European Journal of Psychotraumatology最新文献

ABSTRACTBackground: Early interventions using trauma-focused cognitive behavioural therapy have the potential to alleviate post-traumatic stress symptoms in individuals who have experienced recent sexual assault. Specialized Sexual Assault Centers (SACs) in Norway offers psychosocial support, however, this support varies across SACs and its efficacy has not been researched. The Early Intervention after Rape (EIR) study is a multisite randomized controlled trial designed to assess the efficacy and effectiveness of training SAC nurses and social workers to deliver a modified version of prolonged exposure therapy shortly after rape.Objective: This article aims to present a qualitative process evaluation of the implementation of the EIR study across three SACs in Norway, from the perspective of nurses and social workers.Method: We conducted semi-structured interviews with fifteen nurses and social workers, ten of whom received training in prolonged exposure therapy (mPE). We used Thematic Analysis to identify themes and subthemes.Results: Thematic analysis yielded four significant themes for process evaluation: (1) The quality of the new intervention modified prolonged exposure was considered satisfactory through training and supervision and delivered with good adherence to the manual, although some therapists perceived the manual as too rigid; (2) Adoption dynamics within the SACs are complex and include both enthusiasm for clinical research as well as resistance to change; (3) Narrow inclusion criteria and burden with participation for patients may limit reach and representativeness of the RCT; (4) Unintended consequences were identified, such as delayed start, conflicting advices and cross-contamination, underscoring the ongoing necessity for process evaluation alongside RCTs.Conclusion: This qualitative process evaluation offers insight into real-world clinical challenges with implementing a new intervention and conducting a multisite RCT within SACs in Norway. This study may inform opportunities to advance evidence-based practices for rape survivors seeking help.Trial registration: ClinicalTrials.gov identifier: NCT05489133..

Background: Many patients with post-traumatic stress disorder (PTSD) due to childhood trauma (Ch-PTSD) also suffer from comorbid personality pathology. Little is known about the effectiveness of treatments for Ch-PTSD in reducing the comorbid personality pathology. Schema Modes are an operationalization of personality pathology according to schema therapy and can be measured with the Schema Mode Inventory (SMI). Therefore, we evaluated the effects of two treatments for adult patients with Ch-PTSD on Schema Modes.Method: Participants (n = 114) of the Imagery Rescripting and Eye Movement Desensitization and Reprocessing (IREM) Randomized Clinical Trial (Boterhoven de Haan, K. L., Lee, C. W., Fassbinder, E., Voncken, M. J., Meewisse, M., Van Es, S. M., Menninga, S., Kousemaker, M., & Arntz, A. (2017). Imagery rescripting and eye movement desensitization and reprocessing for treatment of adults with childhood trauma-related post-traumatic stress disorder: IREM study design. BMC Psychiatry, 17(1), 1-12, Boterhoven de Haan, K. L., Lee, C. W., Fassbinder, E., van Es, S. M., Menninga, S., Meewisse, M.-L., Rijkeboer, M., Kousemaker, M., & Arntz, A. (2020). Imagery rescripting and eye movement desensitization and reprocessing as treatment for adults with post-traumatic stress disorder from childhood trauma: Randomised clinical trial. The British Journal of Psychiatry, 217(5), 609-615) with Ch-PTSD who filled in the SMI next to other outcomes, were randomly allocated to a 12-session treatment of Imagery Rescripting (ImRs) or Eye Movement Desensitization and Reprocessing (EMDR). The SMI was collected at waitlist, pre-treatment, mid-treatment, posttreatment, and 8-week and 1-year follow-up.Results: For both treatments, patients reported large reductions in the Maladaptive Schema Modes and improvements in the Adaptive Schema Modes (Cohen's d = .94-1.18) from pre-treatment to posttreatment, 8-week follow-up, and 1-year follow-up. No statistically significant differences were found between ImRs and EMDR regarding changes in Schema Modes over time. No significant changes were observed during the waitlist period.Conclusions: ImRs and EMDR showed improvements in Schema Modes when primarily targeting Ch-PTSD. The results indicate the possible value of both treatments in reducing comorbid personality pathology.

