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

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

DOI:	https://doi.org/10.1007/s00406-017-0823-9
URL:	https://link.springer.com/article/10.1007%2Fs00406...
Additional URL:	https://www.researchgate.net/publication/318318269...
Document Type:	Article
Year of publication:	2019
The title of a journal, publication series:	European Archives of Psychiatry and Clinical Neuroscience
Volume:	269
Issue number:	2
Page range:	161-170
Place of publication:	Berlin [u.a.]
Publishing house:	Springer Medizin-Verlag
ISSN:	0940-1334 , 1433-8491
Publication language:	English
Institution:	School of Social Sciences > Klinische u. Biologische Psychologie u. Psychotherapie (Alpers 2010-)
Subject:	150 Psychology
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.