Journal of traumatic stress最新文献

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals experience elevated rates of trauma exposure, minority stress, and posttraumatic stress disorder (PTSD). Yet, research examining how geographic location and LGBTQ+ identity shape PTSD outcomes is scant, particularly studies considering structural facilitators and barriers, such as health care access. This cross-sectional, secondary study investigated associations between several individual- and structural-level factors and PTSD symptoms in LGBTQ+ adults (N = 131) recruited from urban and rural U.S. regions, most of whom identified as non-Hispanic White, bisexual, cisgender women. Analyses examined whether intersecting demographic characteristics, urban or rural location, perceived health care access, LGBTQ+ identity disclosure to providers, and experiences of LGBTQ+ discrimination were associated with PTSD symptom severity and probable PTSD diagnosis. Approximately 62% of participants reported experiencing a DSM-5 Criterion A traumatic event; of these individuals, 24.4% met the criteria for probable PTSD. General health care access, β = -.27, 95% CI [-.45, -.09], p = .003, and LGBTQ+ identity disclosure, β = -.19, 95% CI [-.31, -.07], p = .039, were significantly associated with PTSD symptom severity. Higher health care access was associated with 50.0% lower odds of probable PTSD, OR_adj = 0.50, 95% CI [0.29, 0.84], p = .009. Bisexual cisgender women had 4-times higher odds of a probable PTSD diagnosis compared to LGQ+ participants, OR_adj = 3.96, 95% CI [1.15, 13.7], p = .030. Improving access to health care and supporting identity disclosure may reduce PTSD risk among LGBTQ+ adults, especially for bisexual cisgender women and rurally situated individuals.

Transgender and nonbinary (TNB) individuals experience high rates of relational trauma from parental figures, yet their pathways to healing remain underexplored. This qualitative study used constructivist grounded theory to develop a theoretical framework of how TNB adults heal from parental relational trauma. In-depth interviews with 15 racially and socioeconomically diverse U.S.-based TNB adults who experienced parental relational trauma generated the core phenomenon: "TNB identity and experiences initiate and sustain pathways of healing from parental relational trauma." This captures that rather than being a source of this trauma, recognizing and actualizing one's TNB identity is the central catalyst for healing from it. The healing process began with three conditions: (a) connecting with one's TNB identity/self, (b) gaining new clarity in parental harm through TNB-related parental harm, and (c) experiencing joy and oppression as TNB while lacking parental support. These conditions gave rise to strategies including (d) creating safer homes through queer/TNB chosen family, (e) committing to individual healing through therapy, and (f) reimagining life through ongoing actualization as TNB. The consequences of these strategies, in turn, created conditions that enabled subsequent strategies, including (g) attempting repair and intergenerational work with families of origin, (h) distancing as self-preservation, and (i) returning to TNB communities to sustain healing across generations. The consequences of these processes included personal, intergenerational, and collective healing. The study offers implications for research, clinical practice, and advocacy, calling for approaches that frame TNB identity not as a source of familial conflict but as a central resource for recovery.

Refugees of war are at high risk of exposure to war-related potentially traumatic events (PTEs) and the development of posttraumatic stress disorder (PTSD). The stress sensitization hypothesis posits that adverse childhood experiences (ACEs) can sensitize individuals to the stress of PTEs in adulthood. This study examined how ACEs might sensitize refugees to war exposure in a sample of 3,486 Ukrainian refugees. We identified four latent classes of ACEs: low exposure (57.4%), household dysfunction (21.5%), maltreatment (16.7%), and high exposure (4.4%). These classes were used in a logistic regression model to test for associations with PTSD, and an ACE Class x War Exposure interaction term was used to test for stress sensitization. Female gender, odds ratio (OR) = 1.99, 95% confidence interval (CI) [1.58, 2.49]; war exposure, OR = 1.55, 95% CI [1.30, 1.83]; and all ACE classes, ORs = 1.14-2.84, were significantly associated with PTSD, whereas we found no effects of stress sensitization. The lack of stress sensitization effects in our analysis might have been caused by uniformly high stress levels in this refugee sample, as well as the broadly defined war exposure measure we used. Future research should aim to assess whether certain types or intensities of exposure better reveal sensitization effects.