Background: Though there is substantial support for the importance of maladaptive appraisals for the development of posttraumatic stress reactions (PTSR), little is known about the long-term temporal relationship between maladaptive appraisals and PTSR beyond the first year after a traumatic event.Objective: We aimed to investigate three research questions: (1) Does the level of maladaptive appraisals change over time? (2) Are maladaptive appraisals and PTSR concurrently related to each other in the long term? (3) What is the direction of the temporal relationship between maladaptive appraisals and PTSR?Method: The participants were young survivors after the terror attack at Utøya island in Norway in 2011. We included data measured at 14-15 months, 30-32 months, and 102-108 months post trauma. The participants (N = 315) were all younger than 25 years at the time of the attack (mean age was 18.4, SD = 2.3), and 48.3% were female. The aims were investigated using correlations, paired t-tests, random intercept cross-lagged panel models (RI-CLPM), and cross-lagged panel models (CLPM).Results: We found a significant decrease in PTSR severity from 14-15 months to 30-32 months, and there was a significant increase in the mean level of maladaptive appraisals from 30-32 months to 102-108 months post trauma. Maladaptive appraisals and PTSR were highly associated across the three time points. Stable individual differences seem to account for most of the longitudinal relationship between maladaptive appraisals and PTSR, and we did not find clear indications of a direction of the temporal relationship between the variables.Conclusions: Our results indicate that the level of maladaptive appraisals can be quite stable once established, that they remain associated with PTSR, and that the long-term relationship between maladaptive appraisals and PTSR in the years following a trauma may best be explained by stable individual differences.

Background: Optimising support for children and families affected by fatal family violence requires understanding all aspects of their experience. So far, little is known regarding the views of those who provide a home to children bereaved due to parental intimate partner homicide.Objective: The aim of the current study was to provide an in-depth exploration of the experiences of caregivers raising children after the loss of a parent due to intimate partner homicide.Method: Within the context of a mixed-methods study among 22 caregivers (16 female, 6 male, aged 33 to 71 years old) related to 35 children and young people (19 female, 16 male), bereaved due to parental intimate partner homicide in the Netherlands, we conducted a reflexive thematic analysis of the qualitative caregiver interviews.Results: Based on caregivers' accounts, we conceptualised four interrelated and ongoing challenges: (1) bringing the children into the family fold; (2) dealing with the perpetrator and relatives; (3) managing underprepared services; and (4) enduring it, mentally and physically. Sticking with their commitment to the children despite these challenges, caregivers also pointed to the potential for positive outcomes or turns of events, and recounted experiences of finding or making meaning.Conclusions: The complexity of the challenges the caregivers in our study faced and their remarkable commitment and perseverance underscore the importance of concerted, continuing efforts to understand and respond to families' needs in the aftermath of parental intimate partner homicide. We discuss practical implications regarding caregivers' assessment of children's needs, mental health care, information provision and agency, mediation of family conflict, provision of respite care, addressing financial and practical needs, and long-term and equitable access to support. We also propose a research agenda involving evaluation of current protocols, in-depth qualitative research, quantitative analyses (where possible based on pooled data), and intervention studies.

To mark 15 years of the European Journal of Psychotraumatology, editors reviewed the past 15-year years of research on trauma exposure and its consequences, as well as developments in (early) psychological, pharmacological and complementary interventions. In all sections of this paper, we provide perspectives on sex/gender aspects, life course trends, and cross-cultural/global and systemic societal contexts. Globally, the majority of people experience stressful events that may be characterized as traumatic. However, definitions of what is traumatic are not necessarily straightforward or universal. Traumatic events may have a wide range of transdiagnostic mental and physical health consequences, not limited to posttraumatic stress disorder (PTSD). Research on genetic, molecular, and neurobiological influences show promise for further understanding underlying risk and resilience for trauma-related consequences. Symptom presentation, prevalence, and course, in response to traumatic experiences, differ depending on individuals' age and developmental phase, sex/gender, sociocultural and environmental contexts, and systemic socio-political forces. Early interventions have the potential to prevent acute posttraumatic stress reactions from escalating to a PTSD diagnosis whether delivered in the golden hours or weeks after trauma. However, research on prevention is still scarce compared to treatment research where several evidence-based psychological, pharmacological and complementary/ integrative interventions exist, and novel forms of delivery have become available. Here, we focus on how best to address the range of negative health outcomes following trauma, how to serve individuals across the age spectrum, including the very young and old, and include considerations of sex/gender, ethnicity, and culture in diverse contexts, beyond Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries. We conclude with providing directions for future research aimed at improving the well-being of all people impacted by trauma around the world. The 15 years EJPT webinar provides a 90-minute summary of this paper and can be downloaded here [http://bit.ly/4jdtx6k].

