European Journal of Psychotraumatology最新文献

Background: Cognitive behavioural therapy with a trauma focus (CBT-TF) is the gold-standard treatment for military post-traumatic stress disorder (PTSD), but access is limited by high costs, therapist shortages, and the demands of in-person delivery. Guided digital CBT-TF, delivered via an app or website with therapist support, offers a scalable alternative.Objective: This study aimed to adapt Spring PTSD, an evidence-based guided digital therapy, for military veterans and conduct an initial pilot test of the adapted version.Method: A two-stage process was used. In Stage 1, veterans with lived experience of PTSD (n = 11) participated in focus groups to guide adaptations. Key themes included the need for a relatable narrator, authentic military representation, diverse visuals, and military-inspired design. Veterans also emphasised addressing emotional regulation. These insights shaped the development of Spring Military-PTSD, which incorporated techniques from Enhanced Skills Training for Affective and Interpersonal Regulation (ESTAIR). In Stage 2, treatment-seeking veterans with PTSD (n = 10) took part in a pilot study that collected qualitative and quantitative data. The primary outcome was change in PTSD severity measured by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Participants received an average of 3 h and 50 min of therapist support.Results: Eight participants completed the pilot; two dropped out. Of the completers, four no longer met diagnostic criteria for PTSD, and six showed reliable improvement on CAPS-5. Statistically significant reductions were also seen in self-reported PTSD, disturbance in self-organisation (DSO), anxiety, and depression. Qualitative feedback supported the relevance and acceptability of the intervention.Conclusions: Findings provide preliminary evidence for the efficacy and acceptability of Spring Military-PTSD. The adapted intervention shows promise as a scalable and engaging treatment for veterans with PTSD. Further research is warranted to evaluate its effectiveness and potential for broader implementation.

Background & Objective: There has been a dearth of empirical research examining suicidality in the context of the new diagnosis of the ICD-11 Complex posttraumatic stress disorder (CPTSD). The main aim of the current cross-sectional study was to test the moderating role of trauma-related shame and depression on the relationship between CPTSD symptoms and suicidal ideation.Method: In total, 300 treatment-seeking trauma-exposed adults were included in the study. The mean age was 39.25 (SD = 12.77), ranging from 18 to 72 years. The majority of the sample (90.3%) were female and had a university degree (67%). Self-report measures for assessing complex posttraumatic stress disorder and depression symptoms, suicidal ideation and trauma-related shame were used.Results: In the study sample, 22.7% of the participants met the criteria for probable PTSD, 45.7% probable CPTSD, and 45% reported suicidal ideation. The levels of trauma-related shame and CPTSD symptoms were the highest in the high suicidal ideation group. Moderation analysis revealed that the association between CPTSD symptom severity and suicidal ideation intensified with increasing levels of trauma-related shame. The findings of the moderated moderation analysis showed that with increasing levels of shame, the effects of interaction between CPTSD and depression symptoms on suicidal ideation were getting stronger.Conclusions: Results demonstrated that the relationship between CPTSD symptoms and suicidal ideation depends on the levels of trauma-related shame and comorbid depressive symptoms. Such findings provide insights for the assessment and management of suicide risk after trauma exposure and suggest that the relationship between complex posttraumatic stress and suicidal ideation depends on other post-traumatic reactions, comorbid conditions, and on how they interact.

Background: Hope has been found to positively influence trauma-focused treatment outcomes and is associated with post-traumatic growth (PTG), which contributes to improved treatment efficacy.Objective: This observational study examined the extent to which hope predicts a decline in post-traumatic stress disorder (PTSD) symptoms and whether an increase in the level of hope predicts changes in PTSD symptoms. This study also investigated whether PTG mediates the relationship between hope and PTSD symptoms.Method: The sample included 339 participants (82.9% female) who were diagnosed with PTSD and underwent an intensive eight-day trauma-focused treatment programme consisting of eight sessions of prolonged exposure, eight sessions of EMDR therapy, physical activity, and psychoeducation. Assessments were performed pre-, mid-, and post-treatment using the PCL-5, HHI and PTGI. Linear Mixed and mediation models were used.Results: Hope significantly increased (Cohen's d = 0.47 at mid-treatment and post-treatment), and PTSD symptoms significantly decreased (Cohen's d = 1.72 at mid-treatment and 2.04 at post-treatment) during treatment. Both hope levels at the start of treatment and subsequent changes in hope during treatment significantly predicted a decline in PTSD symptoms (p < .01 and p < .001) and vice versa (p < .001). Pre-treatment PTG mediated the relationship between pre-treatment hope and mid-treatment PTSD symptoms but did not mediate the relationship between pre-treatment hope and post-treatment PTSD symptoms.Conclusions: These outcomes emphasise the critical importance of hope in PTSD treatment, highlighting its potential to bolster mental well-being and enhance the overall quality of life. More research is needed to gain more insight into the exact mechanisms underlying the interactions between hope, PTG and PTSD symptoms during treatment.

