Post-Traumatic Stress Disorder Outcome Research: Why Moderators Should not be Neglected

Abstract

Several psychotherapeutic treatments have been developed over the years for treating the symptoms of post-traumatic stress disorder (PTSD). But it remains still unclear which components of the complex treatment packages are necessary and most beneficial for PTSD symptom improvement. In PTSD outcome research, the randomized controlled trial (RCT) design has been applied in order to address this issue. However, meta-analyses repeatedly reported considerable variation between results from individual RCTs (i.e. between-study heterogeneity). Attempts to explain such heterogeneity led to the identification of relevant moderators of treatment effects in PTSD RCTs. This study presents meta-analytic findings, which show that factors, which are not part of the treatment (such as the investigators' preferences for a particular treatment or the complexity of the patients' clinical problems), impact on outcome in PTSD RCTs. We show that considering extra-therapeutic moderators in meta-analyses on PTSD RCTs may impact the conclusions and recommendations that may be deduced. The summarized findings confirm the notion that no PTSD treatment consistently outperforms the others and strengthen the position that even non-trauma-focused treatments may be beneficial PTSD treatments,