Doubly Randomized Preference Trial of Prolonged Exposure Versus Sertraline for Treatment of PTSD

Zoellner, Lori A.; Roy-Byrne, Peter P.; Mavissakalian, Matig; Feeny, Norah C.

doi:10.1176/appi.ajp.2018.17090995

Cited by 126Posttraumatic Stress Disorder ResearchPsychotherapy Techniques and ApplicationsSleep and related disorders

Doubly Randomized Preference Trial of Prolonged Exposure Versus Sertraline for Treatment of PTSD

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Zoellner, Lori A., Roy-Byrne, Peter P., Mavissakalian, Matig, Feeny, Norah C.·2019·American Journal of Psychiatry

DOI 10.1176/appi.ajp.2018.17090995

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Abstract

OBJECTIVE: The authors examined the effect of patient treatment preference on the differential effectiveness of prolonged exposure and sertraline for the treatment of posttraumatic stress disorder (PTSD). METHOD: In a doubly randomized preference trial, 200 patients with PTSD viewed standardized treatment rationales prior to randomization. Patients were first randomized to choice of treatment or no choice. Those assigned to no choice were then randomized to prolonged exposure or sertraline. Acute treatment was 10 weeks, with 24-month follow-up. Interviewer-rated PTSD symptom severity was the main outcome measure, and depression, anxiety, and functioning were assessed as additional outcomes. RESULTS: Patients preferred prolonged exposure over sertraline (number needed to benefit [NNTB]=4.5). Using intent-to-treat analyses (N=200), both prolonged exposure and sertraline showed large gains that were maintained over 24 months. Although no differential effect was observed on interviewer-rated PTSD severity, there was a significant benefit of prolonged exposure over sertraline on interview-rated loss of PTSD diagnosis (NNTB=7.0), responder status (NNTB=5.7), and self-reported PTSD, depression, and anxiety symptoms and functioning (effect sizes, 0.35-0.44). Patients who received their preferred treatment were more likely to be adherent, lose their PTSD diagnosis (NNTB=3.4), achieve responder status (NNTB=3.4), and have lower self-reported PTSD, depression, and anxiety symptoms (effect sizes, 0.40-0.72). CONCLUSIONS: Prolonged exposure and sertraline confer significant benefits for PTSD, with some evidence of an advantage for prolonged exposure. Giving patients with PTSD their preferred treatment also confers important benefits, including enhancing adherence.

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Self-citation

Authors: Zoellner, L. A., Roy-Byrne, P. P., Mavissakalian, M., & Feeny, N. C.
Affiliations: University of Washington (US)
From the Department of Psychology and the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle; and the Department of Psychiatry and the Department of Psychology, Case Western Reserve University, Cleveland.
ORCID: Zoellner, Lori A.
Feeny, Norah C.
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 2019-04-01
Volume: 176
Issue: 4
Pages: 287-296
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/appi.ajp.2018.17090995
OpenAlex: W2896074510
Cited by: 125
References: 28
Citations by year: 2026: 8 · 2025: 8 · 2024: 19 · 2023: 15 · 2022: 23 · 2021: 14 · 2020: 21 · 2019: 13 · 2018: 2 · 2017: 1 · 2016: 1
FWCI: 14.66
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: American Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of Mental Health (R01MH066348, R01MH066347)
National Center for Research Resources (UL1RR024989)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords: post-traumatic stress disorder, prolonged exposure, sertraline, patient treatment preferences, medication adherence, psychotherapy versus pharmacotherapy, depression, anxiety, functional outcome, long-term follow-up
MeSH terms: Adult, Female, Humans, Implosive Therapy, Male, Stress Disorders, Post-Traumatic, Selective Serotonin Reuptake Inhibitors, Sertraline

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Doubly Randomized Preference Trial of Prolonged Exposure Versus Sertraline for Treatment of PTSD

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