History of sexual trauma moderates psychotherapy outcome for posttraumatic stress disorder

• Published in: Depression and anxiety Vol. 34; no. 8; pp. 692 - 700
• Main Authors: Markowitz, John C., Neria, Yuval, Lovell, Karina, Meter, Page E., Petkova, Eva
• Format: Journal Article
• Language: English
• Published: United States Hindawi Limited 01.08.2017
• Subjects: Adult; Female; Humans; Implosive Therapy - methods; Interpersonal Relations; Male; Middle Aged; moderation; Outcome Assessment (Health Care); Post traumatic stress disorder; posttraumatic stress disorder; Psychotherapy; Psychotherapy, Brief - methods; Relaxation Therapy - methods; Sex crimes; Sex Offenses; sexual trauma; Stress Disorders, Post-Traumatic - therapy; Treatment Outcome; Violence; psychotherapy; sexual trauma; moderation; posttraumatic stress disorder
• ISSN: 1091-4269; 1520-6394
• DOI: 10.1002/da.22619

Background Moderators of differential psychotherapy outcome for posttraumatic stress disorder (PTSD) are rare, yet have crucial clinical importance. We tested the moderating effects of trauma type for three psychotherapies in 110 unmedicated patients with chronic DSM‐IV PTSD. Methods Patients were randomized to 14 weeks of prolonged exposure (PE, N = 38), interpersonal psychotherapy (IPT, N = 40), or relaxation therapy (RT, N = 32). The Clinician‐Administered PTSD Scale (CAPS) was the primary outcome measure. Moderator candidates were trauma type: interpersonal, sexual, physical. We fit a regression model for week 14 CAPS as a function of treatment (a three‐level factor), an indicator of trauma type presence/absence, and their interactions, controlling for baseline CAPS, and evaluated potential confounds. Results Thirty‐nine (35%) patients reported sexual, 68 (62%) physical, and 102 (93%) interpersonal trauma. Baseline CAPS scores did not differ by presence/absence of trauma types. Sexual trauma as PTSD criterion A significantly moderated treatment effect: whereas all therapies had similar efficacy among nonsexually‐traumatized patients, IPT had greater efficacy among sexually traumatized patients (efficacy difference with and without sexual trauma: IPT vs. PE and IPT vs. RT P’s < .05), specifically in PTSD symptom clusters B and D (P’s < .05). Conclusions Few studies have assessed effects of varying trauma types on effects of differing psychotherapies. In this exploratory study, sexual trauma moderated PTSD outcomes of three therapies: IPT showed greater benefit for sexually traumatized patients than PE or RT. The IPT focuses on affect to help patients determine trust in their current environments may particularly benefit patients who have suffered sexual assault.