Early PTSD symptom trajectories: persistence, recovery, and response to treatment: results from the Jerusalem Trauma Outreach and Prevention Study (J-TOPS)
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CONTEXT: Uncovering heterogeneities in the progression of early PTSD symptoms can improve our understanding of the disorder's pathogenesis and prophylaxis. OBJECTIVES: To describe discrete symptom trajectories and examine their relevance for preventive interventions. DESIGN: Latent Growth Mixture Modeling (LGMM) of data from a randomized controlled study of early treatment. LGMM identifies latent longitudinal trajectories by exploring discrete mixture distributions underlying observable data. SETTING: Hadassah Hospital unselectively receives trauma survivors from Jerusalem and vicinity. PARTICIPANTS: Adult survivors of potentially traumatic events consecutively admitted to the hospital's emergency department (ED) were assessed ten days and one-, five-, nine- and fifteen months after ED admission. Participants with data at ten days and at least two additional assessments (n = 957) were included; 125 received cognitive behavioral therapy (CBT) between one and nine months. APPROACH: We used LGMM to identify latent parameters of symptom progression and tested the effect of CBT on these parameters. CBT consisted of 12 weekly sessions of either cognitive therapy (n = 41) or prolonged exposure (PE, n = 49), starting 29.8±5.7 days after ED admission, or delayed PE (n = 35) starting at 151.8±42.4 days. CBT effectively reduced PTSD symptoms in the entire sample. MAIN OUTCOME MEASURE: Latent trajectories of PTSD symptoms; effects of CBT on these trajectories. RESULTS: THREE TRAJECTORIES WERE IDENTIFIED: Rapid Remitting (rapid decrease in symptoms from 1- to 5-months; 56% of the sample), Slow Remitting (progressive decrease in symptoms over 15 months; 27%) and Non-Remitting (persistently elevated symptoms; 17%). CBT accelerated the recovery of the Slow Remitting class but did not affect the other classes. CONCLUSIONS: The early course of PTSD symptoms is characterized by distinct and diverging response patterns that are centrally relevant to understanding the disorder and preventing its occurrence. Studies of the pathogenesis of PTSD may benefit from using clustered symptom trajectories as their dependent variables.
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The presence of divergent extinction trajectories represents a new avenue of study and may be analogous to heterogeneous responses to trauma in PTSD.
“The presence of divergent extinction trajectories as described above represents an exciting new avenue of study and has recently been introduced in the rodent literature (43), which may be analogous to heterogeneous responses to trauma in PTSD (44).”
From Conditioned fear associated phenotypes as robust, translational indices of trauma-, stressor-, and anxiety-related behaviors (2014) · cites this paper as [44]
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- Authors
- Galatzer-Levy, I. R., Ankri, Y., Freedman, S., Israeli-Shalev, Y., Roitman, P., Gilad, M., & Shalev, A. Y.
- Affiliations
- Hadassah Medical Center (IL)
- Bar-Ilan University (IL)
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2013-08-22
- Volume
- 8
- Issue
- 8
- Pages
- e70084
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3750016
- OpenAlex
- W2056633716
- Cited by
- 137
- References
- 45
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 14 · 2023: 9 · 2022: 12 · 2021: 8 · 2020: 13 · 2019: 15 · 2018: 17 · 2017: 11 · 2016: 10 · 2015: 11 · 2014: 11
- FWCI
- 11.87
- Type
- journal article
- Language
- en
- Update notices
- correction (2013-08-27)
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- H. Lundbeck A/S
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- post-traumatic stress disorder, PTSD symptom trajectories, symptom remission, cognitive behavioral therapy, prolonged exposure therapy, cognitive therapy, early intervention, trauma survivors, emergency department, growth mixture modeling, PTSD prevention, symptom persistence
- MeSH terms
- Adolescent, Adult, Aged, Data Interpretation, Statistical, Female, Humans, Israel, Male, Middle Aged, Psychometrics, Stress Disorders, Post-Traumatic, Time Factors, Models, Statistical, Cohort Studies, Cognitive Behavioral Therapy, Likelihood Functions, Treatment Outcome, Disease Progression, Symptom Assessment
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