Background: Sleep disturbances are widely reported in Post-Traumatic Stress Disorder (PTSD). Although Dream Enactment Behaviour (DEB) has long been associated with PTSD, its high prevalence has only recently been recognized, sparking discussions about the classification of trauma-related sleep disorders. The impact of DEB on treatment outcomes in PTSD remains unexplored.Objective: To investigate the role of DEB in functional impairment, symptom severity, subjective sleep disturbances, and treatment response in patients with PTSD, and how it relates to Trauma-Associated Sleep Disorder (TASD).Methods: We analyzed data from a randomized controlled trial carried out in a specialized mental health clinic in Denmark. The trial investigated refugees with PTSD allocated to four groups receiving different combinations of PTSD therapy. Participants completed self-report questionnaires assessing functional impairment, symptom severity, and subjective sleep disturbances, including the REM Sleep Behaviour Disorder Screening Questionnaire (RBDSQ), the Pittsburgh Sleep Quality Index (PSQI), and the Typical Dream Questionnaire (TDQ), at baseline and follow-up. The sample was split into two groups based on the presence of self-reported DEB, and compared at baseline and follow-up. Statistical analyses included chi-square test, Mann-Whitney U test, and regression.Results: A sample of 176 RBDSQ respondents was studied, of which 71% met the criteria for DEB (N = 125). DEB was significantly associated with a poorer treatment response on sleep quality as assessed by the PSQI (N = 122, p = .035), irrespective of treatment group. No differences were observed in functional impairment or symptom severity. Of the 67 TDQ respondents with DEB, 60% did not have trauma-related nightmares (N = 40).Conclusions: DEB is a significant feature of sleep in PTSD and seems to limit the efficacy of treatment interventions. TASD does not encompass all cases of DEB in PTSD and the concept needs further development to be clinically useful.Trail Registration: ClinicalTrials.gov identifier: NCT02761161; clinicaltrials.gov/study/NCT02761161.

Background: The International Trauma Interview (ITI) is a clinician-administered assessment that has been newly developed for the International Classification of Diseases (ICD-11) diagnoses of posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD).Objective: The current study evaluated the psychometric properties of the ITI for treatment-seeking people with adverse childhood experiences (ACE) in South Korea, with the aims of verifying the validity and reliability of ITI as well as examining the differentiation of ICD-11 CPTSD and borderline personality disorder (BPD).Methods: In total, data of 103 people were analysed. Clinical psychologists conducted the ITI and the structured interview for BPD. Along with the International Trauma Questionnaire (ITQ), self-report measurements on ACE, adulthood trauma, emotion dysregulation, dissociation, depression, adult attachment, BPD symptoms, self-harm, self-compassion, and quality of life were collected. A confirmatory factor analysis (CFA) was conducted to examine the factorial validity and a structural equation model (SEM) was used to evaluate the convergent and discriminant validity.Results: The CFA supported the second-order two-factor model of ICD-11 CPTSD. However, we determined that the alternatively suggested second-order two-factor model of reexperience avoidance combined PTSD and DSO described the data the best. As was hypothesized, ITI PTSD and DSO showed convergent and discriminant validity, and ITI DSO also showed distinctive features with BPD. Interrater reliability and composite reliability were both found to be acceptable. Agreement and consistency between ITQ and ITI were also fair although tentative.Conclusions: The ITI is determined to be a valid and reliable method for the assessment and diagnosis of ICD-11 PTSD and CPTSD, and it is considered to be promising for the differential diagnosis of BPD in South Korean treatment-seeking people with ACE. Future research should aim to assess the agreement between ITI and ITQ while also seeking alternative criteria for ITI PTSD across variant trauma memory features.

