European Journal of Psychotraumatology最新文献

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: 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.

Background: People compare their current well-being to different comparison standards (e.g. social or temporal comparisons). These standards are considered as aversive if perceived as threatening to self-motives or appetitive if perceived as consistent with self-motives. However, it remains unknown whether the congruence (vs. incongruence) of aversive and appetitive well-being comparisons (high levels of both vs. preponderance of aversive comparisons over appetitive comparisons) is differentially related to symptoms of depression and post-traumatic stress disorder (PTSD) and self-esteem.Methods: We conducted response surface analysis (RSA) on data from a study with two-timepoints three months apart (N = 921). RSA tests whether the degree of (in-)congruence of two variables is positively or negatively related to an outcome variable. Here, baseline aversive and appetitive well-being comparisons (comparison frequency, discrepancy, and affective impact) served as the two predictor variables, while depression, PTSD, and self-esteem three months later served as outcomes.Results: Findings partially confirmed our hypotheses. Congruently high (vs. low) levels of aversive and appetitive comparison frequency and discrepancy predicted more depressive/PTSD symptoms and lower self-esteem. Some evidence indicated more pronounced depressive symptoms and lower self-esteem (but not PTSD) for the preponderance of aversive over appetitive comparisons.Conclusions: The effects of congruent and incongruent aversive and appetitive comparisons as well as a potentially more crucial role of aversive than appetitive well-being comparisons in depression and self-esteem align with comparison theory.

ABSTRACTBackground: European health care workers recently experienced serious challenges to their mental health. Following the extremely stressful experience of the COVID-19 pandemic, the war in Ukraine caused a humanitarian influx of refugees in need of social and healthcare. We aimed to explore: (1) how working with refugees has affected the mental well-being of health care workers in the context of the COVID-19 pandemic, and (2) the nature of health care workers' emotional strain related to the refugee situation and the war in Ukraine.Methods: We used a combination of quantitative regression analyses and qualitative content analysis to assess data collected by an online questionnaire in 2022. The study included 1121 health care workers from the Czech arm of the international HEROES Study.Results: Quantitative findings did not indicate that working with Ukrainian refugees was reliably associated with a greater occurrence of symptoms of depression, anxiety, distress, or burnout. Qualitative analysis revealed five categories of emotional strain: impacts on working conditions, emotional reactions to refugees and the war, comparisons with the COVID-19 pandemic, and coping strategies.Conclusions: This study highlights the resilience of health care workers but also points to the need for ongoing support to address the complex emotional challenges they face during health crises.

Background: Dissociative symptoms are suggested to compete with the effectiveness of psychotherapeutic treatment and frequently co-occur with early life trauma and self-harm patterns, including self-injury, suicidal ideation, and suicide attempts, which are characteristic for borderline personality disorder (BPD).Objective: We explore the connections between dissociation and other BPD features like self-harm and childhood traumatization and examine the impact of trait dissociation on both immediate and follow-up psychotherapy outcomes.Method: In this naturalistic prospective evaluation study, we investigated psychopathology including general psychological distress (SCL-90), depression (BDI-II), and borderline-specific pathology (BSL) in 131 patients with BPD pre and post of a certified 8-week inpatient Dialectical Behaviour Therapy (DBT), as well as 3- and 6-month post inpatient treatment. Prior to therapy, we evaluated trait dissociation (Dissociative Experience Scale), early life trauma (Childhood Trauma Questionnaire), and self-harm patterns (clinical interview). We performed a network analysis to explore the interplay between dissociation, self-harm, and childhood traumatization. To analyse the influence of dissociation on treatment outcomes, we employed linear mixed models.Results: Psychopathology (SCL-90, BDI-II and BSL) exhibited significant reductions at post-treatment and follow-up assessments when compared to baseline measurements. Higher levels of trait dissociation were consistently related to higher psychopathology but did not suggest poorer symptom reduction during DBT. However, trait dissociation predicted reduced 6-month follow-up benefits from DBT, regardless of the baseline symptom burden. The network analysis revealed a close association between self-injury and derealization/depersonalization, while the frequency of suicide attempts was more closely connected to childhood emotional abuse, which was identified as a central node of the network.Conclusions: Dissociation was not related to poorer outcomes regarding inpatient DBT. However, trait dissociation predicted reduced follow-up benefits, highlighting the need to address dissociation during psychotherapeutic interventions. Based on the estimated network structure, treating dissociative symptoms could potentially mitigate self-injury while especially childhood emotional abuse was linked with suicide attempts.

