Congratulations to Susan Silva, associate professor, who has received an award for her Case Western Reserve University subcontract proposal entitled: ”Optimizing Treatment for Post-Traumatic Stress Disorder (PTSD)." This award is for a six-month period, awarded January 1, 2021, to June 30, 2021.

Project Summary

Post-traumatic stress disorder (PTSD) is a chronic and debilitating condition, with a lifetime prevalence rate of 35.6% for woman who have experienced criminal victimization. Thus, the development of efficacious and cost-effective treatments for PTSD is imperative. Both prolonged exposure therapy (PE) and Zoloft (MED) are of established efficacy for PTSD. Yet, we do not know to what extent these efficacy findings generalize, nor what factors influence treatment acceptance/refusal and completion/drop-out. In a five-year, two-site study, we will examine these issues. In this collaborative clinical trial, the influence of patient preference will be evaluated in a randomized design; using broad inclusion criteria, participants with chronic assault related PTSD will be randomly assigned to either choice or no-choice of treatment. In the choice conditions, participants will choose among PE, PE + MED, or no treatment. In the no-choice condition, participants will be randomly assigned either to PE or PE + MED. The results of the research will inform clinicians about the relative effectiveness of PE and MED, provide guidelines for communicating information about treatment modalities in order to maximize treatment utilization, provide information about how treatments influence functional impairment, and provide important information about the short- and long-term cost effectiveness of PE and MED for chronic PTSD.

The specific aims are to: (1) compare the short-term effectiveness of PE to that of PE + MED in a sample of “typical” patients utilizing a broad range of outcome assessments. We will assess PTSD, depression, anxiety, functioning, disability, and quality of life before, during, and after treatment and compare the degree improvement and percent responders (at least 50% reduction in PTSD symptoms) achieved with PE to that of PE + MED; (2) compare the durability of PE gains to that of PE + MED at 3, 6, and 9 months post-treatment by examining PTSD symptom severity and percent responders, anxiety and depression, general functioning, disability and quality of life, obtained at each follow-up in the two groups; (3) compare those who have chosen their treatment to those who have not in terms of completion of treatment, treatment satisfaction, and short- and long-term effectiveness of the treatment. Further, to examine factors (e.g., rationale credibility, psychopathology, and trauma history) that predict patient treatment choice (PE, PE + MED, or No treatment); and (4) examine the cost-effectiveness of treatment delivery to trauma victims. We will use the data from the study to examine the cost effectiveness by relating the costs of providing the treatments to their outcomes. In addition to the aims outlined above, there are exploratory analyses we intend to conduct to better understand treatment for PTSD. These include examinations of the role of therapeutic alliance and the role of cognitions in treatment outcome.