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.

ABSTRACTBackground: Structural and functional changes in stress-related gray matter (GM) regions have been found in trauma-exposed individuals. However, the nature of underlying neurobiological abnormalities in individuals following stress, particularly acute stress, is unclear.Methods: In this study, thirty-two motor vehicle accident (MVA) survivors and thirty-one nonexposed controls were recruited. MVA survivors were scanned and received trauma-specific clinical assessments within one week of their accident. Mean diffusivity (MD), fractional anisotropy (FA), and GM volume (GMV) were measured as indicators of GM structural changes in the medial orbitofrontal cortex (mOFC), amygdala, hippocampus, insula, and anterior cingulate cortex (ACC) bilaterally. In these regions with significant structural changes in the MVA group, sex differences were assessed. Functional connectivity (FC) analysis was conducted to explore the brain network effect of these structural alterations. Correlation analyses were performed to explore the association between the resultant GM structure and anxiety symptoms.Results: Significantly lower fractional anisotropy (FA) in the mOFC and ACC was detected in the MVA group. In these regions, females in the MVA group had lower MD in the right ACC, but no sex-by-stress interactions were found. Compared with controls, the MVA group had less connectivity between the right mOFC and the left inferior OFC. No significant association was found between GM structure and anxiety symptoms.Conclusion: MVA survivors showed potential GM microstructure alterations which may affect functional consequences shortly after acute stress. These findings may contribute to informing future strategies for timely interventions after acute stress.

Background: Torture, banned under international treaties such as the UN Convention Against Torture, remains a widespread violation with profound health consequences. The Istanbul Protocol (IP) sets global standards for the medical documentation of torture highlighting the important role of healthcare providers. A limitation of existing research on torture's health impacts is that studies are largely cross-sectional and reliant on self-reported clinical data. Norway's detailed healthcare registry data offers a robust opportunity to conduct longitudinal, population-based studies, advancing our understanding of torture's long-term effects on refugees and its public health implications.Objectives: This study has two main aims: (1) to examine the frequency of torture-related diagnostic codes and the factors associated with their use in primary and specialized care among adult Syrian refugees resettled in Norway, and (2) to link self-report data on torture exposure in adult refugees from Syria with data on HCSU over a 6-year follow-up to explore group differences in utilization patterns.Methods: Study participants include the RBMI cohort (N = 14,350), comprised of all adult refugees from Syria resettled in Norway in 2015-2017; and the REFUGE cohort - a subsample of the RBMI cohort - comprised of those in the RBMI cohort who participated in a nationwide survey study in 2018. Aim 1 will be addressed using data (2015-2024) from the Norwegian Registry for Primary Health Care (KPR) and the Norwegian Patient Registry (NPR), which contain information on all contacts with primary- and specialized healthcare services throughout Norway (e.g. date of contact, diagnostic code given). To address aim 2, we will link 2018 survey data on torture exposure to the abovementioned registry data on HCSU. In addition to descriptive statistics, multivariable, two-part hurdle regression models will be used to analyse data since we expect zero inflation and overdispersion of the outcomes (HCSU).Stage of study: This manuscript reports Stage 1 of a Registered Report; analyses will be conducted after in-principle acceptance.

Background: Disengaged coping is often associated with worse mental health outcomes in reaction to stress. However, little research has explored the associations of disengaged coping and mental health consequences during warfare, especially its potentially moderating role in the relationship between acute stress disorder (ASD) and subsequent posttraumatic stress disorder (PTSD) in the context of war-related trauma.Objective: This study examined (a) the association between ASD shortly after the outbreak of the 7 October war with PTSD 6 months later and (b) the moderating role of disengaged coping in the relationship between ASD and subsequent PTSD.Method: The study was conducted in the fourth week after the 7 October war started and included 341 Israeli citizens (women and men, Jews and Arabs) affected by the all-encompassing threatening situation in Israel. Questionnaires measured sociodemographic and war-related variables, ASD, disengaged coping, and PTSD.Results: The mean score for ASD was relatively high, whereas the mean score for subsequent PTSD was medium. The higher the ASD, the higher the use of disengaged coping and the level of PTSD. Additionally, a moderation effect was identified, indicating that the association between ASD and subsequent PTSD was present only at moderate to high levels of disengaged coping.Conclusions: During exposure to traumatic events, such as war, mental healthcare professionals should identify individuals who develop ASD and use disengaged coping and provide immediate psychological help to prevent the subsequent development of chronic symptoms, such as PTSD.

Background: The ICD-11 introduced distinct criteria for Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD), necessitating validated assessment tools. While the International Trauma Questionnaire (ITQ) is a widely used self-report measure, the International Trauma Interview (ITI) is a structured clinician-administered interview considered a gold standard. This study investigated the correspondence between ITQ and ITI symptom and diagnostic classifications in a treatment-seeking veteran population.Methods: A sample of 108 Danish veterans completed both the ITQ and ITI. We calculated descriptive statistics, bivariate correlations, and Cohen's κ values to assess agreement for individual symptom items and diagnostic categories (ICD-11 PTSD, CPTSD, and PTSD or CPTSD combined), using the ITI as the reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also determined.Results: ITQ scores were consistently higher than ITI scores across all symptom domains. Total symptom scores for PTSD, DSO, and CPTSD showed strong associations between instruments (r = .74 to .82, all p < .001). Agreement for individual symptom items varied from fair to substantial (κ = .33 to .70). The combined diagnosis of PTSD or CPTSD showed moderate agreement (κ = .60) with high sensitivity (0.94) and PPV (0.90). However, agreement for ICD-11 PTSD alone was fair (κ = .38), with low PPV (0.39) despite good sensitivity (0.65).Conclusion: The ITQ consistently reported higher symptom endorsement than the ITI. While the ITQ shows strong convergent validity for overall symptom burden and high sensitivity for screening trauma-related psychopathology (PTSD or CPTSD combined), its limited agreement for standalone ICD-11 PTSD diagnosis suggests it should not be used as a sole diagnostic tool. Comprehensive clinical interviews remain crucial for definitive diagnosis, while the ITQ can serve as an effective screening instrument.

