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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

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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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Acknowledgements

This work is part of the German multi-center trial ‘Mechanisms of Action in CBT’ (MAC). The MAC study was funded by the German Federal Ministry of Education and Research (BMBF; project no. 01GV0615) as part of the BMBF Psychotherapy Research Funding Initiative. The study was further supported by the DFG (Grant RE1632/5-1 to AR, DE357/4-1 to JD, RTG 1256 to JD and AR, and SFB TRR 58 Z02 to JD and AR). The principal investigators (PIs) of the centers with respective areas of responsibility in the MAC study were: V Arolt (Münster: Overall MAC Program Coordination), HU Wittchen (Dresden: PI for the Randomized Clinical Trial and Manual Development), A. Hamm (Greifswald: PI for Psychophysiology), A. L. Gerlach (Münster: PI for Psychophysiology and Panic subtypes), A. Ströhle (Berlin: PI for Experimental Pharmacology), T. Kircher (Marburg: PI for functional neuroimaging) and J. Deckert (Würzburg: PI for Genetics). Additional site directors in the RTC component of the program were GW Alpers (Würzburg), T. Fydrich and L. Fehm (Berlin-Adlershof) and T. Lang (Bremen). T. Töpner, N. Steigerwald, C. Gagel and J. Auer are credited for excellent technical assistance.

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Authors and Affiliations

  1. Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany

    Sebastian Trautmann, Markus Muehlhan, Michael Höfler & Hans-Ulrich Wittchen

  2. Department of Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany

    Jan Richter & Alfons O. Hamm

  3. Department of Psychology, Faculty of Human Science, Medical School Hamburg, Hamburg, Germany

    Markus Muehlhan

  4. Department of Psychiatry, Psychosomatics, and Psychotherapy, University of Würzburg, Würzburg, Germany

    Katharina Domschke & Heike Weber

  5. Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Katharina Domschke

  6. Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany

    Andreas Ströhle

  7. Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University Frankfurt, Frankfurt, Germany

    Heike Weber & Andreas Reif

  8. Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany

    Tilo Kircher

  9. Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany

    Volker Arolt

  10. Department of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany

    Alexander L. Gerlach

  11. Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany

    Georg W. Alpers

  12. Institute of Psychology, Humboldt-University, Berlin, Germany

    Thomas Fydrich

  13. Christoph-Dornier-Foundation for Clinical Psychology, Bremen, Germany

    Thomas Lang

  14. Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany

    Thomas Lang

  15. Clinical Psychology and Psychotherapy RG, Department of Psychiatry and Psychotherapy, Ludwig Maximilans Universität Munich, Munich, Germany

    Hans-Ulrich Wittchen

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  1. Sebastian Trautmann
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  15. Thomas Lang
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  16. Andreas Reif
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Correspondence to Sebastian Trautmann.

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All participants provided informed consent. The study protocol was approved by the Ethics Committee of the Medical Faculty of the Technische Universität Dresden (EK164082006).

Conflict of interest

HUW has served as a general consultant (non-product related) for Lundbeck.

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Trautmann, S., Richter, J., Muehlhan, M. et al. Does prior traumatization affect the treatment outcome of CBT for panic disorder? The potential role of the MAOA gene and depression symptoms. Eur Arch Psychiatry Clin Neurosci 269, 161–170 (2019). https://doi.org/10.1007/s00406-017-0823-9

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