Treatment Outcomes for Military Veterans With Posttraumatic Stress Disorder: Response Trajectories by Symptom Cluster

Abstract

Although effective posttraumatic stress disorder (PTSD) treatments are available, outcomes for veterans with PTSD are relatively modest. Previous researchers have identified subgroups of veterans with different response trajectories but have not investigated whether PTSD symptom clusters (based on a four-factor model) have different patterns of response to treatment. The importance of this lies in the potential to increase treatment focus on less responsive symptoms. We investigated treatment outcomes by symptom cluster for 2,685 Australian veterans with PTSD. We used Posttraumatic Stress Disorder Checklist scores obtained at treatment intake, posttreatment, and 3- and 9-month follow-ups to define change across symptom clusters. Repeated measures effect sizes indicated that arousal and numbing symptoms exhibited the largest changes between intake and posttreatment, d = -0.61 and d = -0.52, respectively, whereas avoidance and intrusion symptoms showed more modest reductions, d = -0.36 and d = -0.30, respectively. However, unlike the other symptom clusters, the intrusions cluster continued to show significant changes between posttreatment and 3-month follow-up, d = -0.21. Intrusion and arousal symptoms also showed continued changes between 3- and 9-month follow-ups although these effects were very small, d = -0.09. Growth curve model analyses produced consistent findings and indicated modest initial changes in intrusion symptoms that continued posttreatment. These findings may reflect the longer time required for emotional processing, relative to behavioral changes in avoidance, numbing, and arousal, during the program; they also reinforce the importance of prioritizing individual trauma-focused therapy directly targeting intrusions as the core component of programmatic treatment.

Posttraumatic Stress Disorder Symptom Cluster Structure in Prolonged Exposure Therapy and Virtual Reality Exposure

“…Alternatively, reductions in avoidance and hyperarousal symptoms may increase patients’ ability and willingness to engage more fully in trauma memories; thus, reductions in reexperiencing symptoms may follow reductions in other symptom clusters. Consistent with this idea, the results of a recent meta‐analysis demonstrated that reexperiencing symptoms evidenced the smallest effect size across exposure‐based therapy compared to the other symptom clusters and that symptoms further decreased to a significant degree between posttreatment and follow‐up assessments (Phelps et al., 2018). This finding should be explored within other samples of active duty military personnel and other trauma‐exposed populations.…”

Novel Approaches for the Treatment of Post-Traumatic Stress Disorder: A Systematic Review of Non-Invasive Brain Stimulation Interventions and Insights from Clinical Trials

“…However, this issue could be tackled through subsequent research endeavors concentrating exclusively on TES or directed towards the isolation of subtypes of PTSD for which NIBS techniques might prove more appropriate. Second, when reported, the types of traumas and time elapsed from the experience of traumatic events were highly dissimilar, which represent, instead, crucial factors for determining the different trajectories of PTSD symptoms and treatment response [ 117 , 118 , 119 , 120 ]. Third, the samples were mostly composed by men, and, in some cases, the sample size was small (e.g., [ 56 , 64 , 66 ]), limiting the generalizability of the findings.…”

To BDZ or not to BDZ? That is the question! Is there reliable scientific evidence for or against using benzodiazepines in the aftermath of potentially traumatic events for the prevention of PTSD? A systematic review and meta-analysis

“…PTSD is associated with intense and extended psychological suffering. The most effective available treatment modality for PTSD—trauma-focused therapy—cannot provide substantial symptomatic relief in the short term (Phelps et al, 2018) and neither can the slow-acting antidepressants, such as the selective serotonin reuptake inhibitors, considered the first-line pharmacological intervention (Akiki and Abdallah, 2019). A single intravenous infusion of a subanesthetic dose of ketamine was found to be associated with a significant and rapid reduction in post-traumatic and depressive symptom severity in patients with chronic PTSD (Feder et al, 2014) and is a promising area of research.…”