Introduction: In Germany, there is a lack of recent population-based data regarding the prevalence of multiple personality disorder (MPD; ICD-10: F44.81) and the treatment of individuals with this diagnosis. This study aimed to assess the prevalence, psychiatric comorbidities, and treatment of MPD in Germany.Materials and Methods: Based on nationwide claims data, an observational trend study was conducted. For each year from 2012 to 2021, the proportion of persons with at least one coded MPD diagnosis was determined, stratified by sex, age and region. Additionally, psychiatric comorbidity, psychopharmacotherapy, hospital treatment, and outpatient psychotherapy among persons diagnosed with MPD in 2021 were assessed.Results: From 2012 to 2021, the administrative prevalence of MPD increased by 58.5% (from 4.1/100,000 to 6.5/100,000), with a prevalence peak in 17- to 24-year-olds and a female/male ratio of 6:1. In 2021, 86.4% of individuals with a MPD diagnosis had at least one co-occurring psychiatric diagnosis, with 23.9% having five or more. Top comorbidities were anxiety disorders (73.7%), depressive disorders (60.5%), other personality disorders (38.9%), substance use disorders (18.4%), and eating disorders (15.4%). Regarding pharmacotherapy, antidepressants (47.4%), tranquilisers (31.5%), antipsychotics (28.0%), and opioid analgesics (12.8%) were most frequently prescribed. 44.4% of individuals with MPD received psychotherapy, and 14.2% underwent psychiatric hospitalisation (median duration: 7 weeks).Discussion: In this study, we found an administrative prevalence of MPD of 4.1/100,000 in 2012 and 6.5/100,000 in 2021. These figures are considerably lower than those found in epidemiological studies, indicating underdiagnosis of MPD in Germany. The increase in MPD diagnoses was mainly due to a surge in outpatient diagnoses. Individuals with MPD diagnoses had high psychiatric comorbidity, especially depression, anxiety, and personality disorders. Therapeutic measures were in line with current guidelines, with the exception of above-average opioid analgesics prescriptions, which may be related to the high BPD comorbidity.

Introduction: Forced migration exposes civilians to multiple potentially traumatic events. Personality traits may shape individual differences in adjustment, yet their role in refugee populations remains underexplored.Methods: We conducted a cross-sectional study of 160 Ukrainian civilian refugees (75% female; M_age = 33.0, SD = 13.9) who completed standardized measures of personality, attachment, posttraumatic stress symptoms, and posttraumatic growth (PTG).Results: Emotional Stability showed a large negative association with PTSD symptoms. In regression models, personality traits explained 26% of the variance in PTSD symptoms, increasing to 30% when attachment styles were included. By contrast, traits explained only 6% of variance in posttraumatic growth, rising to 9% after accounting for parental-closeness variables.Conclusions: Emotional Stability is a robust correlate of PTSD severity in this refugee sample, while personality and attachment play a limited role in posttraumatic growth. These findings suggest that trait-informed screening may help identify individuals at risk for severe posttraumatic distress.

Background: Childhood adversity (CA) predicts borderline personality disorder (BPD) and depression. Although underlying mechanisms are unclear, emerging data draw attention to reward processing (RP).Objective: Building on these, we investigated associations between variables and tested the mediating role of distinct RP dimensions in the associations between CA and both BPD and depressive symptoms using structural equation modeling.Method: Participants (N = 1048; m = 25.24; SD = 5.34) completed self-report measures on variables of interest.Results: We found significant associations between CA, BPD and depressive symptoms, and RP dimensions. Both reward responsiveness and learning mediated the association between CA and BPD symptoms, while only reward learning mediated the association between CA and depressive symptoms.Conclusions: These findings illustrate the key role of RP in the association between CA and both BPD and depressive symptoms and underscore the transdiagnostic nature of reward learning. Together, they suggest that this RP dimension may be an important treatment target in those with a history of CA experiencing BPD and depressive symptoms.

Background: Workplace fatalities are sudden, traumatic events that can have significant psychological and emotional consequences for those exposed to them.Objective: To explore coworkers' lived experiences of workplace fatalities, with particular attention to their exposure and trauma responses.Method: A qualitative descriptive study with semi-structured interviews was undertaken to understand the lived experiences of coworkers exposed to traumatic workplace fatalities. Eighteen participants from five industry groups took part. Thematic analysis was used to understand and interpret the interviews, guided by Carlson and Dalenberg's (2000) conceptual framework of traumatic experiences.Results: Exposure to traumatic workplace fatalities includes the experience of confronting visual, auditory and tactile experiences. Participants described peritraumatic responses such as emotional withdrawal, panic, numbness and shock, as well as acting instinctively to assist the victim. Posttraumatic trauma responses included re-experiencing and avoidance, with some reporting secondary and associated responses such as PTSD, suicidal ideation and relationship breakdowns. Investigative processes were also described as retraumatising and distressing.Conclusions: This study identifies that coworkers can be significantly affected by traumatic workplace fatalities, often experiencing emotional and psychological harm as secondary victims. The investigative process that follows can compound their distress and be retraumatising. Findings highlight a clear need for trauma-informed support that addresses both immediate and ongoing psychological needs of coworkers. Better recognition and response to their experiences and needs are essential in reducing further harm.

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.