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European Archives of Psychiatry and Clinical Neuroscience

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01-03-2019 | Original Paper

Does prior traumatization affect the treatment outcome of CBT for panic disorder? The potential role of the MAOA gene and depression symptoms

Authors: Sebastian Trautmann, Jan Richter, Markus Muehlhan, Michael Höfler, Hans-Ulrich Wittchen, Katharina Domschke, Andreas Ströhle, Alfons O. Hamm, Heike Weber, Tilo Kircher, Volker Arolt, Alexander L. Gerlach, Georg W. Alpers, Thomas Fydrich, Thomas Lang, Andreas Reif

Published in: European Archives of Psychiatry and Clinical Neuroscience | Issue 2/2019

Abstract

Although cognitive behavioral therapy (CBT) is highly effective in the treatment of anxiety disorders, many patients still do not benefit. This study investigates whether a history of traumatic event experience is negatively associated with outcomes of CBT for panic disorder. The moderating role of the monoamine oxidase A (MAOA) gene and depression symptoms as well as the association between trauma history and fear reactivity as a potential mechanism are further analyzed. We conducted a post-hoc analysis of 172 male and 60 female patients with panic disorder treated with CBT in a multi-center study. Treatment outcome was assessed at post-treatment using self-report and clinician rating scales. Fear reactivity before treatment was assessed via heart rate and self-reported anxiety during a behavioral avoidance test. Among females, we did not find any differences in treatment response between traumatized and non-traumatized individuals or any two-way interaction trauma history × MAOA genotype. There was a significant three-way interaction trauma history × MAOA genotype × depression symptoms on all treatment outcomes indicating that in traumatized female patients carrying the low-activity allele, treatment effect sizes decreased with increasing depression symptoms at baseline. No such effects were observed for males. In conclusion, we found no evidence for a differential treatment response in traumatized and non-traumatized individuals. There is preliminary evidence for poorer treatment outcomes in a subgroup of female traumatized individuals carrying the low-active variant of the MAOA gene. These patients also report more symptoms of depression symptomatology and exhibit a dampened fear response before treatment which warrants further investigation.

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Title: Does prior traumatization affect the treatment outcome of CBT for panic disorder? The potential role of the MAOA gene and depression symptoms
Authors: Sebastian Trautmann
Jan Richter
Markus Muehlhan
Michael Höfler
Hans-Ulrich Wittchen
Katharina Domschke
Andreas Ströhle
Alfons O. Hamm
Heike Weber
Tilo Kircher
Volker Arolt
Alexander L. Gerlach
Georg W. Alpers
Thomas Fydrich
Thomas Lang
Andreas Reif
Publication date: 01-03-2019
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Psychiatry and Clinical Neuroscience / Issue 2/2019
Print ISSN: 0940-1334
Electronic ISSN: 1433-8491
DOI: https://doi.org/10.1007/s00406-017-0823-9

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Does prior traumatization affect the treatment outcome of CBT for panic disorder? The potential role of the MAOA gene and depression symptoms

Abstract

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Abstract

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