Trauma exposure can lead to posttraumatic stress disorder (PTSD), a condition with significant individual and societal costs. Yet, access to evidence-based PTSD treatment, such as cognitive processing therapy (CPT), remains limited. Delivering CPT on an accelerated (i.e., massed) schedule via telehealth could increase access while preserving effectiveness. This study aimed to evaluate changes in PTSD, anxiety, and depressive symptoms over the course of virtual massed CPT delivered by a commercial virtual trauma clinic. The sample included adult patients with clinician‑diagnosed PTSD who completed 3 or more telehealth CPT sessions per week. PTSD, anxiety, and depressive symptoms were assessed at intake, discharge, and 30 and 90 days postdischarge. Paired t tests compared symptoms from intake to discharge; linear mixed‑effects models examined symptom trajectories over time. Analyses included 148 patients. Large effect sizes were observed for improvements in PTSD (ΔM = 39.00), d = 2.94; anxiety (ΔM = 8.90), d = 1.79; and depressive symptoms (ΔM = 8.23), d = 1.49, from intake to discharge. Symptom improvements for PTSD and depression were maintained at 30 and 90 days, whereas anxiety remained significantly improved from baseline at both time points but showed modest rebound between 30 and 90 days. Virtual massed CPT produced rapid, very large, and durable reductions in PTSD, depression, and anxiety. These findings support virtual massed CPT as a feasible option to expand access to evidence‑based PTSD care in community settings.

Clinical treatment guidelines consistently recommend cognitive processing therapy (CPT), prolonged exposure (PE), and eye movement desensitization and reprocessing (EMDR) for posttraumatic stress disorder (PTSD). The efficacy of these interventions among sexual- and/or gender-minoritized (SGM) individuals has not been thoroughly investigated within randomized clinical trials (RCTs), despite known elevations in exposure to potentially traumatic events and PTSD symptoms relative to cisgender heterosexual individuals. We conducted a systematic literature review to examine the frequency with which SGM adults were enrolled in RCTs of CPT, PE, and EMDR and investigate these interventions' efficacy in reducing PTSD symptoms among SGM adults. We searched eight databases to identify RCTs published before August 7, 2025. The inclusion criteria were: written in English; RCT investigating the impact of CPT, PE, or EMDR on PTSD symptoms; utilized a standardized PTSD measure; reported PTSD outcome data; and enrolled individuals who were at least 18 years old. Literature reviews, case studies, protocols, and non-peer reviewed articles were excluded. Our search returned 1,821 unique records, with 519 meeting all eligibility criteria. Ten records reported sexual orientation and gender identity (SOGI) information and enrolled at least one SGM individual. Among studies that reported SOGI information, 12.1% and 2.2% of participants identified as sexual- and gender-minoritized, respectively. Results highlight that SOGI information is underreported in PTSD treatment research, posing significant challenges in determining the relative efficacy of these treatments and the extent to which SGM-affirmative adaptations are necessary. We offer recommendations for clinicians and researchers, including consistent reporting of full SOGI data.

Posttraumatic stress disorder (PTSD) is a disruptive, multifaceted disorder with an estimated lifetime prevalence of 8.3% in the U.S. population. Yoga has been shown to reduce PTSD symptoms overall, though little is known about its efficacy relative to specific PTSD symptom clusters. In this systematic review and meta-analysis, we examined the associations between yoga and symptom change in each DSM-5 PTSD symptom cluster. We hypothesized that yoga participation would be associated with significant reductions in each cluster, particularly alterations in arousal and reactivity/hyperarousal (AAR/H), relative to controls. We searched PubMed, PsycInfo, CINAHL, and SPORTDiscus for eligible studies published through October 2025. Studies that were yoga intervention randomized controlled trials, enrolled trauma survivors, and reported PTSD subscale scores were included. We computed standardized mean difference scores and used an NIH tool to assess risk of bias. In direct models (k = 9 studies), yoga led to small-medium reductions in intrusions, d = -0.31, p = .027, and total PTSD symptoms, d = -0.29, p = .030. When including age as a moderator, yoga also improved avoidance, d = -2.28, p = .003, and AAR/H symptoms, d = -1.92, p = .007. There was a substantial risk of bias across studies. Yoga showed the most robust effects for reducing intrusions and total PTSD symptoms, with efficacy in reducing avoidance and AAR/H symptoms when age was added as a moderator. Yoga's emphasis on mindfulness in the present moment may allow for attentional awareness that is protective against intrusions.

Research has shown that better recall for treatment information is related to improved adherence and outcomes in psychotherapy. There has been minimal research on whether patients are able to recall information about posttraumatic stress disorder (PTSD) treatment options. To address this gap, participants who screened positive for PTSD (N = 887) were provided with descriptions of seven treatment options and asked to recall each treatment's effectiveness and whether it was a trauma-focused talk therapy. Participants were also randomly assigned a treatment and asked to write a brief description of the treatment as if they were describing it to a loved one. Correlates of recall (educational attainment level, numeracy) were also assessed. The results revealed that recall for treatment effectiveness was under 50%. Participants' ability to accurately identify trauma-focused talk therapy was under 75%. Only 31.8% of participants described their assigned treatment accurately. These findings suggest that patients retain little information about treatment options and underscore the importance of using strategies to enhance patients' memory during psychoeducation and treatment planning.