Background: Individuals impacted by adverse childhood experiences (ACEs) are at greater risk of developing obesity, however, few studies have prospectively measured ACEs and obesity during childhood. Associations with the adoption of obesogenic behaviours during childhood, which directly contribute to obesity are also understudied.Objective: To examine associations between individual and cumulative ACEs, obesity, and obesogenic behaviours during childhood.Methods: Data came from Growing Up in New Zealand. The study sample was restricted to those who provided obesity data at age 8 and one child per mother, resulting in an analytic sample of 4895 children. A newly developed ACEs index consisted of nine individual ACEs and cumulative ACEs scores (0, 1, 2, 3, 4+ ACEs), two obesity measures (BMI and waist circumference/height ratio), and eight obesogenic behaviours including unhealthy dietary behaviours, inadequate sleep duration, excessive screen time, and physical inactivity were included in the analyses.Results: ACEs were prevalent among this cohort of NZ children. By age eight, 87.1% of children experienced at least one ACE and 16% experienced at least 4 ACEs. Six individuals assessed ACEs showed significant associations with childhood obesity (AORs ranging from 1.22 to 1.44). A significant dose-response effect was observed where the experience of a higher number of ACEs was associated with greater risk for obesity (AORs increased from 1.78 for one ACE to 2.84 for 4+ ACEs). Further, a significant dose-response relationship was found between experiencing two or more ACEs and higher odds of adopting obesogenic behaviours (AORs ranging from 1.29 for physical inactivity to 3.16 for no regular breakfast consumption).Conclusions: ACEs exposure contributes to population-level burden of childhood obesity. Our findings highlight the importance of a holistic understanding of the determinants of obesity, reinforcing calls for ACEs prevention and necessitating incorporation of ACEs-informed services into obesity reduction initiatives.

Background: Psychotherapeutic interventions aimed at treating posttraumatic stress disorder (PTSD) in adolescents and young adults are hampered by high dropout rates. Looking at the results from adult treatments, short, intensive, outpatient treatment programmes may offer a promising alternative, but it has yet to be tested in this young population.Objective: To assess the results of a six-day intensive outpatient trauma-focused treatment programme for young individuals (12-25 years) with PTSD. The treatment combined prolonged exposure and EMDR therapy, supplemented with physical activity and the participation of relatives and/or friends. Treatment was performed by a rotating team of therapists.Methods: Seventy-four adolescents and young adults (89% women, mean age = 18.6 years, 36 patients aged 12-17 and 38 patients aged 18-25; SD = 3.1) with PTSD and a minimum of four memories of A-criterion traumatic events participated in the programme. PTSD symptoms, depressive symptoms, and the perceived burden of trauma symptoms were assessed before treatment, at the start and one month after treatment.Results: Patients showed a significant reduction in PTSD symptoms from pre-treatment to one month after treatment (Cohen's d = 1.66). Of all patients, 52 (70%) showed a clinically meaningful response, and 48 (65%) no longer met the diagnostic criteria for PTSD one month after treatment. Depressive symptoms also decreased significantly (Cohen's d = 1.02). The dropout rate was 4% (N = 3). None of the patients experienced an adverse event or worsening of symptoms.Conclusions: Results suggest that a short, intensive, outpatient therapy programme combining prolonged exposure, EMDR therapy, physical activity, and participation of relatives and friends, is well-tolerated, and an effective and safe treatment alternative for adolescents and young adults with PTSD due to multiple traumatization.

Background: This study seeks to explore the Post-Traumatic Growth (PTG) condition, a transformative psychological process that promotes improved cognitive functioning and resilience in individuals who suffered childhood trauma, including those affected by the Iran-Iraq war. PTG denotes positive psychological changes, such as enhanced reasoning abilities and emotional strength (Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 1-18)).Method: This study views trauma responses as complex and multidimensional, including not only negative outcomes but also coping strategies and psychological growth. Data was collected through semi-structured interviews with 11 participants who witnessed the Iran-Iraq war during childhood. Participants were from a broad spectrum of ethnic backgrounds, reflecting the multiethnic diversity of the war-affected areas. This is significant as their cultural background could affect how they process and heal from trauma due to the multiplicity of values, beliefs, and behaviours. Also, participants' socio-economic backgrounds ranged from low to middle-income, allowing for an investigation of how trauma and growth are impacted by financial resources and constraints. Data were analyzed using Moustakas's phenomenological analysis approach.Results: The findings revealed eight primary and twelve secondary themes ranging from psychological effects and long-term coping mechanisms and wartime recollections. The analysis also revealed distinct patterns of trauma symptoms and growth in adults approaching middle age. The available evidence points to the fact that, although the war-afflicted participants had to contantly live with the lingering effects of trauma across different stages of their lives, they continued to flourish and remain resilient with efficient stress management.Conclusions: The study emphasizes that, in theoretical terms, unexpected developmental steps are crucial, suggesting that childhood trauma, while commonly associated with negative outcomes, can also lead to growth and resilience in certain circumstances.