European Journal of Psychotraumatology最新文献

Background: Peritraumatic dissociation is thought to contribute to posttraumatic symptoms like intrusions and memory disturbances. However, trauma-analogue studies that examined effects of experimental dissociation-induction on intrusions and memory were inconclusive. To better understand this, a necessary first step is to more systematically compare various induction methods.Objective: We evaluate different dissociation-induction-methods regarding their effectiveness, the intensity and quality of induced dissociation, and their effects on intrusions and memory in a pre-registered randomised-controlled online experiment.Method: Healthy participants (N = 213) were randomised to one of six dissociation-induction-methods: audio-photic stimulation, hypnotic-suggestion, or spiral-staring, each for one-minute or three-minute duration. Participants also completed two further conditions: a non-dissociation-inducing picture task (control condition) and the comparison dissociation-induction-method dot-staring (benchmark condition). Each condition was followed by an aversive ('trauma') film. Peri-film dissociation intensity (measured using an adapted version of the Peritraumatic Dissociative Experiences Questionnaire) and quality, as well as film-specific intrusion-load and memory performance, were assessed. Dissociation-induction-methods were deemed successful if they elicited dissociation levels higher than the control condition and at least as high as the benchmark condition. Only successful dissociation-induction-methods were examined further.Results: Three minutes of hypnotic-suggestion and one minute of spiral-staring successfully induced dissociation during the film, while other methods did not meet the effectiveness threshold. Hypnotic-suggestion led to a greater increase in dissociation intensity than spiral-staring, dissociation induced by spiral-staring was perceived as more uncontrollable and unpleasant. Results did not support an adverse effect of dissociation-induction or dissociation intensity on intrusion-load, but they did support an adverse effect on self-reported and objectively assessed memory performance.Conclusions: Results indicate that hypnotic-suggestion and spiral-staring constitute effective, easy-to-implement, and in principle, neuroimaging-compatible dissociation-induction-methods that allow studying dissociation in the laboratory. The present data did not support the notion that dissociation fosters intrusion formation but provides causal support for effects of dissociation on trauma memory.

Background: The mental health impact of the COVID-19 pandemic is well documented. However, only a few studies investigated mental health in later phases of the pandemic and after its official end. Moreover, little is known about people's psychological burden related to the pandemic and other global crises post-pandemic.Objective: Study's first objective was to compare mental health outcomes in the general population over the course of the pandemic and ten months post-pandemic. The second objective was to explore people's psychological burden regarding the pandemic, in comparison to current wars, climate crises, inflation, and poor government management and/or corruption in the post-pandemic era.Method: Participants from the general population of Austria, Croatia, Germany, Greece, and Portugal (68.8% female, M_age = 41.55) were assessed online up to four times between June 2020 and March 2024 (baseline sample: N = 7913). Adjustment Disorder New Module - 8 (ADNM-8), Patient Health Questionnaire (PHQ-2), and World Health Organization-Five Well-Being Index (WHO-5) were used to measure adjustment disorder, depression, and well-being. Prevalence rates were calculated and repeated measures ANOVAs applied to assess mental health at four time points. One-way repeated measures ANOVA was run to explore how the different global crises were related to participants' burden.Results: Temporal variations in mental health were evident across four assessment waves, with highest levels of probable adjustment disorder and depression in winter 2020/2021 (T2). A slight improvement of mental health was found at later time points. Current wars and inflation were the greatest sources of psychological burden at the post-pandemic assessment, revealing some cross-country differences.Conclusion: Although mental health differences in the general population were not as pronounced as in the acute phase of the pandemic, psychosocial support is still needed post-pandemic. This is likely to be due to other global crises that take a toll on people's mental health.

