Individuals with post-traumatic stress disorder (PTSD) who receive their preferred form of treatment — whether drugs or therapy — are more likely to improve compared to those who are randomly prescribed the non-preferred treatment.
That is the finding of a new large-scale clinical trial conducted by researchers from the University of Washington (UW) and Case Western Reserve University.
The study, published in the American Journal of Psychiatry, involved 200 patients with chronic PTSD, including veterans and survivors of sexual assault. Three-quarters of participants were women.
The goal of the study was to measure whether patient preference in the course of treatment was able to influence the success of either behavioral therapy or the use of selective serotonin reuptake inhibitors, a type of antidepressant often prescribed for PTSD.
The findings show that both medication — in this case, sertraline (brand name Zoloft) — and a specific form of therapy known as prolonged exposure were each effective in reducing PTSD symptoms during the course of treatment, with improvements maintained at least two years later.
But patients who received their choice of treatment were more likely to stick to their treatment program, showed greater reduction in symptoms, and even lost their PTSD diagnosis over time.
“In any form of health care, when receiving a recommendation from a provider, patients may or may not be given a choice of approaches to address their problems,” said the study’s lead author, Dr. Lori Zoellner, a UW professor of psychology and director of the Center for Anxiety & Traumatic Stress.
“This research suggests that prolonged exposure and sertraline are both good, evidence-based options for PTSD treatment and that providing information to make an informed choice enhances long-term outcomes.”
At the beginning of the research, all participants expressed a treatment preference between two options: medication or 10 weeks of therapy. The study was doubly randomized, meaning that participants were randomly assigned to either a group in which they received their preferred treatment, or to a group in which they were randomly assigned to one treatment program or the other.
All participants were evaluated by clinicians for PTSD symptoms, and they also gave self-reports of their feelings and behaviors, before, immediately after, and at three, six, 12 and 24 months.
When asked, 61 percent of participants expressed a preference for prolonged exposure therapy. This type of counseling is often used to treat PTSD because it encourages patients to talk about what happened to them, learn coping strategies and explore their thoughts and feelings through repeatedly approaching the trauma memory and reminders of the trauma.
Of those participants who received prolonged exposure therapy, nearly 70 percent were determined to be free of their PTSD diagnosis two years after the therapy ended, compared with 55 percent of those who had started and remained on the drug sertraline through the follow-up.
Comparing medication to psychotherapy is rare in a clinical trial because it is time- and labor-intensive, Zoellner explained. In this case, both treatments had positive effects, though therapy demonstrated a slight edge.
“When both interventions reduce symptoms, it is often difficult to detect a difference because of patients’ varying responses — some get a lot better, some do not. This study showed both prolonged exposure and sertraline provide generally large and clinically meaningful effects to reduce PTSD and related symptoms,” she said. “Prolonged exposure psychotherapy for PTSD is as good as Sertraline, if not better, for the treatment of PTSD.”
When treatment preference was taken into account, however, the results were more dramatic. Of those who wanted and received therapy, 74 percent had lost their PTSD diagnosis two years later; of those who preferred therapy but received medication instead, only 37 percent were PTSD-free after two years.
Whether or not patients received their preferred course of treatment appeared to directly affect their commitment: Nearly 75 percent of patients who were “matched” with their preferred method completed their full treatment program, while more than half of those who were “mismatched” with a treatment method did not complete that course of treatment.
Not all survivors of sexual assault have PTSD or depression, Zoellner pointed out, but those who do may not know that short-term therapy or a medication can bring about significant long-term benefits.
In addition to greater success, patient choice in treatment also saves money, in the form of fewer emergency department visits, hospitalizations and other care, as well as indirect savings such as fewer lost work hours.
Source: University of Washington