Utility of Psychophysiological Metrics in Guiding Treatment of Trauma Symptoms: A Systematic Review

The reliability of gold standard symptom assessments of post-traumatic stress disorder (PTSD) can be compromised by memory, emotional or cultural bias. The use of psychophysiological measures may complement psychometrics in tracking changes during treatment in physiological response and emotion regulation. In this systematic review, we integrate knowledge about the correlation between psychometric and psychophysiological measures in 22 prospective studies with trauma-focused cognitive, exposure, pharmacological and other interventions. Our objective was to determine how physiological resting states and reactivity pre- vs. post-intervention correspond to the effect of intervention on PTSD symptoms. Trends towards normalizing physiological resting states and arousal, as measured before and after treatment, were seen to correlate with a psychometric recovery. In patients with significant changes in trauma symptoms, pre- vs. post-treatment resting heart rate, heart rate reactivity to trauma cues and skin conductance decreased, and heart rate variability increased. Electromyography could measure adaptive decreases in startle responses to exposure content. Both blood pressure raw values and reactivity decreased post-treatment following cognitive therapy. Additional longitudinal studies are needed to explore standard testing paradigms that can be used for psychophysiological measures, and the corresponding cut-off levels that can indicate healthy and abnormal treatment response levels. The current findings stress a need for the development of a psychophysiological methodology that is feasible and reliable during experimental and clinical procedures to elucidate the effects of trauma intervention on emotional processing. Systematic review PROSPERO registration ID:CRD42021227774.