Journal of traumatic stress最新文献

Social support is protective in the recovery from mental health diagnoses. However, well-intended support can also interfere with treatment, as in the case of accommodation, when a support person changes their behaviors to alleviate a patient's distress. This paper describes a scoping review of the research literature regarding posttraumatic stress symptoms (PTSS) and accommodation, conducted using the Preferred Reporting Items extension for Scoping Review Guidelines (PRISMA-ScR). A total of 26 articles were included in the review. Designs and settings were mixed, but most studies examined accommodation by female adult intimate partners of male military members, veterans, and first responders with PTSS. Most participants were White. Accommodation was typically associated with negative relationship outcomes, and some couples treatments (e.g., cognitive behavioral conjoint therapy interventions) were associated with improvements in PTSS accommodation. Future work on PTSS accommodation should prioritize recruiting more diverse participants (i.e., gender, race, ethnicity, military status, types of support people). In addition, researchers should continue to examine accommodation as a mediator or moderator variable. Further examination of accommodation and PTSS may provide helpful insights into the involvement of support people in treatment to increase treatment effectiveness.

Few studies have considered the influence of cultural factors on the associations between posttraumatic stress disorder (PTSD) and key emotion regulation strategies, such as expressive suppression and reappraisal. This study investigated the influences of cultural background and self-construal orientation on PTSD symptoms and both suppression and reappraisal. Chinese Australian (n = 129) and European Australian (n = 140) trauma survivors completed an online survey assessing suppression and reappraisal (Emotion Regulation Questionnaire), cultural values (Self Construal Scale), and PTSD symptoms (PTSD Checklist for DSM-5). We hypothesized that participants in the Chinese Australian group would report higher levels of suppression and reappraisal than those in the European Australian group and that self-construal and cultural group would moderate both the associations between PTSD symptoms and both suppression reappraisal. Correlation and moderation analyses were performed to examine these hypotheses. Chinese Australian participants reported higher levels of reappraisal than European Australian participants, η_p ² = .05, p < .001. Regardless of cultural group, there was no significant association between reappraisal and PTSD symptoms, B = 0.10, p = .849, 95% CI [-0.93,1.13]. Cultural group and self-construal moderated the association between suppression and PTSD symptoms, ΔR² = .02, p = .007, whereas a positive association was observed between suppression and PTSD symptoms; however, this association was not significant for Chinese Australians who endorsed higher levels of interdependence. These findings suggest that suppression may be less strongly associated with PTSD symptoms for Chinese Australians who value interdependence. This finding highlights the importance of considering cultural values in PTSD treatment approaches.

Negative mental health outcomes are prevalent among veterans exposed to military-related stressors and are associated with social isolation. Limited research exists on resilience following military separation and its impact on social isolation in veterans. We examined resilience against military-related stressors and 2-year longitudinal associations with social isolation indicators; gender differences were also explored. U.S. military veterans (N = 351, 70.4% men) who deployed to the wars in and around Iraq and Afghanistan following the September 11, 2001, terrorist attacks (9/11) were recruited as part of a longitudinal assessment study examining predictors of postdeployment adjustment. Using a residualization approach, resilience was approximated as low stressor reactivity (SR), calculated by regressing mental health onto military-related stressor exposure. Military-related stressors were significantly associated with posttraumatic stress disorder (PTSD) related to both events during post-9/11 deployment (deployment event) and outside of post-9/11 deployment (other event), functional disability, and depression. After correcting for multiple comparisons, only SR derived from depressive symptoms predicted more closeness difficulties in social relationships longitudinally, B = 0.50, q = .023. Women also demonstrated higher SR than men regarding other event-related PTSD symptoms, B = -0.52, q < .001; functional disability, B = -0.28, q = .028; and depression, B = -0.34, q = .012. Results suggest that veterans with higher depressogenic reactivity to military-related stressors were more likely to endorse discomfort with closeness than those with lower depressogenic reactivity. Women veterans may also be more impacted by nondeployment traumatic distress, psychosocial dysfunction, and depression in response to military-related stressors.

