Symptom benchmarks of improved quality of life among military veterans with PTSD

To optimize treatment outcome and promote recovery, it is necessary to understand how clinical indicators of improvement translate into meaningful differences in the lives of individuals with posttraumatic stress disorder (PTSD). Prior research has suggested that treatment response alone is insufficient and that more substantial improvement is needed, but data are limited. This study addressed the gap through secondary analysis of a pragmatic comparative effectiveness trial of Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) in veterans.

Participants were 597 male and female US military veterans who were randomized to receive CPT or PE. PTSD symptom change from pre- to posttreatment was categorized into four mutually exclusive categories: No Response, Response, Loss of Diagnosis, and Remission. Analyses compared each category to the prior one to identify the effect of attaining a higher benchmark on experiencing clinically meaningful improvements and good endpoints (no/little impairment in functioning or ≥70% on a QoL scale) on clinician-rated and self-reported measures.

Response was associated with improvement on most outcomes, but with a good endpoint on only one. Loss of Diagnosis added little benefit beyond response. Remission was associated with increased likelihood of meaningful improvement (OR=2.31-23.65, lowest p < .001) and a good endpoint (OR=3.37-13.50, lowest p < .001) on all measures.

Response without more substantial improvement following PTSD treatment is insufficient for helping patients achieve good QoL. Findings support the position that focusing on more than symptom change and response alone is necessary when setting treatment goals for individual patients and for evaluating treatments.