Background: Studies have shown that media exposure to critical public events can lead to secondary traumatic stress (STS). Personal trauma history, self-compassion and resilience are important factors influencing STS in healthy professionals. However, whether these variables are associated with social media-induced STS in college students and the underlying mechanisms remain unclear. The purpose of this study was to explore the complex relationship linking childhood trauma to social media-induced STS in a large sample of college students.Methods: A total of 1151 Chinese college students from Chengdu, Sichuan Province of China completed a web-based cross-sectional survey, which included standard assessments of childhood trauma, self-compassion, resilience and social media-induced STS, as well as sociodemographic questionnaires. The chain mediation model was tested using the PROCESS macro programme in SPSS software.Results: There was a moderate correlation between childhood trauma and social media-induced STS (r = 0.34, p < .001). This association was significantly mediated by self-compassion (indirect effect [95% CI] = 0.14[0.11, 0.17]) and resilience (indirect effect = 0.03[0.01, 0.04]), respectively. Further, a chained mediating effect was observed with self-compassion and resilience consecutively mediated the relationship between childhood trauma and social media-induced STS (indirect effect = 0.02[0.01, 0.03]). These results persisted after sociodemographic characteristics were included as controlling variables.Conclusions: Early life trauma impacts STS induced by exposure to traumatic materials on social media through self-compassion and resilience among Chinese college students. Psychological interventions targeting self-compassion and resilience can be implemented to reduce the risk of STS, especially in vulnerable individuals.

Background: Parental post-traumatic stress disorder (PTSD) can impact parenting and child psychosocial wellbeing. Complementing trauma-focused psychotherapy with parenting interventions can thus have important preventive value. Understanding parents' lived experiences is necessary to tailor such interventions to their needs.Objective: This study addressed the question: how can preventive parenting support be shaped to the needs of parents entering specialized psychotherapy for PTSD? To answer this question, we investigated parenting challenges, parent-child communication about PTSD, strengths, and social support experiences of parents with PTSD.Method: The sample included 14 parents seeking PTSD treatment at a tertiary mental healthcare institution, while parenting children aged 4-17. Data were collected using semi-structured interviews and analysed using reflexive thematic analysis.Results: On the one hand, parental dysregulation (e.g. exploding or shutting down) was an important challenge. On the other hand, parents' attempts to remain regulated (e.g. through overcontrol and overprotectiveness) also affected family life. When talking to their child about PTSD, parents were guided by what they considered beneficial for the child to know. An important strength was that parents tried to remain attuned to the child's needs, regardless of their own struggles. Parents also described experiences that could be understood as post-traumatic growth through parenting. Generally, parents experienced a lack of social support.Conclusion: Our findings illustrate that parents entering PTSD treatment are highly motivated to do what is best for their child. Based on parents' lived experiences, preventive parenting interventions should address the impacts of both dysregulation and overcontrolling regulation attempts. Another important goal is reducing feelings of incompetence. Integrating the parenting role in psychotherapy for PTSD could also be beneficial. For example, setting parenting-related therapy goals can be motivating. Furthermore, parent-child interactions can be a mirror that reflects the parents' inner state: considering these interactions can help recognize changes in symptomatology.

Background: The ongoing conflict in Ukraine has led to a rise in stress-related symptoms, including anxiety and depression, among veterans, necessitating accessible and effective mental health interventions. Traditional rehabilitation resources are often limited, prompting exploration into alternative therapies.Objective: This paper aims to assess the effectiveness of immersive 360° video-based Virtual Reality (VR) therapy as an enhancement to standard rehabilitation programmes for Ukrainian veterans experiencing anxiety and depression.Method: A randomised controlled trial (RCT) was conducted with 69 participants, who were randomly assigned to either the experimental group (n = 34), receiving daily VR sessions alongside standard rehabilitation, or the control group (n = 35), following standard rehabilitation alone. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) both at baseline and post-intervention. Additionally, momentary changes in anxiety and mood were measured immediately before and after each VR session to evaluate the immediate effects. The VR intervention was designed with veteran and expert feedback to enhance emotional regulation and stress resilience, integrating evidence-based psychotherapeutic techniques.Results: Results demonstrate significant rapid improvement in mood and reduction in anxiety following each session, along with significant reductions in anxiety (up to 14.5%) and depression (up to 12.3%) upon programme completion. Consistent results across all study iterations confirmed the reliability and scalability of 360-VR therapy as a short-term rehabilitation tool.Conclusions: Immersive VR therapy presents an effective, accessible solution for managing the psychological impact of war, particularly within the limitations of Ukraine's healthcare system.