European Journal of Psychotraumatology最新文献

Background: Network control theory can quantify controllability to evaluate how altered transitions between brain states contribute to cognitive, emotional, and behavioural challenges. Childhood abuse, influenced by genetics, is associated with disrupted network function, though the exact control processes are not yet understood.Objective: This study aims to investigate the association between brain network controllability and childhood abuse experiences, and to elucidate its potential mediating role in the relationship among polygenic risk scores (PRS) for childhood abuse, childhood abuse experiences, and adult health outcomes.Methods: This study measured the controllability of functional brain networks, including both average and modal controllability, in a cohort of 214 young adults with varied histories of childhood abuse. Participants also completed psychological assessments, whole-exome sequencing, and the calculation of PRS for childhood abuse. This study investigate the association between brain network controllability and childhood abuse. Furthermore, a mediation model was performed to explore the potential mediating role of brain network controllability in the relationship between genetic risk, childhood abuse experiences, and adult health outcomes.Results: The controllability of the dorsal attention and sensorimotor networks, as well as the controllability of key ROIs within the sensorimotor, default mode, dorsal attention, visual, and control networks, demonstrated significant correlations with abuse scores. Despite no direct correlation between PRS and self-reported childhood abuse, indirect effects through the controllability of visual and control network regions were identified. The controllability of the left postcentral gyrus in the dorsal attention network mediated the relationship between childhood abuse and adult anxiety.Conclusions: This study reveals that brain network controllability is a pivotal factor, not only bridging PRS and childhood abuse but also serving as a potential mediator between childhood trauma and adult anxiety, offering a new perspective on the neurobiology of childhood abuse-related psychopathology.

Background: This study investigates the psychological underpinnings of chronic pain conditions, specifically fibromyalgia, chronic headache, vulvodynia, and mixed condition (consisting of fibromyalgia in comorbidity with chronic headache and/or vulvodynia), with a focus on nociplastic pain mechanisms.Objective: The aim of the study is to better understand the psychological functioning of women with different chronic pain conditions to identify and discuss similarities and differences. In particular, we aim to explore any significant differences in the domain of traumatic experiences, in global defensive functioning, and in the domain of alexithymia among the evaluated groups. Further, the 4 groups with chronic pain will be compared with a healthy control group.Methods: A sample of 1006 Italian women diagnosed with chronic pain participated in the study, categorized into four clinical groups and a healthy control group. Measures were assessed using self-report measures, in particular: Traumatic Experiences Checklist, Defense Mechanism Rating Scales, and Toronto Alexithymia Scale.Results: There are significant differences among groups, with mixed conditions exhibiting the highest levels of traumatic experiences, particularly emotional neglect and physical threats. Fibromyalgia and mixed condition groups displayed greater reliance on neurotic defense mechanisms. Additionally, fibromyalgia and mixed condition participants exhibited higher levels of alexithymia, indicating difficulties in emotional processing.Conclusions: These findings underscore the complex interplay between psychological factors and nociplastic pain conditions, emphasizing the importance of personalized psychological interventions in managing nociplastic pain. The study highlights the need for multidisciplinary approaches to nociplastic pain treatment, considering the diverse psychological profiles of affected individuals.

Background: Burnout and secondary traumatic stress (STS) are common among therapists working with trauma-exposed clients, which can negatively impact them professionally and personally. The shared trauma of war exposure may put therapists at greater risk. To help support their wellbeing, an eight-session course was offered to Ukrainian therapists following training in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). This course involves therapists personally utilizing the PRACTICE skills taught to clients in TF-CBT for professional and personal benefit.Objective: The objective was to gather preliminary evidence on the potential impact of implementing the course with Ukrainian therapists providing TF-CBT during a period of war in Ukraine. Specifically, this study examined if course participation was associated with increased PRACTICE coping skills usage, decreased burnout and STS, increased feelings of TF-CBT competency/confidence, and increased empathy for clients' experiences when implementing the skills.Method: The eight-session virtual course included cultural adaptations to increase its compatibility with Ukrainian culture. Thirteen matched pre-post course surveys were analysed to provide preliminary data on the course's effect on PRACTICE coping skills usage, burnout, and STS. The course's impact on therapist coping/wellbeing, TF-CBT competency/confidence, and empathy for clients was also examined qualitatively.Results: PRACTICE coping skills were utilized significantly more frequently at post-course compared to pre-course (p = .010). Therapists also reported lower average scores for burnout and STS after course completion, though these changes were not statistically significant. Most participants (92.3%) reported professional benefits from course participation including increased competency/confidence and empathy for clients. All therapists (100%) reported personal benefits from course participation including increased use of coping skills.Conclusions: Results indicate that participants experienced professional and personal benefits from course completion. This study provides helpful preliminary evidence of a positive impact, however, given the small sample size, larger scale implementation is needed.

