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. 2019 Mar;269(2):161-170. doi: 10.1007/s00406-017-0823-9. Epub 2017 Jul 15.


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.

Keywords: CBT; Depression; Fear reactivity; MAOA; Panic disorder; Trauma.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Cognitive Behavioral Therapy*
  • Comorbidity
  • Depression / epidemiology
  • Depression / genetics
  • Depression / physiopathology*
  • Fear / physiology*
  • Female
  • Humans
  • Male
  • Monoamine Oxidase / genetics*
  • Outcome Assessment, Health Care*
  • Panic Disorder / epidemiology
  • Panic Disorder / genetics
  • Panic Disorder / therapy*
  • Psychological Trauma / epidemiology
  • Psychological Trauma / genetics
  • Psychological Trauma / therapy*
  • Sex Factors


  • Monoamine Oxidase
  • monoamine oxidase A, human