma memories. The present article demonstrates the utility and effects of a novel Processing of Positive Memories Technique (PPMT) with three clients who reported a history of traumatic experiences. We outline the procedures of a 5-session PPMT, that incorporates symptom assessment, detailed imaginal experiencing of positive memories, and processing of associated positive values, affect, strengths, and thoughts. We utilize longitudinal assessment data to demonstrate the clinical benefits of PPMT, such as less PTSD severity, improved mood (e.g., less negative affect), and greater self-esteem. Finally, we discuss treatment considerations based on unique client factors and treatment modalities (i.e., in-person vs. video telehealth).

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Treatment augmentation for posttraumatic stress disorder: A systematic review.

Cited by 7 publications

References 45 publications

Heterogeneity of treatment effects in trials on psychotherapy of depression.

Heterogeneity of treatment effects in trials on psychotherapy of depression.

Defining response and nonresponse to posttraumatic stress disorder treatments: A systematic review.

Processing of Positive Memories Technique among Clients Reporting Traumatic Experiences: A Case Series

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