Background: Women report higher rates of trauma-related disorders compared to men. With women being disproportionately impacted by the consequences of natural hazards, this gender disparity may increase in their aftermath.Objective: This meta-analysis aimed at quantifying gender gaps in mental disorder prevalence following natural hazards, considering both the recent and long-term aftermath of natural hazards, the developmental status of affected countries, and type of hazard.Method: A systematic search was conducted in MEDLINE, PsycINFO, and Web of Science in February 2024. Random effects models were used to calculate odds ratios (OR) based on point prevalences. OR adjusted for covariates were also descriptively reported.Results: In total, 141 reports (N = 3,726,153 independent participants) were included. The prevalence for posttraumatic stress disorder (PTSD), major depression (MD), and generalized anxiety disorder (GAD) within the first year after the hazard were 24.95%, 8.11%, and 14.24%, respectively. More than one-year post-natural hazard the prevalence for PTSD and MD were 22.89% and 13.51%, respectively. Women had significantly higher odds for PTSD (OR = 1.85) and MD (OR = 1.52) within the first year after the hazard, as well as in later assessments (OR = 1.83 for PTSD, OR = 1.41 for MD). Only four studies reported on GAD gender differences in the recent aftermath of natural hazards, resulting in a non-significant OR of 1.85. Subgroup analyses indicated no differences between developmental status of affected countries and adjusted OR showed no systematic variations upon the inclusion of covariates. Gender differences were larger in the aftermath of earthquakes.Conclusions: Significant gender differences for mental disorders following natural hazards exist, although these differences appear similar to other contexts. Gender-sensitive disaster response plans for mental health are essential.

Background: Armed conflicts continue to inflict profound human suffering, dismantling health systems, displacing populations, and leaving lasting psychological scars. Although war is rooted in political and geopolitical dynamics, its consequences manifest daily in the clinical and ethical dilemmas faced by health professionals.Objective: This editorial calls for a greater ethical and professional commitment from mental health professionals - particularly those in safer contexts - to address the psychological, systemic, and societal impacts of war.Method: Drawing from current evidence in traumatic stress, humanitarian law, and global health, we examine the multilayered consequences of armed conflict, including PTSD, depression, grief, and intergenerational trauma. We reflect on the responsibilities of trauma specialists in times of political violence and mass displacement.Results: The psychological toll of war is amplified by the collapse of support systems, obstruction of care, and direct targeting of healthcare workers. Mental health professionals possess unique expertise not only in treatment, but also in advocacy, education, and testimony. However, trauma care often remains confined to clinical settings, disconnected from policy and public discourse. This editorial emphasises that silence - particularly from those in positions of relative safety - is not neutral, but complicit.Conclusions: There is a professional and ethical imperative for trauma specialists to move beyond the treatment room. This includes amplifying the voices of affected communities, informing policy with trauma-informed evidence, and confronting the systemic injustices that perpetuate violence. Upholding the core values of care, dignity, and justice requires a broader, more engaged response: not only to the aftermath of trauma, but to the structures that produce and sustain it.

Background: On 7 October 2023, Israel suffered a massive deadly terror attack with 1400 civilians murdered and 240 kidnapped. Recent studies have documented an increase in depression, anxiety, and posttraumatic symptoms in the aftermath of the attack. In the area of trauma, it has been shown that while some individuals are vulnerable to developing psychopathology following exposure to a traumatic event, the majority are not.Objective: In the present prospective study, we examined the contributions of internal (self-compassion and self-coldness) and external (social support) resources to depression, anxiety, and posttraumatic symptoms among civilians following a massive terror attack.Method: A total of 250 participants - 126 females (50.4%) and 124 males (49.6%); 156 Jews (62.4%) and 94 Arabs (37.6%) - aged 21-60 (M  = 41.7, SD = 10.63) completed questionnaires at two time points: T1 was in September 2023 (3-4 weeks before the attack) and T2 was in February-March 2024 (19-20 weeks after the attack). Participants were assessed using the Multidimensional Scale of Perceived Social Support (MSPSS), Self-Compassion Scale - Short Form (SCS-SF), Depression, Anxiety, and Stress Scale-21 Items (DASS-21), and International Trauma Questionnaire (ITQ).Results: Self-compassion and social support were negatively associated with depression and anxiety, while self-coldness was positively associated with depression and anxiety. In addition, self-coldness uniquely contributed to the prediction of psychopathological outcomes, including the sense of threat symptoms cluster of posttraumatic stress disorder, beyond known risk factors.Conclusions: Our study highlights the role of self-coldness as a vulnerability factor for civilians following a terror attack. It is important to view the distinct facets of self-compassion as a therapeutic target when building both intervention and prevention programs for people exposed directly and indirectly to trauma.

