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In rape trauma PTSD, patient characteristics indicate which trauma-focused treatment they are most likely to complete.

Publication ,  Journal Article
Keefe, JR; Wiltsey Stirman, S; Cohen, ZD; DeRubeis, RJ; Smith, BN; Resick, PA
Published in: Depress Anxiety
April 2018

BACKGROUND: Dropout rates for effective therapies for posttraumatic stress disorder (PTSD) can be high, especially in practice settings. Although clinicians have intuitions regarding what treatment patients may complete, there are few systematic data to drive those judgments. METHODS: A multivariable model of dropout risk was constructed with randomized clinical trial data (n = 160) comparing prolonged exposure (PE) and cognitive processing therapy (CPT) for rape-induced PTSD. A two-step bootstrapped variable selection algorithm was applied to identify moderators of dropout as a function of treatment condition. Employing identified moderators in a model, fivefold cross-validation yielded estimates of dropout probability for each patient in each condition. Dropout rates between patients who did and did not receive their model-indicated treatment were compared. RESULTS: Despite equivalent dropout rates across treatments, patients assigned to their model-indicated treatment were significantly less likely to drop out relative to patients who did not (relative risk = 0.49 [95% CI: 0.29-0.82]). Moderators included in the model were: childhood physical abuse, current relationship conflict, anger, and being a racial minority, all of which were associated with higher likelihood of dropout in PE than CPT. CONCLUSIONS: Individual differences among patients affect the likelihood they will complete a particular treatment, and clinicians can consider these moderators in treatment planning. In the future, treatment selection models could be used to increase the percentage of patients who will receive a full course of treatment, but replication and extension of such models, and consideration of how best to integrate them into routine practice, are needed.

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Published In

Depress Anxiety

DOI

EISSN

1520-6394

Publication Date

April 2018

Volume

35

Issue

4

Start / End Page

330 / 338

Location

United States

Related Subject Headings

  • Young Adult
  • Stress Disorders, Post-Traumatic
  • Rape
  • Psychiatry
  • Patient Compliance
  • Middle Aged
  • Individuality
  • Implosive Therapy
  • Humans
  • Female
 

Citation

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Keefe, J. R., Wiltsey Stirman, S., Cohen, Z. D., DeRubeis, R. J., Smith, B. N., & Resick, P. A. (2018). In rape trauma PTSD, patient characteristics indicate which trauma-focused treatment they are most likely to complete. Depress Anxiety, 35(4), 330–338. https://doi.org/10.1002/da.22731
Keefe, John R., Shannon Wiltsey Stirman, Zachary D. Cohen, Robert J. DeRubeis, Brian N. Smith, and Patricia A. Resick. “In rape trauma PTSD, patient characteristics indicate which trauma-focused treatment they are most likely to complete.Depress Anxiety 35, no. 4 (April 2018): 330–38. https://doi.org/10.1002/da.22731.
Keefe JR, Wiltsey Stirman S, Cohen ZD, DeRubeis RJ, Smith BN, Resick PA. In rape trauma PTSD, patient characteristics indicate which trauma-focused treatment they are most likely to complete. Depress Anxiety. 2018 Apr;35(4):330–8.
Keefe, John R., et al. “In rape trauma PTSD, patient characteristics indicate which trauma-focused treatment they are most likely to complete.Depress Anxiety, vol. 35, no. 4, Apr. 2018, pp. 330–38. Pubmed, doi:10.1002/da.22731.
Keefe JR, Wiltsey Stirman S, Cohen ZD, DeRubeis RJ, Smith BN, Resick PA. In rape trauma PTSD, patient characteristics indicate which trauma-focused treatment they are most likely to complete. Depress Anxiety. 2018 Apr;35(4):330–338.
Journal cover image

Published In

Depress Anxiety

DOI

EISSN

1520-6394

Publication Date

April 2018

Volume

35

Issue

4

Start / End Page

330 / 338

Location

United States

Related Subject Headings

  • Young Adult
  • Stress Disorders, Post-Traumatic
  • Rape
  • Psychiatry
  • Patient Compliance
  • Middle Aged
  • Individuality
  • Implosive Therapy
  • Humans
  • Female