Given their sudden onset and life-threatening consequences, strokes and transient ischemic attacks (TIAs) can trigger posttraumatic stress disorder (PTSD). To gain a deeper understanding of the potential influence of factors in patients' descriptions of these medical events on PTSD, we conducted a standardized trauma interview with a convenience sample of patients hospitalized for suspected stroke/TIA (N = 98) to assess the details and emotional experience of the stroke/TIA event. Three researchers reviewed the interviews and the research literature on risk and protective factors for PTSD. From this analysis, a codebook with descriptions, examples, and scoring protocols for eight Likert scale, two categorical, and four binary codes was developed. Upon demonstrating sufficient interrater reliability, the research team scored all narratives. Three superordinate themes were identified in the analysis: distress (e.g., fear, helplessness), potential protective factors (e.g., positive expectancies, concern for loved ones), and level of detail (e.g., somatic detail, emotional detail). Differences in perceptions, themes, and expectations emerged in the narratives, indicating a wide range of responses following stroke/TIA. Additionally, patient age was negatively correlated with scores for the fear, r = -.34, p < .001, and negative consequences, r = -.24, p = .018, codes and positively associated with the likelihood of having positive expectancies, OR = 1.05, 95% CI [1.00, 1.10], p = .039. These findings provide a more comprehensive understanding of how patients reflect on their experiences post-stroke/TIA and can inform future research on the contributions of trauma narrative characteristics and emotional responses to PTSD risk.

Posttraumatic stress disorder (PTSD) often occurs following mass casualty events, yet the connection between the number of individuals injured in an event and PTSD risk in smaller-scale events (i.e., involving one or several injured persons) remains unclear. We conducted a registries-based study cross-referencing three databases across the continuum of care for military trauma patients hospitalized for traumatic injuries. The study population was categorized into three groups based on the number of injured individuals involved (i.e., single injured person, two to four [2-4] injured people, and five or more [≥ 5] injured people), and PTSD prevalence was assessed using long-term disability claim diagnoses. Overall, 4,030 military personnel were included (age at injury: Mdn = 20 years), and 18.3% were subsequently diagnosed with PTSD, with the highest prevalence in events involving ≥ 5 injured individuals (35.8%). Regression analyses adjusted for potential confounders revealed that being injured in an event with 2-4 injured persons, OR = 1.68, 95% CI [1.31, 2.15], or ≥ 5 injured persons, OR = 2.36, 95% CI [1.79, 3.13], was associated with increased odds of developing PTSD compared to being the sole injured person. The findings suggest a direct association between the number of injured individuals in an event and PTSD prevalence among traumatic injury survivors. The results underscore the importance of early diagnosis and interventions to prevent PTSD in individuals injured in multicasualty and mass casualty events.

Cognitive processing therapy (CPT) is a well-known trauma-focused treatment that aims to generate more adaptive posttrauma cognitions and emotions. Changes in cognitions are theorized to be the mechanism by which CPT leads to improvement in posttraumatic stress disorder (PTSD) symptoms. The present study aimed to explore associations between changes in PTSD symptom clusters during CPT. We hypothesized that early changes in negative alterations in cognitions and mood (NACM) would correlate with later changes in other symptom clusters. Data were collected from 296 veterans participating a 7-week PTSD residential treatment program at a U.S. Veterans Affairs medical center. PTSD symptoms were assessed at pretreatment (Week 1), midtreatment (Week 4), and posttreatment (Week 7). Cross-lagged path analyses demonstrated that pretreatment-to-midtreatment improvement in NACM was correlated with midtreatment-to-posttreatment improvement in avoidance, β = .52, though this association was bidirectional, suggesting pretreatment-to-midtreatment improvements in either cluster may be correlated with midtreatment-to-posttreatment improvements. Similarly, pretreatment-to-midtreatment improvement in intrusions, β = .40, and arousal, β = .49, were correlated with later improvement in avoidance, suggesting avoidance may improve after improvement in other clusters. Interestingly, pretreatment-to-midtreatment arousal improvement was significantly correlated with midtreatment-to-posttreatment NACM improvement, β = .27, though the reverse was nonsignificant, whereas a bidirectional association between arousal and intrusions emerged, β = .34, β = .53. Early changes in arousal were correlated with later changes in several other symptom clusters, whereas other clusters demonstrated bidirectional associations. These results may inform understanding of symptom improvement timing across CPT, which may aid in treatment selection and planning.

Few studies have examined anger concerns among postpartum women despite their risk of mood dysregulation. This study examined the performance of the Dimensions of Anger Reactions-5 (DAR-5) scale, a brief screen for problematic anger, in a sample of 1,383 postpartum women in Wisconsin who received perinatal home visiting services. We aimed to analyze the discriminant validity and measurement invariance of the DAR-5, the occurrence of problematic anger symptoms and their co-occurrence with mental health concerns, and the association between elevated anger levels and exposure to potentially traumatic events in childhood and adulthood. Descriptive statistics for anger symptoms and their associations with depression, anxiety, and PTSD were calculated. Psychometric properties of the DAR-5 were assessed via confirmatory factor analyses, and associations between trauma exposure and anger were evaluated as bivariate and partial correlations. Approximately 21% of the sample exhibited problematic anger based on an established DAR-5 cutoff score (≥ 12). Anger symptoms co-occurred with posttraumatic stress disorder (PTSD), depressive, and anxiety symptoms, though the DAR-5 sufficiently distinguished anger from these correlated symptom profiles. The DAR-5 also demonstrated acceptable measurement invariance across levels of trauma exposure. Higher levels of trauma exposure in childhood and adulthood significantly increased the risk of problematic anger even after controlling for PTSD, anxiety, and depressive symptoms, partial $\gamma$ _pb range: .07-.16. The findings suggest the DAR-5 is a valid brief screen for anger in postpartum women. Increased attention should be paid to elevated anger and the co-occurrence of other mental health concerns following childbirth.