Background: The International Trauma Questionnaire (ITQ) is a validated measure supporting the diagnosis of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD (cPTSD). It has been translated into 35 languages, also into Polish. Due to the lack of information in the literature about its validation, new Polish version has been re-adapted and validated in the Polish non-clinical and clinical samples of the present study.Objective: The study aimed (1) to adapt the ITQ for use in Polish, (2) to assess the construct validity of ICD-11 PTSD and cPTSD in the Polish ITQ, and (3) to examine the convergent and discriminant validity of the Polish ITQ.Method: The study sample comprised of 452 adults: a non-clinical sample, N = 314, (completed the online version of the questionnaire) and a clinical sample, N = 138, (used a pen-and-paper version). Confirmatory Factor Analysis (CFA) and Latent Class Analysis (LCA) were performed to assess the structure of the ITQ.Results: The CFA supported a two-factor second-order model as the best fit to the data. All factor loadings were statistically significant and reached a satisfactory level. Cronbach's alpha for ITQ (α = 0.887), PTSD (α = 0.810) and DSO (α = 0.875) were good. The LPA revealed four classes: (1) a cPTSD class with elevated PTSD and DSO symptoms; (2) a PTSD class with elevated PTSD symptoms but low scores on the DSO; (3) a DSO class with elevated DSO symptoms but low scores on the PTSD; and (4) a low symptom class with low scores on all symptoms.Conclusion: The amended Polish ITQ has good internal consistency and psychometric properties. The model is well fitted to differentiating PTSD/cPTSD diagnoses according to ICD-11 and is a reliable measure of support for the making of a PTSD/cPTSD diagnosis in the conduct of clinical interview.

Background: Immigrant and refugee adolescents often face traumatic experiences and are vulnerable to mental health problems, such as post-traumatic stress disorder (PTSD), anxiety and depression. Yet, they also show remarkable resilience in the face of these stressors. Research is still scarce on how both mental health problems and resilience dynamically interplay in immigrant and refugee adolescents' development.Objective: We aimed to identify latent profiles of immigrant and refugee adolescents' wellbeing, consisting of externalizing and internalizing symptoms, PTSD (intrusion and avoidance), and resilience, and analyse the demographic and contextual determinants of these profiles.Method: We employed cross-sectional survey data from the RefugeesWellSchool project for 1607 immigrant and refugee adolescents (mean age 15.3 years, SD 2.15, 42.3% girls) from six European countries: Belgium, Denmark, Finland, Norway, Sweden, and the United Kingdom. Latent profile analysis and three-step procedure with BCH weights were used to identify the wellbeing profiles and their determinants.Results: Results identified four adolescent wellbeing profiles: (1) Low symptoms (49.7%, n = 791); (2) High symptoms with intrusion (10.6%, n = 169); (3) Moderate symptoms (26.9%, n = 428); and (4) Resilient avoidant (12.8%, n = 203). Older participants, those with refugee background, shorter residence in the host country, more experiences of daily stressors or discrimination, or low family support were less likely to belong to the Low symptoms or Resilient avoidant groups (p ≤ .001).Conclusions: The profiles reflected distinct differentiation of intrusive and avoidance dimensions of the PTSD-symptoms. Intrusion clustered with high level of other mental health problems, whereas avoidance co-occurred with high resilience. Experiences related to immigration, stressors, and family support were crucial determinants of the wellbeing profile membership. Future interventions should utilize information obtained by person-centered studies to create better targeted and tailored support for immigrant and refugee adolescents.

Background: Posttraumatic stress disorder (PTSD) and chronic pain are devastating conditions that often co-occur. Current understanding of comorbid PTSD and chronic pain is limited, and treatment options are undereffective.Objective: This paper presents a theoretical basis for conceptualising chronic pain symptoms within Emotional Processing Theory (EPT), the foundation for Prolonged Exposure (PE), an effective treatment for PTSD. EPT conceptualises the development and treatment of PTSD using a trauma structure that strongly overlaps with pain's neurobiology.Method: This paper proposes a model of shared aetiology and treatment of comorbid PTSD and chronic pain, emphasising these shared neurobiological underpinnings. Discussion details how the comorbidity is maintained through parallel avoidance processes focused on: (1) trauma memories and reminders in PTSD preventing reduction of negative affect (extinction) and inhibitory learning, and (2) physical pain in chronic pain fuelling increased pain and reduced function.Results: A conceptualisation is presented on how PTSD and chronic pain symptomology can be addressed within the EPT framework, increasing the confidence of providers and patients while addressing an important gap in the literature. Finally, recommendations for providers using PE with patients with PTSD and pain are provided including a case example and treatment plan based on real patients.Conclusions: This model provides a clinically useful understanding of the underlying neurobiology for the co-occurrence of PTSD and chronic pain and offers direction for future research.

