Category: Adult Anxiety

Symposium

Exploring Treatment Heterogeneity in Prolonged Exposure for Veterans Using Growth Mixture Modeling

Saturday, November 18
12:00 PM - 1:30 PM
Location: Indigo Ballroom E, Level 2, Indigo Level

Keywords: Clinical Trial | PTSD Posttraumatic Stress Disorder | Veterans
Presentation Type: Symposium

Prolonged exposure (PE) is one of the most prominent PTSD treatments. However, not all who receive PE attain meaningful reductions in PTSD symptoms. A large minority of people (approximately 30%) engaged in PE drop out before treatment completion and 30-50% who do remain in treatment do not experience clinically significant symptom reduction. This issue is amplified in Veteran populations as they experience smaller treatment gains in PE than do civilians. Given this lack of treatment success, it is important to identify differential treatment response trajectories and identify predictors of these trajectories. Growth mixture modeling (GMM) is a data-analytic approach that can classify people into classes based on their treatment response. The current study used GMM to examine response to PE in a sample of 128 Veterans (M age = 41.83, SD = 14.58; 96.2% male) with a PTSD diagnosis. Veterans were randomized to either in-person PE (IP-PE; N = 68) or home-based telehealth PE (HBT-PE; N = 65) and received up to 12 treatment sessions (mean sessions attended = 8.14). The best-fitting model allowed for the intercept and slope variance to be equal across classes and resulted in three trajectories. The largest class (N = 89), labeled Non-Responders, contained Veterans with stable PTSD symptoms across the intervention. A smaller class, labeled Responders, contained individuals with steadily declining PTSD symptoms (N = 33). Finally, a very small class (N = 6), labeled Rapid Responders, with initial rapidly-declining and then stable PTSD symptoms emerged. Significantly lower baseline levels of CAPS-rated PTSD symptoms, depression symptoms, and anxiety symptoms were found in the Non-Responders, compared to the Responders. Controlling for baseline CAPS scores, month 3 and month 6 CAPS scores were significantly lower in the Responders than they were in the Non-Responders. The extracted trajectories conform to a prior study conducted by our group in a Veteran sample receiving a modified PE treatment (e.g., Allan et al., 2016). Together, these studies suggest that a large percentage of Veterans receiving PE for PTSD do not achieve significant reductions in their PTSD symptoms.

Nicholas P. Allan

Assistant Professor
Ohio University

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