The influence of posttraumatic stress disorder treatment on anxiety sensitivity: Impact of prolonged exposure, sertraline, and their combination

• Published in: Journal of traumatic stress 2023-02, Vol.36 (1), p.157-166
• Main Authors: Luciano, Matthew T., Norman, Sonya B., Allard, Carolyn B., Acierno, Ron, Simon, Naomi M., Szuhany, Kristin L., Baker, Amanda W., Stein, Murray B., Martis, Brian, Tuerk, Peter W., Rauch, Sheila A. M.
• Format: Article
• Language: English
• Subjects: Antidepressants; Anxiety; Anxiety Disorders; Female; Humans; Implosive Therapy; Male; Post traumatic stress disorder; Sertraline; Stress Disorders, Post-Traumatic - therapy; Treatment Outcome; Veterans
• ISSN: 0894-9867; 1573-6598
• DOI: 10.1002/jts.22894

Trauma‐informed beliefs often decrease during posttraumatic stress disorder (PTSD) treatment. This may also extend to anxiety sensitivity (AS), defined as a fear of anxiety‐related sensations and beliefs that anxiety is dangerous and/or intolerable. However, little is known about how AS changes during exposure‐based and psychopharmacological PTSD treatments. Further, high AS may be a risk factor for diminished PTSD symptom improvement and increased treatment dropout. To better understand how AS impacts and is impacted by PTSD treatment, we conducted a secondary analysis of a randomized clinical trial with a sample of 223 veterans (87.0% male, 57.5% White) with PTSD from four U.S. sites. Veterans were randomized to receive prolonged exposure (PE) plus placebo (n = 74), sertraline plus enhanced medication management (n = 74), or PE plus sertraline (n = 75). Veterans answered questions about PTSD symptoms and AS at baseline and 6‐, 12‐, 24‐, 36‐, and 52‐week follow‐ups. High baseline AS was related to high levels of PTSD severity at 24 weeks across all conditions, β = .244, p = .013, but did not predict dropout from exposure‐based, β = .077, p = .374, or psychopharmacological therapy, β = .009, p = .893. AS also significantly decreased across all three treatment arms, with no between‐group differences; these reductions were maintained at the 52‐week follow‐up. These findings suggest that high AS is a risk factor for attenuated PTSD treatment response but also provide evidence that AS can be improved by both PE and an enhanced psychopharmacological intervention for PTSD.