European Journal of Psychotraumatology最新文献

Background Complex Post-Traumatic Stress Disorder (C-PTSD) is a severe mental illness recently defined in the International Classification of Diseases 11th edition. In addition to the classic PTSD symptoms of avoidance, re-experiencing, and hypervigilance, it includes disturbances in emotion regulation, negative self-concept, and interpersonal relationships. Emerging evidence suggests C-PTSD has distinct neurobiological profiles compared to PTSD, but comprehensive investigations are lacking. This study aims to explore the neural mechanisms associated with C-PTSD, identifying distinct and shared brain alterations in C-PTSD and PTSD, while establishing a biobank incorporating neuroimaging, inflammatory, physiological, genetic, and psychosocial measures.Methods This cross-sectional study will compare three groups: individuals with C-PTSD (n = 40), PTSD (n = 30), and trauma-exposed healthy controls (n = 30). During a single visit, participants will undergo MRI scanning including structural, diffusion-weighted, resting-state, and task-based functional MRI. Blood samples will be collected for inflammatory marker analysis, and Genome-Wide Association Studies (GWAS). Participants will complete validated psychosocial self-report measures assessing trauma history, resilience, social support, emotion regulation, sleep quality, and mental health symptoms. Additionally, participants will wear an Actigraph smart watch for seven days to collect actigraphy-derived physiological data, including sleep patterns and heart rate variability. All de-identified data will be made openly available on the Open Science Framework upon publication of the main study findings, in accordance with ethical approvals and institutional guidelines for privacy and data security.Conclusion This comprehensive protocol addresses significant gaps in understanding C-PTSD through its multimodal approach. By comparing C-PTSD, PTSD, and trauma-exposed controls, the study aims to identify neurobiological markers specific to C-PTSD, potentially supporting its diagnostic distinction and informing targeted treatment approaches. Integrating neuroimaging, inflammatory, genetic, and psychophysiological measures acknowledges the complex interactions between biological systems in trauma responses. Findings may help inform future research on personalized intervention strategies by identifying potential biological profiles and resilience factors associated with trauma-related outcomes.

Background: The SARS-Cov-2 pandemic was associated with a substantial rise in trauma and stressor exposure. The Co-RESPOND consortium (part of the EU horizon 2020-funded RESPOND project) has been initiated to study the impact on mental health, using longitudinal data of separate international cohorts.Aims: The Co-RESPOND initiative aims to retrospectively harmonize mental health and resilience data of ongoing longitudinal cohort studies at the individual participant level; to create an interoperable network of cohorts within a secure environment; to manage these data along with harmonization products (e.g. transformation procedures and variable dictionaries) according to the FAIR principles; and to keep this network live in order to add new data waves or to be joined by new cohorts.Methods: Data were harmonized retrospectively according to the Maelstrom guidance. A federated data network (FDN) was created using the OBiBa software suite.Results: To date, Co-RESPOND consists of nine European cohorts and one global cohort, including 50,885 individual participants. This paper presents Co-RESPOND as a case study for retrospective harmonization of decentralized data where teams collected and transformed data without prior coordination, facing methodological as well as regulatory challenges. The process of this project is outlined in detail, so it could be applied by other researchers for future projects. Its outcomes and the resulting data harmonization products are presented.Conclusions and outlook: The harmonized data are now ready to be shared with external partners for analyses, and Co-RESPOND is open for more partners to join. Lessons learned throughout the project will be reported, and established classification standards will be recommended for use to generate data sets that are available for joint analyses from the start.Trial registration: ClinicalTrials.gov identifier: NCT04556565.