Background: Post-traumatic stress disorder (PTSD) is a complex condition linked to inflammation. The causality between inflammatory cytokines and PTSD risk remains unclear.Methods: We conducted a bidirectional two-sample Mendelian randomization (MR) study using genome-wide association study (GWAS) data from 41 inflammatory cytokines and PTSD. Additional analyses included differential gene expression, protein-protein interaction, and functional enrichment to explore underlying mechanisms.Results: MR analysis indicated that higher levels of stem cell factor (SCF) and interleukin-4 (IL-4) are associated with a reduced risk of PTSD. Genes POGZ and LRIG2 were identified as mediators, implicated in the TGF-beta signalling pathway.Conclusion: Our findings suggest a protective role of certain cytokines against PTSD and highlight potential molecular mediators. This knowledge could inform future therapeutic strategies for PTSD.

Background: Most individuals with posttraumatic stress disorder (PTSD) report sleep disturbances. Yet, results on the impact of trauma-focused therapy on subjective and objective sleep disturbances are inconsistent.Objectives: This study conducted secondary analyses from a randomized controlled trial (RCT; German Clinical Trials Registration: DRKS00005578) to investigate changes in both subjective and objective sleep over the course of trauma-focused therapy and whether these changes differed for dialectical behaviour therapy for PTSD (DBT-PTSD) or cognitive processing therapy (CPT).Methods: Women with PTSD related to childhood abuse were randomized to receive DBT-PTSD or CPT. Sleep was assessed in n = 180 women using the Pittsburgh Sleep Quality Index (PSQI), sleep diaries, and actigraphy at baseline, 6 and 12 months into treatment, with sleep monitoring for 1 week at each assessment.Results: Subjective sleep disturbances improved significantly from pre- to post-treatment, reflected in better PSQI scores (d = 0.76), sleep quality (d = 0.69), and total sleep time (d = 0.11) in sleep diary entries with no differences between treatment groups. No significant changes were observed in actigraphy measures. In total, 76% of participants still met the clinical cut-off of 5 on the PSQI, indicating clinically significant subjective sleep disturbances.Conclusions: PTSD treatments were linked to improvements in subjective sleep quality, but objective sleep measures remained unaffected. A high percentage of participants with persistent clinical sleep disturbances after treatment highlight the need for further research on the efficacy of PTSD treatments on sleep disturbances. To reduce the burden of sleep disturbances, sleep-specific treatment components may need to be added to trauma-focused treatments.

Background: Research has demonstrated that the verbal disclosure for adult victims of childhood sexual trauma (CST) presents significant challenges and seldom provides comprehensive trauma integration. Limited psychosocial support and specialist trauma care particularly in marginalised communities, can further exacerbate the non-disclosure of CST. Although various intervention models for adult victims of CST exist, the potential of facilitating integrative silence as part of community centred integrative trauma informed care (ITIC), remains under-explored.Objective: The objective of this article, is to document how facilitating spaces of integrative silence in a therapeutic context, shifts embodied trauma awareness, comprehensive trauma realisation and trauma integration for adult victims of CST from intergenerational marginalised contexts.Methods: Through participatory action research (PAR), framed in de-colonial feminist community praxis with 13 women aged 21-62, the first author as therapist-researcher facilitated audio-visual recorded semi-structured interviews (n = 13) and integrative trauma informed care (ITIC) follow-up sessions (n = 60) to assess the value of the spoken, unspoken and silence in trauma care. Inductive reflexive thematic analysis and a multistage recursive coding process of verbatim transcriptions, were used to identify embodied trauma awareness before, during, and after periods of silence.Results: The de-colonial, feminist framing for community centred ITIC enhanced participant-specific embodied awareness, establishing a safe space for self-reflection. Contextual sensitivity and careful attention to the therapeutic environment were paramount. The facilitation of non-verbal expression empowered participants to explore alternatives to normative, essentialist and religious narratives that often stigmatise trauma responses. This approach enabled participants to reclaim a sense of agency, improving self-regulation and self-care.Conclusion: This study highlights the potential of integrative silence in community based therapeutic contexts. Future research could explore the role of integrative silence in treating various forms of trauma in different cultural and geographic settings and its integration with other therapeutic modalities to enhance culturally sensitive mental health care.

