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Using the Personalized Advantage Index to determine which veterans may benefit from more vs. less comprehensive intensive PTSD treatment programs.

ABSTRACT: Background: Intensive PTSD treatment programs (ITPs) are highly effective but tend to differ greatly in length and the number of adjunctive services that are provided in conjunction with evidence-based PTSD treatments. Individuals' treatment response to more or less comprehensive ITPs is poorly understood.Objective: To apply a machine learning-based decision-making model (the Personalized Advantage Index (PAI)), using clinical and demographic factors to predict response to more or less comprehensive ITPs.Methods: The PAI was developed and tested on a sample of 747 veterans with PTSD who completed a 3-week (more comprehensive; n = 360) or 2-week (less comprehensive; n = 387) ITP.Results: Approximately 12.32% of the sample had a PAI value that suggests that individuals would have experienced greater PTSD symptom change (5 points) on the PTSD Checklist for DSM-5 in either a more- or less comprehensive ITP. For individuals with the highest 25% of PAI values, effect sizes for the amount of PTSD symptom change between those in their optimal vs. non-optimal programs was d = 0.35.Conclusions: Although a minority was predicted to have benefited more from a program, there generally was not a substantial difference in predicted outcomes. Less comprehensive and thus more financially sustainable ITPs appear to work well for most individuals with PTSD.

SUBMITTER: Held P

PROVIDER: S-EPMC10990437 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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Using the Personalized Advantage Index to determine which veterans may benefit from more vs. less comprehensive intensive PTSD treatment programs.

Held Philip P Patton Emily E Pridgen Sarah A SA Smith Dale L DL Kaysen Debra L DL Klassen Brian J BJ

European journal of psychotraumatology 20231127 2

<b>Background:</b> Intensive PTSD treatment programs (ITPs) are highly effective but tend to differ greatly in length and the number of adjunctive services that are provided in conjunction with evidence-based PTSD treatments. Individuals' treatment response to more or less comprehensive ITPs is poorly understood.<b>Objective:</b> To apply a machine learning-based decision-making model (the Personalized Advantage Index (PAI)), using clinical and demographic factors to predict response to more or ...[more]

PMID: 38010280

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Project description:A wealth of evidence has illustrated that reductions in negative posttrauma cognitions (NPCs) predict improvement in posttraumatic stress disorder (PTSD) symptoms during treatment. Yet, the specific temporal arrangement of changes in these constructs is less well understood. This study examined the temporal association between NPC changes and PTSD symptom changes in two distinct intensive PTSD treatment samples. Data from 502 veterans who completed a 3-week CPT-based intensive PTSD treatment program was used to test the extent to which lagged NPC measurement predicted the next occurring PTSD severity measurement using linear mixed effects regression models. PTSD severity was assessed every other day during treatment. NPCs were assessed at three treatment timepoints. A second sample of 229 veterans who completed a 2-week CPT-based intensive PTSD treatment program was used to replicate these findings. Across both intensive PTSD treatment programs, NPCs generally increased from intake the end of the first treatment week, which was followed by gradual decreases in NPCs throughout the rest of both programs. Change in NPCs during both the 3-week (b = .21, p < .001, R2 = .38) and the 2-week programs (b = 0.20, p < .001, R2 = .24) were significant predictors of change in PTSD symptom severity. However, the reverse was true as well, with change in PTSD severity predicting latter change in NPCs during both the 3-week (b = 1.51, p < .001, R2 = .37) and 2-week (b = 1.37, p < .001, R2 = .33) programs, further raising questions about temporality of the association between NPCs and PTSD symptom severity during treatment. The present study demonstrated that changes in NPCs may not temporally precede changes in PTSD symptom severity in PTSD treatment samples. Instead, we observed earlier PTSD symptom changes and a bidirectional association between the two constructs across both samples. Clinically, the study supports the continued focus on NPCs as an important treatment target as they are an important indicator of successful PTSD treatment, even if they may not be a direct mechanism of treatment-based changes in PTSD severity. Future research should attempt to identify alternative mechanisms of change in CPT.

Dataset Information

Using the Personalized Advantage Index to determine which veterans may benefit from more vs. less comprehensive intensive PTSD treatment programs.

Publications

Using the Personalized Advantage Index to determine which veterans may benefit from more vs. less comprehensive intensive PTSD treatment programs.

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