Background: Due to the Russian invasion of Ukraine and the intense battlefield combat, many Ukrainian defenders have severe gunshot and explosion injuries, which result in broken bones, spinal damage, limb loss, and more. This physically and emotionally intensive experience often leads to acute stress disorder (ASD) and/or post-traumatic stress disorder (PTSD). During post-surgical recovery, injured military personnel need trauma-centred psychotherapy, which is often unavailable because of the hospital's setting limitations.Objective: The article aims to present adjustments of the Reconsolidation of Traumatic Memories (RTM) (US Patent Pending Number US-2024-0148297-A1) Protocol, a structured non-pharmaceutical neuro-based treatment that targets traumatic memory, to the remote treatment of injured Ukrainian military personnel in hospital settings.Method: This clinical practice paper presents two cases of online administration of the RTM Protocol in hospital settings to demonstrate the main adjustments made for remote work with physically injured military personnel.Results: The patients were referred to receive online RTM Protocol treatment by a surgeon due to the psychiatrist-assigned ASD diagnosis, presenting in repetitive flashbacks and sleep disturbances interfering with the post-surgical recovery. Initial and post-treatment screenings using the PCL-5 showed a significant drop in scores: from 36 to 12 points for the first case and from 41 to 7 points for the second case. The patients reported improvements in their mood and sleep, as well as the disappearance of flashbacks. The main adjustments involved on-site adaptations (using the procedure room, utilising nurse assistance, ensuring a stable Internet connection) and modifications to the procedure (conducting shorter sessions, up to 45 min), delegating some Protocol administration steps to patients, and using military jargon and commands.Conclusions: The online administration of the RTM Protocol shows promise for treating combat-related ASD in hospital settings, providing a structured intervention for recovering military personnel, and ensuring accessibility and effectiveness in resource-limited settings.

Background and Objective: We review the empirical evidence about how moral injury, the experience of a transgression of one's moral framework, can be understood in refugee and asylum seekers.Method: Systematic search identified 12 studies that utilised a range of methodologies (8 quantitative, one qualitative, one mixed methods, and one case study). Study quality was assessed using critical appraisal tools: studies varied in quality from moderate to high (75-100%) with some having methodological issues or a risk of bias.Results: Moral injury is suggested to play a major role in psychological distress and mental health outcomes in these populations: refugees are exposed to a wide range of potentially morally injurious events (PMIEs) and suggest that it is the cognitive appraisal of the event that leads to negative psychological outcomes. Specifically, two distinct subtypes of moral injury appraisals appear pertinent to refugees: the appraisal of one's own actions as violating moral beliefs (MI-self) and the appraisal of others' actions as violating moral beliefs (MI-other).Conclusions: Moral injury may play a key role in understanding the psychological impact of traumatic events and stressful experiences that violate an individual's moral beliefs. Consequently, there is potential benefit in targeting moral injury appraisals in therapeutic interventions for refugee populations.

Background: Evidence suggests that veterans with post-traumatic stress disorder (PTSD) are less likely to benefit from trauma-focused treatment than are patients with PTSD who have not been exposed to war-related trauma. However, new developments in PTSD treatment that combine several evidence-based trauma-focused therapies within a short time frame may help veterans achieve outcomes similar to those of non-veterans.Objective: In this retrospective cohort study, we examined changes in PTSD symptoms and diagnostic status after treatment between veterans and non-veterans. The treatment consisted of a four- or eight-day intensive trauma-focused treatment programme that integrated prolonged exposure, EMDR therapy, psycho-education, and physical activities.Methods: The sample consisted of 43 veterans and 43 non-veterans, matched based on age, sex, starting date, and duration of treatment. Participants were assessed pre- and post-treatment using the Clinician-Administered PTSD Scale-5 (CAPS-5). The differences in CAPS-5 scores over time and between groups were modelled using Bayesian repeated-measures ANOVA. We performed Bayesian model averaging to quantify the differences in PTSD symptom changes between groups, based on treatment response, using the exclusion Bayes factor ($B{F}_{\mathrm{EXCL}}$).Results: PTSD symptoms in both veterans and non-veterans decreased between pre- and post-treatment (Cohen's d = 2.17 and 1.54, respectively). Furthermore, we found moderate evidence of no differences in CAPS-5 scores between the groups (BF_EXCL = 4.8) or between the groups over time (BF_EXCL = 4.9). Although a greater proportion of veterans showed improvement according to the reliable change index than non-veterans (83.7% and 74.4%, respectively), there was no difference between the groups in terms of loss of diagnostic status after treatment (74.4% for veterans and 76.7% for non-veterans).Conclusion: This study provides evidence that veterans with war-related PTSD can benefit from brief intensive, trauma-focused treatment and does not support the notion that veterans need a different treatment approach in such settings.

