Abstract
Patients with posttraumatic stress disorder (PTSD) who fail to respond to established treatments are at risk for chronic disability and distress. Although treatment-resistant PTSD (TR-PTSD) is a common clinical problem, there is currently no standard method for evaluating previous treatment outcomes. Development of a tool that could quantify the degree of resistance to previously provided treatments would inform research in patients with PTSD. We conducted a systematic review of PTSD treatment trials to identify medication and psychotherapy interventions proven to be efficacious for PTSD. We then developed a semi-structured clinician interview called the Emory Treatment Resistance Interview for PTSD (E-TRIP). The E-TRIP includes clinician-administered questions to assess the adequacy and benefit derived from past treatment trials. For each adequately delivered treatment to which the patient failed to respond, a score is assigned depending on the strength of evidence supporting the treatment’s efficacy. The E-TRIP provides a comprehensive assessment of prior PTSD treatments that should prove valuable for researchers studying TR-PTSD and evaluating the efficacy of new treatments for patients with PTSD. The E-TRIP is not intended to guide treatment; rather, the tool quantifies the level of treatment resistance in patients with PTSD in order to standardize TR-PTSD in the research domain.
Highlights
Several evidence-based psychotherapies and medications are available to treat posttraumatic stress disorder (PTSD)
Despite the clinical significance of treatment resistant PTSD (TR-PTSD), there is currently no standard tool to identify patients as treatment resistant, and there is no agreement on what level of prior treatment should constitute TR-PTSD [2]
While there are several published guidelines to help clinicians make treatment choices for patients with PTSD, each guideline differentially weights certain aspects of study design and outcomes when reviewing clinical trials, which has resulted in substantial variability about treatment efficacy across guidelines [3]
Summary
Several evidence-based psychotherapies and medications are available to treat posttraumatic stress disorder (PTSD). While there are several published guidelines to help clinicians make treatment choices for patients with PTSD, each guideline differentially weights certain aspects of study design and outcomes when reviewing clinical trials, which has resulted in substantial variability about treatment efficacy across guidelines [3]. The lack of agreement about treatment efficacy presents a challenge for developing a measure of TR-PTSD because defining treatment resistance requires a single standard for efficacy. The guidelines were intended to help guide treatment decisions for patients with PTSD, rather than quantify the level of treatment resistance. There is a need for a TR-PTSD measure that could be incorporated into clinical research to characterize patients’ previous treatment outcomes. We conducted a systematic review of the evidence to determine which treatments have sufficient evidence of efficacy to warrant inclusion in a measure of TR-PTSD. We describe the development of the Emory Treatment Resistance Interview for PTSD (E-TRIP), a semi-structured interview designed to quantify TR-PTSD
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