Although trauma-focused psychotherapy (T-F psychotherapy) is the treatment of choice for posttraumatic stress disorder (PTSD), up to one half of patients do not respond to this treatment. Attempts to improve response to T-F psychotherapy have focused on augmenting fear extinction-based factors. Here, a systematic and meta-analytic review of predictors of T-F psychotherapy outcome was conducted with the goal of using an aggregate data-driven approach to elucidate baseline factors associated with treatment outcome. There were 114 studies that met inclusion criteria (N = 61, 970; Mage = 40.1 years; 40.1% female). There were 237 effect sizes across 24 meta-analytic categories. Poorer treatment response is associated with lower pretreatment levels of activation of fear-related brain regions, psychophysiological reactivity to fear provocation, trauma-related cognitions, anger, depression, high-risk alleles of genes linked to fear, lower levels of executive control, and social support. A range of other factors also predicted poorer responses including being male, non-Caucasian, older in age, early trauma occurrence, more trauma experience, history of combat trauma, as well as comorbid sleep, pain, poor quality life, and alcohol abuse difficulties. This review provides one potential explanation for the limited success of T-F psychotherapy augmentation strategies that have focused only on fear circuity mechanisms at the exclusion of other factors. Here, poor response relating to predictors of early trauma onset and comorbidity are consistent with clinical presentations of complex PTSD, which may suggest T-F psychotherapy is less effective for this condition. This collective evidence suggests that clinicians should consider a tailored approach that targets potential barriers to successful treatment response. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

中文翻译：

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对创伤后应激障碍以创伤为中心的心理治疗反应的预测因素的系统回顾和荟萃分析。


尽管以创伤为中心的心理治疗（TF 心理治疗）是创伤后应激障碍（PTSD）的首选治疗方法，但多达一半的患者对此治疗没有反应。改善 TF 心理治疗反应的尝试集中于增强基于恐惧消退的因素。在这里，对 TF 心理治疗结果的预测因素进行了系统的荟萃分析审查，目的是使用汇总数据驱动的方法来阐明与治疗结果相关的基线因素。有 114 项研究符合纳入标准（N = 61, 970；Mage = 40.1 岁；40.1% 女性）。 24 个荟萃分析类别有 237 个效应大小。治疗反应较差与治疗前恐惧相关大脑区域激活水平较低、对恐惧挑衅的心理生理反应、创伤相关认知、愤怒、抑郁、与恐惧相关的基因的高风险等位基因、执行控制水平较低以及社会支持。一系列其他因素也预测了较差的反应，包括男性、非白人、年龄较大、早期发生创伤、更多的创伤经历、战斗创伤史，以及共病睡眠、疼痛、生活质量差和酗酒困难。这篇综述为 TF 心理治疗增强策略的有限成功提供了一种可能的解释，这些策略仅关注恐惧回路机制而排除了其他因素。在这里，与早期创伤发作和合并症的预测因素相关的不良反应与复杂 PTSD 的临床表现一致，这可能表明 TF 心理治疗对于这种情况效果较差。 这些集体证据表明，临床医生应该考虑采取量身定制的方法，针对成功治疗反应的潜在障碍。 （PsycInfo 数据库记录 (c) 2024 APA，保留所有权利）。