A Personalized Index to Inform Selection of a Trauma-Focused or Non-Trauma-Focused Treatment for PTSD

Abstract PTSD treatment guidelines recommend several treatments with extensive empirical support, including Prolonged Exposure (PE), a trauma-focused treatment and Present-Centered Therapy (PCT), a non-trauma-focused therapy. Research to inform treatment selection has yielded inconsistent findings with single prognostic variables that are difficult to integrate into clinical decision-making. We examined whether a combination of prognostic factors can predict different benefits in a trauma-focused vs. a non-trauma-focused psychotherapy. We applied a multi-method variable selection procedure and developed a prognostic index (PI) with a sample of 267 female veterans and active-duty service members (mean age 45; SD = 9.37; 53% White) with current PTSD who began treatment in a randomized clinical trial comparing PE and PCT. We conducted linear regressions predicting outcomes (Clinician-Administered PTSD Scale score) with treatment condition, the PI, and the interaction between the PI and treatment condition. The PI moderated treatment response, b = 0.32, SEb = 0.16 [95% CI: 0.02, 0.63], p = .04. For the 64% of participants with the best prognoses, PE resulted in better post-treatment outcomes; for the remainder, there was no difference. Use of a PI may lead to optimized patient outcomes and greater confidence when selecting trauma-focused treatments.