Differential Effects of Comorbid Psychiatric Disorders on Treatment Outcome in Posttraumatic Stress Disorder from Childhood Trauma

Nele Assmann*, Eva Fassbinder, Anja Schaich, Christopher W. Lee, Katrina Boterhoven de Haan, Marleen Rijkeboer, Arnoud Arntz

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Patients with posttraumatic stress disorder (PTSD) frequently have comorbid diagnoses such as major depressive disorder (MDD) and anxiety disorders (AD). Studies into the impact of these comorbidities on the outcome of PTSD treatment have yielded mixed results. The different treatments investigated in these studies might explain the varied outcome. The purpose of this study was to examine the impact of these comorbidities on the outcome of two specific PTSD treatments. MDD and AD were analyzed as predictors and moderators in a trial comparing 12 sessions of either eye movement desensitization and reprocessing (EMDR) or imagery rescripting (IR) in 155 adult patients with PTSD from childhood trauma. The primary outcome was reduction of PTSD symptoms (clinician-administered PTSD Scale for DSM-5, CAPS-5) assessed at eight-week follow-up and a secondary outcome was self-report PTSD symptoms (Impact of Event Scale, IES-R). MDD was not a predictor of treatment outcome but did have a significant moderator effect. Patients with MDD showed a better outcome if they were treated with IR, whereas patients without MDD improved more in the EMDR condition. No impact of AD emerged. It seems essential to consider comorbid MDD when planning PTSD treatment to improve treatment outcomes. More research is needed to replicate our findings and focus on different kinds of PTSD treatments and other comorbidities.

Original languageEnglish
Article number3708
Number of pages14
JournalJournal of Clinical Medicine
Issue number16
Publication statusPublished - 20 Aug 2021


  • posttraumatic stress disorder
  • depression
  • anxiety disorder
  • therapy
  • prediction
  • moderator
  • treatment outcome
  • PTSD
  • RISK

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