Background: Care-experienced young people (CEYP) have higher rates of PTSD than their peers; however, their post-traumatic stress disorder (PTSD) symptoms are often missed. The Child Revised Impact of Events Scale (8 items; CRIES-8) is a well-validated and widely available screening tool, which could identify children at risk of PTSD.Objective: This project aimed to understand barriers and facilitators for the use of the CRIES-8 with CEYP accessing mental health services, as a means of increasing their access to evidence-based support.Methods: We recruited 243 mental health professionals from 28 mental health teams across England and provided training in the CRIES-8 and cognitive therapy for PTSD. Focus groups and interviews were conducted approximately every three months for 12-18 months, as well as a brief one-off questionnaire about implementation completed 6-9 months post-training. Qualitative data were analysed via thematic analysis.Results: While 80% of the sample did use the CRIES-8, only 50% used it with CEYP, and overall use was sporadic and inconsistent. The main barriers included capacity, CEYP access to mental health services, and professionals' beliefs around diagnoses and routine outcome measures, particularly for CEYP. Flexibility and proactivity amongst the team were important facilitators. In practice, there were a variety of methods to implement the CRIES-8, each with a different impact on service resources and the young person completing it.Conclusions Further service-based research to develop and test methods to address the identified barriers is essential to ensure that CEYP receive access to best-evidenced, needs-matched treatments.

Background: Psychological maltreatment is linked to negative developmental outcomes in adolescents. It includes psychological abuse (PA) and psychological neglect (PN), which are commonly studied as a pair. This study applied the dimensional model of adversity and psychopathology (DMAP), which conceptualises abuse as a threatening experience involving harm or the threat of harm that primarily impairs social-emotional processing, such as emotion regulation, while it views neglect as deprivation or absence of parental care that predominantly affects cognitive functioning, such as working memory.Objective: In an effort to better understand the harmful nature of psychological maltreatment, this study applies the DMAP to understand whether PA and PN have differential effects paving divergent trajectories to psychopathology, hypothesising that PA predicts dysfunctional emotion regulation, whereas PN impairs working memory.Method: A classroom-based online survey was conducted in Switzerland. The analysis incorporated a sample size of 1,207 adolescents across 82 classes. PA, PN, and dysfunctional emotion regulation were assessed using self-report, and working memory was assessed using a performance task. Hierarchical linear regression models were conducted with controls for co-occurring deprivation, threat, and other individual and family factors (e.g. socioeconomic status, attention deficit hyperactivity disorder) at level 1, and for education level and the trauma load of the school class at level 2.Results: In modelling dysfunctional emotion regulation, PA (β = 0.45, p < .001) was the strongest predictor, whereas PN had no significant effect. In the working memory model, neither PN nor PA was significantly predictive.Conclusion: These findings partially support the DMAP framework, underscoring psychological abuse as an important factor in dysfunctional emotion regulation and psychopathology.

Background and Objective: Previous studies have shown that experience of racial discrimination is associated with increased mental health problems, especially stress. Using a cluster analytical procedure, the current study aimed to examine stress characteristics related to racial discrimination in individuals from diverse racial identities.Method: In total, 4220 participants completed the questionnaires assessing stress, resilience, everyday racial discrimination, and experience of major racial discrimination. K-means cluster analysis was performed to cluster participants' features regarding stress, resilience, everyday racial discrimination, and major racial discrimination. To determine the optimal number of clusters, the gap statistic was employed. Extracted clusters were then compared across racial groups using chi-square tests.Results: Cluster analysis revealed a three-cluster solution, including 'low stress', 'stress cluster with high racial discrimination', and 'stress cluster with low racial discrimination' clusters. Concerning the race-differences, Black (32.57%) and Indigenous (33.63%) participants had higher membership in the stress cluster with high racial discrimination compared to other racialized groups. Regarding the stress cluster with low racial discrimination, a higher membership was observed among Arab participants (30.82%) and those with other racial identities (30.40%) compared to other racialized groups.Conclusions: The findings demonstrate a type of stress characterized by high levels of racial discrimination and accompanying psychosocial burdens. Implications for intervention, prevention, and future research are discussed in the paper.