ABSTRACTBackground: Confucianist, Buddhist and Taoist teachings offer insight into emotion processing for members of East Asian cultures. Emerging research also suggests distinguishing Confucianism into restrictive (focused on restricting self-needs for the greater good), and empowering (emphasising self-improvement) facets, and this distinction may be relevant for emotional processes. However, research has not considered how endorsement of these teachings influence emotion regulation among East Asian trauma survivors.Objective: This study presents a secondary analysis from a larger study on cultural differences in emotion regulation, and explored how levels of adherence to these teachings influence daily emotion regulation and affective outcomes among Chinese Australian trauma survivors.Method: Chinese Australian trauma survivors (n = 49) completed a baseline questionnaire assessing trauma exposure, posttraumatic stress disorder (PTSD) symptomatology and endorsement of Confucianism (restrictive and empowering), Buddhism, and Taoism. Participants then completed ecological momentary assessments (EMA) measuring daily use of suppression, acceptance and interpersonal emotion regulation and both positive and negative affect over seven days.Results: First, Taoism was positively associated with the use of daily acceptance, and Buddhism was positively associated with daily use of interpersonal emotion regulation. Second, Taoism moderated the positive relationship between acceptance and positive affect, whereby the strength of this association increased as Taoism endorsement increased. Taoism also moderated the relationship between interpersonal emotion regulation and both positive and negative affect, such that the associations were only significant for participants with higher levels of Taoism. Both restrictive and empowering Confucianism also moderated the negative association between acceptance and negative affect, with this association only being significant for individuals with low levels of empowering Confucianism and high levels of restrictive Confucianism.Conclusions: Our findings provide preliminary indications that the Three Teachings of East Asia may influence emotion regulation and associated affective outcomes among Chinese trauma survivors, highlighting a need for further research.

ABSTRACTBackground: After the loss of a child, bereaved parents typically experience profound grief and face an increased risk of both physical and mental health challenges. Research shows that bereaved parents need support, but there is limited knowledge on their experiences with receiving help.Objective: To explore how bereaved parents following the 2011 Utøya terror attack have experienced the help they have received.Method: Bereaved parents (n = 22) were interviewed nine years post loss. The interview guide had questions about their experiences with grief and trauma, the impact of other life events and their experience of professional help. Interviews were analysed using reflexive thematic analysis.Results: Participants' experiences were found to represent three different pathways: (1) Receiving help, but not feeling helped, (2) Securing the help they needed and (3) Feeling left alone - mismatch between the help received and the help needed. Across all pathways, participants described helpful meetings with professionals, constructed as the cross-cutting theme: 'Seen but gently challenged'.Conclusion: Our findings demonstrate that bereaved parents are not a homogenous group, which emphasises the need for individualised interventions. Although most parents appear to have received some form of professional support, it was not always proactive or continuous. As a result, some parents struggled to access the right help when they needed it. Those who did manage to secure appropriate support were often those with the resources to seek it out. Although our data do not fully clarify which factors influence this disparity, it is evident that across all pathways, parents reported positive interactions with professionals. The issue, therefore, seems less about the competence of helpers and more about ensuring access to this expertise. However, the current study also reveals that some bereaved individuals lacked access to the right type of help, while others were unable to utilise the help.

