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Comment & Response
June 19, 2018

Motivation to Participate in PTSD Research—Reply

Author Affiliations
  • 1Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia
  • 2Department of Psychiatry, University of Texas Health Science Center, San Antonio
JAMA. 2018;319(23):2440-2441. doi:10.1001/jama.2018.4330

In Reply Drs Roth and Hofmann comment on how motivational factors may have influenced the outcomes of our recent randomized clinical trial comparing prolonged exposure therapy with present-centered therapy in active duty military with PTSD. We agree that motivational factors are important and may help explain the more modest outcomes observed for prolonged exposure and other evidence-based PTSD treatments1,2 in military personnel compared with civilians. Other reasons may include the repeated and yet varied nature of military combat trauma, the type of trauma, the use of multiple medications, and comorbid conditions such as head injuries, physical injuries, and chronic pain. However, motivational factors in civilians, such as Medicaid and service-related compensation for veterans, can also influence treatment outcome. The purpose of our study was to report the main findings from our clinical trial; the analysis of predictors of treatment response is currently ongoing. Other research studies are being conducted by our group and others testing intervention modifications to improve treatment outcomes for combat-related PTSD.