ABSTRACTBackground: Childhood adversity and trauma have been linked to altered thyroid function and hypothyroidism, yet few randomised controlled trials (RCTs) have examined the effectiveness of trauma-focused psychological interventions in patients with Hashimoto's thyroiditis (HT).Objective: This study aimed to evaluate the effectiveness of Identity-Oriented Psychotrauma Therapy (IOPT) in adults with HT, focusing on both immunological and psychological outcomes.Method: This parallel-group RCT randomised 70 adults with HT (93.94% women; age 25-57) to receive treatment as usual (TAU) or TAU plus IOPT. The intervention comprised 10 bimonthly group sessions, one session every two weeks. Outcomes included thyroid peroxidase (TPO-ab) and thyroglobulin (TG-ab) antibodies, along with depression, anxiety, stress, dissociation, alexithymia, and anger, assessed at baseline, post-treatment, and 3-month follow-up. A series of 2-way mixed-model ANOVAs and Bonferroni-corrected post-hoc tests were used. Missing data due to attrition - particularly in the control group (37%) - were addressed via multiple imputation, and sensitivity analyses were conducted to test robustness.Results: Initial analyses suggested that IOPT significantly reduced TPO-ab levels compared to TAU (p < .001), with effects maintained at follow-up (p = .01); however, these effects were not replicated in complete case analysis. IOPT led to significant improvements in dissociation (p = .03), alexithymia (p < .001), depression (p < .001), anxiety (p < .001), stress (p = .015), state anger (p = .009), anger-in (p = .009), and quality of life (p = .042) at follow-up.Conclusion: These preliminary findings suggest that IOPT, when added to standard medical care, may offer psychological benefits for HT patients and could potentially influence immunological outcomes. However, given the attrition-related sensitivity of some results, further replication in larger, well-retained samples is necessary before drawing definitive conclusions.Trial registration: ClinicalTrials.gov identifier: NCT04600349.

Background: PTSD is disproportionately prevalent among immigrants in Sweden, yet access to evidence-based treatments remains limited, especially for those facing language barriers. Internet-delivered prolonged exposure (I-PE) may help overcome these challenges, but its feasibility and effectiveness in diverse populations remain underexplored.Objective: This study evaluated the feasibility, acceptability, and preliminary effects of a culturally inclusive, therapist-guided I-PE programme in easy-to-read English for immigrants with PTSD.Method: A nested pilot study within an ongoing RCT randomised 30 participants to I-PE or a waitlist control. The intervention incorporated simplified language, diverse visual representations, and a user-friendly platform. Feasibility outcomes included recruitment, adherence, and retention. Acceptability was assessed through satisfaction, adverse effects, and cultural appropriateness, while preliminary efficacy was evaluated via PTSD symptom severity and secondary measures of depression.Results: Recruitment was completed in six weeks, with moderate to high retention. Adherence was strong, with 63% completing at least five I-PE modules. Participants rated the intervention as highly acceptable, with no major cultural barriers. The easy-to-read English format was well received, with no reported linguistic accessibility issues. No serious adverse events were reported. PTSD symptoms significantly decreased in the I-PE group (Cohen's d = 1.45; p < .001), with moderate reductions in depression (Cohen's d = .80; p < .01).Conclusions: The findings support the feasibility and acceptability of a culturally inclusive, therapist-guided I-PE programme for PTSD among immigrants. The participants perceived the I-PE as helpful, trustworthy, and easy to use, with no suggestions for further cultural modifications or reports of cultural inappropriateness. However, the sample's relatively high English proficiency and education may limit generalizability to other groups who have migrated to Sweden. A full-scale randomised controlled trial is needed to assess clinical and cost-effectiveness, as well as implementation across more diverse immigrant populations.Trial registration: ClinicalTrials.gov identifier: NCT06193161..