Prior research has rarely examined how people understand or react to the names of psychological treatments. In the case of evidence-based psychotherapies for posttraumatic stress disorder (PTSD), such reactions may be relevant to the low rates of uptake of such treatments. Participants who screened positive for PTSD (n = 887) completed questions assessing their initial reactions to PTSD treatment names as well as how a different name would affect their openness to treatment. In addition, they gave brief responses to open-ended questions about the reason for their initial reactions, and content analysis was used to better understand these reasons. The results indicated that among the treatment name options, cognitive processing therapy (CPT) and present-centered therapy (PCT) were viewed most positively. Approximately 40% of the sample preferred plain language alternatives for treatment names. Content analyses focused on descriptions of the treatments-which could be accurate or inaccurate-as well as whether respondents evaluated a treatment name itself as positive or negative. Some names conveyed treatments more accurately (e.g., CPT and written exposure therapy) than others (e.g., eye movement desensitization and reprocessing and prolonged exposure [PE]). Some names were also evaluated more positively (e.g., PCT) than others (e.g., PE). The general term "trauma-focused therapy" was seen as positive and clear. Addressing the ways patients react to psychological terms and treatment names could help clarify misperceptions about evidence-based psychotherapies and promote more widespread uptake of effective treatments for PTSD.

Attentional bias and deficits in attentional control are associated with posttraumatic stress disorder (PTSD) symptoms. Attention control training (ACT) may address these factors. We reviewed randomized controlled trials (RCTs) of ACT for PTSD to address unanswered questions about ACT's effectiveness, tolerability, and implementation. Studies were included if they were an RCT that used an adult sample, recruited participants with a PTSD diagnosis, and had ACT as at least one treatment arm. The PTSD Trials Standardized Data Repository (PTSD-Repository) and additional databases were searched to identify PTSD RCTs published through May 2024. Seven studies met the inclusion criteria (N = 407). The effect size for ACT versus a comparison condition on PTSD symptoms was large, but the confidence interval (CI) overlapped with 0, g = 0.75, 95% CI [-0.63, 2.12]. The same pattern was observed for attention bias variability, g = 1.04, 95% CI [-0.90, 2.98]. There was a significant within-group effect of ACT on self-reported PTSD symptoms, g = -1.43, 95% CI [-2.83, -0.03]. Risk of bias varied, with high risk of bias being primarily due to bias in the measurement of the outcome. These effects should be interpreted cautiously given the significant heterogeneity and wide confidence intervals observed. It remains unclear for whom and under what conditions ACT may be most effective. Future studies should move beyond response time measures, employ an inactive comparator, and examine the mechanism of action to determine whether ACT could be a viable intervention for PTSD.

Anger can adversely impact functioning in veterans. Psychological aggression, which is related to but distinct from anger, is particularly detrimental to veterans' mental health. Research examining anger and psychological aggression following individual therapy for posttraumatic stress disorder (PTSD) has demonstrated small effect sizes. Treatments that directly target conflict management and interpersonal functioning, both regarding content and delivery to veterans and their loved ones (e.g., couples-based PTSD treatments), may be more effective in alleviating anger symptoms. This study examined whether larger reductions in anger and psychological aggression would be observed in a couples-based intervention compared to an active comparator at posttreatment and follow-up. Data were derived from a randomized trial comparing brief cognitive-behavioral conjoint therapy for PTSD (bCBCT) and PTSD family education (PFE). Participants were 137 veterans and their intimate partners (bCBCT: n = 92, PFE: n = 45). We observed within-condition significant reductions in angry temperament, d = -0.47, p < .001, and angry reaction, d = -0.26, p = .004, among veterans in bCBCT but not PFE, |d|s = 0.13-0.17, ps = .166-.268. Veterans and partners in both conditions reported reductions in psychological aggression, |d|s = 1.09-1.46, ps < .001. There were no significant differences between the treatment conditions on any outcome, ps = .103-.443, and there were no significant changes in anger between posttreatment and follow-up, |d|s = 0.07-0.24, ps = .052-.582. Couples-based interventions for PTSD, including bCBCT and PFE, can be effective in improving aspects of anger among veterans and their intimate partners.