Posttraumatic stress disorder (PTSD) causes a great deal of mental and physical distress, and can significantly reduce a person’s quality of life. While there are a number of effective treatments available, many people fail to improve or are left with residual symptoms that cause persisting problems. Mental health practitioners who treat PTSD are hampered in their treatment planning by the lack of a dependable definition of what is good treatment response.
Researchers at Phoenix Australia have conducted an in-depth review of the PTSD treatment research published in the journal Clinical Psychology: Science and Practice, and have proposed a set of uniform definitions to guide both practitioners and researchers.
It is widely recognised that the concept of recovery from PTSD is not straightforward, yet the treatment outcome literature does not provide clear guidance on what constitutes treatment response or non-response. Studies that report on the effectiveness of PTSD treatment are difficult to compare, because there are differences in terms of what is considered to be a response to treatment (i.e. someone getting better), and when someone is considered to have not responded (i.e. not gotten better).
This lack of a standard definition of what it means for a person to respond or not respond to PTSD treatment is in stark contrast to other areas of psychiatry that have well developed definitions, such as depression or obsessive-compulsive disorder. More importantly, in the absence of a clear agreement on treatment response or non-response, it is difficult to effectively plan treatment and make timely clinical decisions such as when to cease, persist with or consider augmenting treatment.
This new study reviewed definitions of response and non-response in all clinical trials testing PTSD treatments over the past few decades. Lead researcher Dr Tracey Varker said that she and her colleagues were surprised to find that nearly a third of trials omitted a definition of response or non-response to treatment altogether.
For trials that did supply a definition, they mostly used either a pre-determined percentage reduction in symptom severity scores across treatment (e.g., -15%) or a set reduction in scores on an assessment measure (e.g., – 15 points), or set a particular cut-off score on a clinician-rated assessment tool. All of these approaches have their strengths and weaknesses.
Using the findings from the review, Dr Varker and her colleagues have proposed a set of definitions that “we think represents a sound way forward and hope might be adopted in order to standardise what it means for someone to get better”. The definitions are set out in the table below.
If these definitions can be adopted across the field, Dr Varker believes they will increase consistency and lead to improved clinical and research practice. She says that, “We also hope that they will help to facilitate the development of clinical algorithms to guide decision-making and treatment planning for people with PTSD. Our ultimate goal is to improve treatment outcomes for people with PTSD”.