What would you choose? Sertraline or prolonged exposure in community and PTSD treatment seeking women

Authors

  • Norah C. Feeny Ph.D.,

    Corresponding author
    1. Department of Psychology, Case Western Reserve University, Cleveland, Ohio
    • Case Western Reserve University, Department of Psychology, 11220 Bellflower, Cleveland, Ohio 44106–7123
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    • Lori A. Zoellner and Norah C. Feeny share first authorship on this paper.

  • Lori A. Zoellner Ph.D.,

    1. Department of Psychology and Department of Psychiatry, University of Washington, Seattle, Washington
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    • Lori A. Zoellner and Norah C. Feeny share first authorship on this paper.

  • Matig R. Mavissakalian M.D.,

    1. Department of Psychology, Case Western Reserve University, Cleveland, Ohio
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  • Peter P. Roy-Byrne M.D.

    1. Department of Psychology and Department of Psychiatry, University of Washington, Seattle, Washington
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Abstract

Background: Both sertraline (SER) and prolonged exposure (PE) are empirically supported treatments for chronic posttraumatic stress disorder (PTSD). While efficacious, these treatments are quite different in approach, and such differences may influence both treatment choice and treatment outcome. To date, we know very little about the relative efficacy of pharmacological and psychological treatments for chronic PTSD. Method: In Study 1, we compared rates of treatment choice (SER or PE) in 74 trauma-exposed women. In Study 2, we extended this work to an open-choice treatment trial, in which 31 female assault survivors with chronic PTSD received their choice of SER or PE for ten weeks and were followed over time. Results: In Study 1 (82%) and Study 2 (74.2%), the majority of women chose PE. In Study 2, both SER and PE evidenced moderate to large unadjusted effect sizes, with evidence of an advantage for PE in propensity adjusted analyses at posttreatment. Women with co-occurring major depressive disorder (MDD) were more likely to choose SER than those without MDD. However, among those with MDD, the advantage of PE was particularly evident. Conclusions: Our results highlight the presence of clear treatment preferences for PTSD and their potential impact on outcome. This study underscores the importance of systematic study of patient preferences and encourages a rethinking of one-size fits all approaches to treatment for mental disorders. Depression and Anxiety, 2009. © 2009 Wiley-Liss, Inc.

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