Toward tailored treatments: Understanding biological stress regulation to personalize therapy for posttraumatic stress disorder

Abstract

Posttraumatic stress disorder (PTSD) can develop after a traumatic event. Current therapies are not always effective. To improve future treatment outcomes, this dissertation focuses on the biological stress system. It shows that people with high levels of early-life stress (a predictor for PTSD from later trauma) have a different balance in their stress system; this is reflected in stress-related molecules. Furthermore, it expands our understanding of safety learning. In PTSD treatment, safety learning is key: it results in ‘extinction’ of fear. Relapse, however, often occurs from trauma reminders outside the context of therapy. My research provides insight into the brain mechanisms underlying this process. Finally, it presents a study design to test whether a short stress system “boost” might support safety learning in PTSD, and how this effect may depend on individual differences in the stress system. Together, these studies move personalized PTSD care a step closer.