title: Pretreatment biomarkers predicting PTSD psychotherapy outcomes: A systematic review.
abstract: Although our understanding of the relationship between posttraumatic stress disorder (PTSD), brain structure and function, neural networks, stress-related systems, and genetics is growing, there is considerably less attention given to which biological markers predict evidence-based PTSD psychotherapy outcomes. Our systematic PRISMA-informed review of 20 studies examined biomarkers as predictors of evidence-based PTSD psychotherapy outcomes. Results provide preliminary evidence that specific structural and functional neural systems (involved in information processing), glucocorticoid sensitivity and metabolism (part of the hypothalamic-pituitary-adrenal axis and the response to stress), heart rate (involved with fear habituation), gene methylation, and certain genotypes (associated with serotonin and glucocorticoids) predicted positive response to PTSD treatment. These pre-treatment biomarkers are associated with processes integral to PTSD treatment, such as those affecting fear learning and extinction, cognitive restructuring, information processing, emotional processing, and interoceptive monitoring. Identifying pre-treatment biomarkers that predict treatment response may offer insight into the mechanisms of psychological treatment, provide a foundation for improving the pharmaceutical augmentation of treatment, and inform treatment matching.
authors.affiliation: VA San Diego Healthcare System, San Diego, CA, USA; Center of Excellence for Stress and Mental Health, San Diego, CA, USA. Electronic address: Peter.Colvonen@va.gov.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Colvonen
authors.affiliation: VA San Diego Healthcare System, San Diego, CA, USA; Center of Excellence for Stress and Mental Health, San Diego, CA, USA.
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Glassman
authors.affiliation: VA San Diego Healthcare System, San Diego, CA, USA.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Crocker
authors.affiliation: VA San Diego Healthcare System, San Diego, CA, USA; Center of Excellence for Stress and Mental Health, San Diego, CA, USA.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Buttner
authors.affiliation: VA San Diego Healthcare System, San Diego, CA, USA; Center of Excellence for Stress and Mental Health, San Diego, CA, USA.
authors.forename: Henry
authors.initials: H
authors.lastname: Orff
authors.affiliation: VA San Diego Healthcare System, San Diego, CA, USA; Center of Excellence for Stress and Mental Health, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Schiehser
authors.affiliation: VA San Diego Healthcare System, San Diego, CA, USA; Center of Excellence for Stress and Mental Health, San Diego, CA, USA; National Center for PTSD, White River Junction, VT, USA; Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
authors.forename: Sonya B
authors.initials: SB
authors.lastname: Norman
authors.affiliation: VA San Diego Healthcare System, San Diego, CA, USA; Center of Excellence for Stress and Mental Health, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
authors.forename: Niloofar
authors.initials: N
authors.lastname: Afari
mesh_terms: D015415:Biomarkers; D006801:Humans; D007030:Hypothalamo-Hypophyseal System; D010913:Pituitary-Adrenal System; D011613:Psychotherapy; D013313:Stress Disorders, Post-Traumatic
chemical_list: D015415:Biomarkers
keywords: Biomarkers; Genes; Glucocorticoids; Heart rate; Neuroimaging; PTSD treatment outcomes; Review