Background: Participating in long-term protests against government actions can affect protesters' mental health and expose protesters to potentially morally injurious events (PMIEs), such as the betrayal by leaders they once trusted. This study aimed to shed light on the potential psychological buffers against the deleterious effects of exposure to PMIEs of betrayal among protesters and to examine the moderating role of belongingness in the relationships between protesters' exposure to PMIEs and stress, PTSD and depression levels.Method: The study sample comprised 4036 Israeli protesters (M_age= 54.27, SD = 12.45; 75.6% females) who took part in the unfolding civil protest movement against the government-led judicial and constitutional overhaul between January 2023 and August 2023. Protesters completed validated self-report questionnaires that included measures of PMIEs, stress, depressive and PTSD symptoms (PTSS).Results: Beyond demographic and protest-related characteristics, exposure to PMIEs of betrayal was found to contribute to both PTSD and depression levels. The indirect effects of PMIE-betrayal on PTSS/depressive symptoms through stress levels were significant, particularly when belongingness levels were low. Thus, a greater sense of PMIE-betrayal contributes to stress symptoms, which, in turn, is linked to higher levels of PTSS and depressive symptoms for protesters having low levels of belongingness.Conclusions: The study's findings highlight the critical contribution of PMIE-betrayal to both PTSS and depression levels, which were mediated by levels of stress. Moreover, experiencing belongingness moderated these relationships. Clinicians treating protesters coping with PTSS and depressive symptoms should also adopt therapeutic aims of establishing belongingness and social support among the protesters.

Background: Prolonged exposure is widely regarded as a first-line treatment for alleviating symptoms of post-traumatic stress disorder (PTSD); however, it is often associated with high dropout rates and may not always be sufficiently efficacious. Intensified treatment has been suggested as a solution to increase treatment efficacy and reduce dropout rates, but little is known about patients' preferences for this type of treatment.

Objective: To investigate patients' experiences of prolonged exposure delivered in an intensive format (iPE).

Method: Semi-structured interviews were conducted with 12 participants after completion of iPE.

Results: Thematic analysis of the data yielded one overarching theme 'Brutal Yet Worth It,' accompanied by five subthemes: Building Blocks of Commitment, Strength through collective support, Overcoming challenges of the intensive treatment week, Therapeutic gains of the intensive treatment, and Facilitating and Enabling Treatment Progress. The participants described short-term discomfort and demands, contrasted with the recognition of substantial benefits that extended beyond PTSD symptom reduction. The interplay of individual attributes and experience of social support emerged as crucial factors shaping the experience.

Conclusions: Participants described the iPE experience as intense and demanding, yet transformative and worthwhile in the interviews. These findings highlight the complex and multifaceted experiences of patients undergoing PE delivered in an intensive format. The findings could offer valuable insights for designing more well-received PTSD treatments, leading to enhancements in the overall quality of intensified treatment approaches.

Introduction: Trauma-focused therapy (TFT) is highly effective in posttraumatic stress disorder (PTSD). However, there is some evidence that TFT is less effective in specific groups, such as veterans and people with comorbid personality disorders, emotion regulation problems or substance use disorders.Aim: In this pre-post pilot study, we investigated feasibility and effectiveness of a 12-week veteran intensive treatment consisting of integrated Dialectical Behavior Therapy (DBT) and TFT, in Dutch veterans with PTSD, comorbid emotion regulation and/or substance use problems.Results: Self-reported PTSD symptoms (PCL-5) showed a statistically significant decrease from pre- to posttreatment, with a large effect size (Cohen's d = 2.92), as well as general psychiatric symptoms (OQ-45, Cohen's d = 1.85). Self-efficacy (Dutch SES) significantly increased with a medium effect size (Cohen's d = 0.80). Reduction of total score of borderline personality symptoms (PAI-BOR) did not reach statistical significance, although its subscale affective instability showed a statistically significant medium decrease (Cohen's d = 0.59). Feasibility of implementation of the treatment programme was sufficiently good, with a response rate on posttreatment measurements of 66% and 50% at 6 and 10 weeks respectively. Patients who did not completed the posttreatment measurements did not significantly differ on primary and secondary outcome measures from completers.Conclusion: Feasibility and preliminary results from the 12-week DBT-based veteran intensive treatment programme are positive. This provides hope and opportunity for this patient group with a generally less positive response to regular evidence-based PTSD treatments.

Moral injury is the persistent mental or emotional distress resulting from events that challenge one's moral beliefs. It is characterised by intense shame, guilt, worthlessness, disgust or anger and can contribute towards the development of serious mental disorders. The nature of working in prisons means that staff often face physically and psychologically challenging scenarios, and prison staff report high rates of mental ill-health and suicidal thoughts. Equally, detainees may be especially vulnerable to moral injury-related mental health difficulties having engaged in illicit actions and been found guilty by a jury of their peers as well as, in high profile cases, the court of public opinion. Despite this, there is an evidence gap about the extent of moral injury in both prison staff and detainee populations, and about how prison staff/detainees can be better supported. How struggling with moral injury may be linked to reoffending amongst detainees and burnout or resignations in prisons staff is currently unknown. In resource strapped prison settings, emerging treatments for moral injury-related mental health difficulties are unlikely to be appropriate or feasible. In this article, we highlight the contexts in which moral injury may arise; the unique challenges to treatment and support for moral injury in prison settings; and offer targeted recommendations for future research and clinical practice.