Background: Early trauma-focused cognitive behavioural therapy may help reduce post-traumatic stress symptoms in individuals recently exposed to sexual assault. In Norway, specialized Sexual Assault Centres (SACs) provide psychosocial support to survivors of sexual assault, yet the effectiveness of these services remains uncertain. The Early Intervention after Rape (EIR) study is a multisite randomized controlled trial evaluating the effectiveness of modified prolonged exposure therapy (mPE) compared to treatment as usual (TAU) in alleviating post-traumatic stress symptoms shortly after rape.Objective: This qualitative study explores patients' experiences with participating in the EIR study and receiving mPE as early psychosocial intervention at three SACs in Norway.Method: We interviewed 15 patients, 10 receiving mPE and five receiving TAU.Results: Thematic analysis revealed that patients found participation in the EIR study beneficial and meaningful, and that it was facilitated by a respectful and a trauma-competent research team. Patients favoured psychosocial support that directly addressed the traumatic event over non-specific focus on everyday concerns and recommended integrating mPE into the SAC's psychosocial support services.Conclusion: This study provides insights into the experiences of women receiving psychosocial support at SACs after recent sexual assault. It highlights clinical and practical challenges in implementing a novel intervention and conducting a multisite RCT, whilst at the same time identifying opportunities to enhance evidence-based support, ensuring alignment with survivors' preferences and recovery process.

Background: Counterfactual thinking (CFT), involves mental simulations of alternative outcomes to past events (e.g. 'What if … ' or 'If only … '), and is commonly observed after trauma. While CFT can be adaptive, it is also linked to psychological distress, including posttraumatic stress reactions (PTSR).Objective: The present study aims to examine the relationship between the frequency and vividness of upward and downward counterfactual thoughts and PTSR, in the recent aftermath of sexual assault (SA).Method: The sample consisted of 327 women who had experienced SA within the last year. PTSR was measured using the International Trauma Questionnaire (ITQ), while CFT was assessed through self-reported frequency and vividness of upward (event could have been less severe or avoided) and downward (event could have been worse) counterfactual thoughts.Results: The results revealed a significant difference in the distribution of upward versus downward CFT. Specifically, more participants reported engaging in upward CFT 'Very Often' and 'Often,' while downward CFT was reported less frequently. Vividness was higher for downward CFT. Both frequency and vividness of upward and downward counterfactuals were significantly associated with higher levels of PTSR.Conclusion: The present findings highlight the role of counterfactual thinking in post-assault distress and emphasize the need for targeted interventions addressing CFT in the aftermath of trauma.

Background: The ICD-11 distinguishes Complex Post-Traumatic Stress Disorder (CPTSD) as a separate trauma-related disorder from PTSD. While numerous studies have examined these conditions globally, no nationwide research has yet investigated their one-month prevalence and associated factors in the general population of China.Objective: This study aimed to determine the one-month prevalence of ICD-11 CPTSD and identify associated factors within a general adult sample in mainland China.Methods: A total of 2,115 adults living in mainland China participated in an online survey. PTSD and CPTSD were assessed using the International Trauma Questionnaire (ITQ) based on ICD-11 criteria. Trauma exposure was measured via the International Trauma Exposure Measure (ITEM). Multinomial logistic regression identified associated factors for PTSD and CPTSD.Results: Among participants, 88.2% reported at least one traumatic exposure. The prevalence of PTSD and CPTSD was 4.9% and 4.5%, respectively. Shared predictors for both conditions included a greater number of siblings, broader interpersonal trauma exposure during adolescence, and more frequent and recent index trauma events. Specific predictors for CPTSD included female gender, older age, being left behind by migrant parents, lower socioeconomic status, and broader trauma exposure in adulthood.Conclusion: This study provides the first estimates of ICD-11 PTSD and CPTSD prevalence in the general population of mainland China, revealing relatively high rates compared to other mental disorders. Findings highlight key associated factors and offer intervention recommendations for at-risk groups.