Background: Natural disasters profoundly upset moral and psychological stability, positioning mental health professionals in dual roles as both helpers and survivors. After devastating earthquakes in Türkiye, counsellors had to deal with stressors that required both personal resilience and professional stability. Belief in a just world (BJW) and perceived social support (PSS) are two factors that may help sustain psychological well-being (PWB) in the post-disaster context following large-scale earthquakes. However, empirical research examining how moral belief systems and relational resources jointly shape the well-being of disaster-exposed mental health professionals remains limited.Objective: This study examined whether PSS mediates the relationship between BJW and PWB among counsellors working in earthquake-affected regions of Türkiye.Methods: A cross-sectional design was employed with 445 licenced counsellors (88.3% female; Mage = 29.8). Participants completed validated measures of BJW, PSS, and PWB. Structural equation modelling (SEM) was used to test a mediation model and a parallel mediation model including three support sources (family, friends, significant others).Results: Mediation analysis revealed that PSS partially mediated the relationship between BJW and PWB (β = .11, 95% CI [.07, .17]), with BJW showing both direct (β = .30, p < .001) and indirect effects. In the parallel mediation model, all support sources acted as significant mediators; family support yielded the strongest indirect effect (β = .05), followed by friends and significant others (β = .03 each). The full model accounted for 48% of the variance in PWB (R² = .48).Conclusion: Counsellors who held stronger BJW experienced greater levels of PSS, which was associated with higher PWB. These findings underscore the significance of incorporating moral belief systems and relational resources in post-disaster interventions for helping professionals.

Background: Moral injury (MI) refers to the profound psychosocial, spiritual and behavioural impacts of exposure to potentially morally injurious events (PMIEs). Despite growing recognition of MI across military and civilian contexts, definitional clarity surrounding PMIEs remains limited.Objective: This study applied e-Delphi methodology to generate consensus on the defining features of PMIEs and their impacts among an interdisciplinary panel of MI experts.Method: The panel first provided narrative responses to open-ended questions on defining PMIEs. These were refined into 63 Likert statements. Experts rated agreement on these and completed card-sort and ranking exercises.Results: Statements addressed eight themes: exposure, transgressive acts, consequences of PMIEs, trauma vs. PMIEs, moral agency, betrayal, subjectivity, and high-stakes. Consensus (≥80% agreement) was reached for 55% of all statements. Consensus for card-sort and ranking exercises was also observed, pertaining to etiological mechanisms of MI, and risk and protective factors. Themes with the highest levels of consensus included exposure and transgressive acts, while moderate consensus was achieved on PMIE consequences and comparisons to trauma. Lower consensus emerged around moral agency, betrayal, high-stakes and subjectivity, substantiating these as areas of ongoing debate.Conclusions: This study clarifies key definitional features of PMIEs and their impacts, with findings organised into a consensus framework for the future study of PMIEs. Findings highlight the need for empirical testing of proposed features and areas of debate, integration with emerging trauma frameworks, and culturally inclusive approaches.

ABSTRACTBackground: Worldwide, about one in five female minors and one in 8-12 male minors experience sexual abuse. However, for various reasons disclosure of these traumatic sexual experiences often does not occur, which may be associated with increased levels of distress.Objective: To examine the extent to which factors in the family of origin are associated with the duration until disclosure of sexual abuse, the environment in which this abuse happens, and the extent to which these family and disclosure characteristics are associated with current psychological distress.Method: Adults with sexual abuse experience(s) before the age of 18 (N = 961) completed an online questionnaire on characteristics of the family of origin (e.g. family climate, religious beliefs, communication about sexuality, adverse childhood experiences), characteristics of (potential) disclosure (e.g. duration and environment to whom the abuse was revealed first) and current levels of psychological distress (Kessler Psychological Distress 10; K10).Results: Logistic and linear regression analyses showed that (a) a warm family climate was associated with shorter duration to disclosure, (b) strong religious beliefs in the family of origin were associated with longer duration to disclosure, (c) a warm family climate was associated with disclosing to someone close, and (d) a warm family climate, <4 adverse childhood experiences, more open communication about sexuality and a shorter duration to disclosure were all associated with lower levels of current psychological distress.Conclusion: The findings show that family characteristics are associated with early disclosure of sexual abuse. In turn, these family characteristics and the time of disclosure are associated with lower levels of current psychological distress. Future research may further investigate the nature of this association, so that guidance on how a safe home environment can help children disclose adverse experiences, such as child sexual abuse, can be developed and promoted.

Background: Research has consistently highlighted the relationship between interpersonal trauma and reduced trust in others. Human trafficking (HT) survivors often report a generalised mistrust in others, leading to poor interpersonal functioning and underutilisation of support services. Despite this, there is limited research investigating trust-related experiences of HT survivors.Objective: This study aimed to explore how trust has been shaped and evolved by the experiences of trafficking survivors prior to, during and since the trafficking.Method: Individual semi-structured interviews were undertaken with 10 survivors of HT on a single occasion. A thematic analysis and an analysis of participants' narratives were undertaken.Results: A rich array of themes were identified, pertaining to attachment and trauma in the development of trust, socioeconomic context in influencing trust in the trafficker, the impact of trafficker control and coercion in survivor's sense of trust in themselves and others, and institutions and support services modelling and helping to rebuild trust.Conclusions: This study provides a rich and nuanced account of how trust is shaped and influenced by survivors' experiences. The findings provide direction for refinement of post-trafficking support for survivors, as well as avenues for future research.