Childhood trauma, defined as violence against individuals under 18 years of age, affects 1,000,000,000 children globally, with neglect being the most common form. Such trauma is linked to various mental health issues and poor emotional regulation. This study aimed to validate the Childhood Trauma Screener (CTS) in a sample of Romanian children, adolescents, and college students, utilizing data from two separate samples: 1,221 first-year college students and 216 children and adolescents aged 8-16 years. We assessed validity using bivariate correlations, reliability using Cronbach's alpha (.63-.75), and structure using confirmatory factor analyses. In the college student sample, higher childhood trauma scores were associated with lower self-compassion, rs = -.24--.29, p < .001, and reappraisal use, rs = -.10--.22, p < .001; higher suppression use for exposure to neglect, r = .16, p < .001, and overall trauma, r = -.11, p < .001; and more mental health difficulties, rs = .29-.31, p < .001. In the child and adolescent sample, higher childhood trauma scores were associated with increased emotional and behavioral difficulties, rs = .28-.45, p < .001, and poorer emotion regulation abilities, particularly lower emotion control and reduced emotional self-awareness, rs = .16-.43, p < .001. The results from both samples supported a two-factor model of abuse and neglect.

The application of machine learning algorithms to daily diary data represents a valuable tool for improving dynamic prediction of posttraumatic stress disorder (PTSD) symptom escalations. This prospective, intensive longitudinal study aimed to evaluate whether combining baseline (static) and daily diary (dynamic) predictors with machine learning can help forecast clinically significant PTSD symptom increases among veterans. Participants were 74 recently discharged U.S. veterans (M_age = 33.5 years) who completed twice-daily diary surveys for up to 87 days via a mobile app, yielding 4,307 diary days. The outcome was a binary indicator of clinically significant daily PTSD symptom increase (> 1.0 standard deviation above a participant's individual mean over the first 2 study weeks). Random forest models identified top predictors; LASSO regression estimated effect sizes among top predictors. Daily negative affect was the top predictive variable, OR = 1.33, retained in 100% of LASSO iterations. Daily depressed mood, OR = 1.35; anxious mood, OR = 1.15; and perceived stress, OR = 1.13, were also reliably retained. Variables involving alcohol, cannabis use, and baseline impulsivity were less robust but remained prominent predictors of PTSD symptom escalations. Post hoc interaction analyses showed that co-occurring high negative affect and anxiety yielded a > 55% probability of PTSD symptom escalation. The findings show that daily affective states, especially negative mood and stress, strongly predict PTSD symptom increases in veterans. Using machine learning and high-frequency tracking, advances in personalized, real-time PTSD care are possible. Findings support just-in-time interventions for when veterans need help most: in the moment.

Posttraumatic stress disorder (PTSD) symptoms and alcohol use frequently co-occur and are mutually reinforcing. Few studies have examined how changes in PTSD severity influence subsequent changes in alcohol use, particularly in the context of comorbidity treatments. This secondary analysis utilized data from a clinical trial comparing 12 weeks of Seeking Safety plus sertraline (SS+S) versus Seeking Safety plus placebo (SS+P) among individuals (N = 69) with co-occurring PTSD and alcohol use disorder. A mediational analysis, using a latent growth modeling framework from five points throughout treatment, was conducted to examine whether reductions in alcohol use were mediated by treatment-led (SS+S vs. SS+P) reductions in PTSD severity. Results revealed a nonsignificant treatment effect on PTSD severity reductions over time, Est. = -0.440. The link between PTSD severity reductions and reductions in alcohol use was significant, Est. = 0.644. Despite the nonsignificant path between treatment group and PTSD severity (and in the presence of bias correction for small sample size), the formal test of mediation was significant such that for participants in the SS+S group, alcohol use reductions were fully mediated by reductions in PTSD severity, Est. = -0.283. These findings suggest one of the mechanisms through which SS+S exerts its effects on alcohol use is through reductions in PTSD severity. Clinicians working within the SS treatment platform may consider augmenting their treatment plan with sertraline in collaboration with clients. Future research is necessary to understand how medication and behavioral therapies synergize over a treatment course to improve PTSD and alcohol use.