European Journal of Psychotraumatology最新文献

Background: Psychophysiological dysregulations and negative alterations in cognitions and mood characterize post traumatic stress disorder (PTSD) and complex PTSD (C-PTSD), contributing to an increased risk of disorder persistence and chronic health problems. However, understanding the differences in physiological stress reactivity and negative cognitive-emotional patterns between adolescents with PTSD and C-PTSD remains a notable research gap.Objective: This study examined group differences in autonomic nervous system (ANS) reactivity during the sharing of a short trauma narrative, including resting and recovery phases, and compared subjective experiences of stress, shame, and guilt among adolescents with PTSD, C-PTSD, and trauma-exposed controls.Methods: In a repeated-measures design, 52 adolescents (14-18 years) with PTSD (n = 17), C-PTSD (n = 18), and a control group (n = 17) were assessed for heart rate, heart rate variability, and subjective experiences of stress, shame, and guilt during a standardized trauma interview, as well as during baseline and recovery phases.Results: Linear mixed-effects models revealed a significant interaction between group and time point (F = 4.134, p < .001). The C-PTSD group exhibited a significantly higher heart rate in the recovery phase compared to the PTSD (p = .010) and control groups (p = .036), alongside significantly higher subjective stress, guilt, and shame experiences. Main effects of group were identified for perceived stress (F = 7.543, p = .002), guilt (F = 21.779, p < .001), and shame (F = 19.309, p < .001), with the C-PTSD group exhibiting higher levels compared to PTSD and control groups across all conditions.Conclusions: Prolonged stress responses and elevated experiences of shame and guilt in adolescents with C-PTSD align with the diagnostic criteria of affective dysregulation and negative self-concept. Objective stress measures during trauma interviews may support the diagnosis of C-PTSD. Findings highlight the importance of phase-based trauma therapies that target emotional dysregulation, shame, and guilt.

Background: Several psychosocial interventions have shown promising effects in treating people affected by childhood maltreatment (CM); however, their comparative efficacy on social functioning remains largely unknown. To address this issue, a systematic review and network meta-analysis (NMA) will be conducted to investigate the comparative efficacy of different psychosocial interventions on global social functioning and specific domains of social functioning, including behavioural, emotional, cognitive and physiological processes. We aim to develop a hierarchical ranking of existing psychosocial interventions concerning their efficacy and acceptability which could inform treatment guidelines.Methods: Randomised controlled trials (RCTs) investigating psychosocial interventions for individuals with exposure to CM when they were younger than age 18 will be included. Primary outcomes will be global and domains of social functioning (measured up to 3, 6, 12 months and at the longest follow-up). Study drop-out will be a secondary outcome that will serve as a measure of acceptability. Study selection and data extraction will be performed by at least two independent reviewers. We will assess the risk of bias for each study using the Cochrane Risk of Bias tool 2 (RoB2) and evaluate the confidence in the results using Confidence in Network Meta-Analysis (CINeMA). The effects of potential moderators, such as age (children/adolescents vs. adults), population type (clinical vs. non-clinical samples), or sex (% males), socioeconomic status (low-income vs. middle-high-income countries), and intervention characteristics (individual vs. group training, number of sessions) will be analysed using subgroup-analyses or meta-regressions. Other candidate moderators/mediators (personality, post-traumatic symptoms, brain structure/function, cognitive reserve) will also be explored and narratively summarised. Sensitivity analyses will be conducted to explore further heterogeneity and assess the robustness of our findings.Discussion: This systematic review and NMA aims to compare multiple existing psychosocial interventions in individuals affected by CM and establish the relative rankings of these interventions for social functioning. Our results may provide practical guidance concerning the most effective psychosocial interventions to reduce the societal burden associated with CM.Protocol registration: PROSPERO CRD42022347034.

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: Individuals with pre-existing heavy alcohol use, prior traumatic exposures, and psychiatric disorders were considered an at-risk group for increased alcohol use and problems in the context of the COVID-19 pandemic.Objective: This study recruited from a multi-centre longitudinal cohort study of US military service members/veterans with combat exposure to examine the trajectories of alcohol use and problems in the context of a prolonged stressor.Methods: Individuals who endorsed heavy drinking and completed a measure of PTSD symptoms prior to the pandemic were invited to participate in a longitudinal survey study at three time points, three months apart, during the second year of the pandemic. Participants (N = 44) completed surveys assessing alcohol consumption and alcohol-related problems (via the AUDIT), PTSD symptoms (via the PCL-5), and infection mitigation behaviours (via a COVID-19 specific survey). Random intercept models were fitted to the longitudinal data for each of these outcomes, covarying for demographics, pandemic quarantine/physical distancing experience, pre-pandemic baseline alcohol consumption and PTSD symptoms, and time-varying alcohol consumption and alcohol-related problems as well as PTSD symptoms.Results: We did not find an increase in alcohol consumption or problems over time. However, pre-pandemic alcohol consumption predicted alcohol consumption over time (B = 0.52, SE = 0.11, p < .01). Time-varying alcohol consumption and PTSD symptoms predicted alcohol problems over time (B = 0.84, SE = 0.18, p < .01; B = 0.04, SE = 0.02, p < .05, respectively).Conclusions: Findings highlight the relevance of pre-existing hazardous alcohol consumption prior to stressors as well as ongoing consumption and PTSD symptoms as risk factors for alcohol-related problems. Findings captured more chronic impacts of pandemic stressors and demonstrated that heavy drinking and PTSD are notable risk factors for alcohol-related problems even if in the context of stabilizing, albeit still high, alcohol use.