Journal of traumatic stress最新文献

The processing of positive memories technique (PPMT) entails detailed narration and processing of specific positive autobiographical memories (AM) and has shown promise in improving posttraumatic stress disorder (PTSD) symptoms. We examined whether participants receiving PPMT reported decreases in PTSD and depressive symptom severity, negative affect levels/reactivity, posttrauma cognitions, and positive emotion dysregulation, as well as increases in positive affect levels/reactivity and the number of retrieved positive AMs across four PPMT sessions. Individuals (N = 70) recruited from the community completed surveys at baseline (pre-PPMT), each PPMT session, and after completing all four PPMT sessions. Multilevel linear growth models indicated session-to-session decreases in PTSD severity, β = -.17, p < .001; depressive symptom severity, β = -.13, p < .001; negative affect levels, β = -.13, p < .001; positive affect reactivity, β = -.14, p = .014; and posttrauma cognitions, β = -.12, p < .001; and session-to-session increases in negative affect reactivity, β = .18, p = .001. Paired-samples t tests indicated decreases in retrieved positive AMs, d = 0.40, p = .001, including specific positive AMs, and negative AMs, d = 0.23, p = .022, and increases in retrieved overgeneral positive AMs, d = -0.38, p = .002, from baseline to postintervention. Thus, PPMT may help decrease PTSD and depression severity, negative affect, posttrauma cognitions, and negative AM recall tendencies. Clinicians may need to incorporate additional skills into the PPMT framework to improve positive affect processes that can be sustained over time.

Although empirical support for the International Statistical Classification of Diseases and Related Health Problems (11th ed.; ICD-11) distinction between posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) is growing, research into the ICD-11 CPTSD model in prison staff is lacking. This study used latent profile analysis (LPA) to (a) determine if there are distinct groups of trauma-exposed prison governors (i.e., "wardens" in the United States and Canada) who have symptom profiles consistent with the distinction between PTSD and CPTSD and (b) identify predictors and posttraumatic maladaptive beliefs associated with the latent profiles. Trauma-exposed prison governors (N = 385) completed the International Trauma Questionnaire (ITQ) and a measure of traumatic life events. LPA was used to extract profiles using the six ITQ symptom clusters and revealed four profiles: CPTSD (8.4%), PTSD (14.4%), disturbances in self-organization (DSO; 11.0%), and low symptoms (66.3%). Membership in the CPTSD and DSO profiles was associated with cumulative traumatization, odds ratios (OR) = 1.42 and OR = 1.26, respectively, and poorer health, OR = 2.84 and OR = 1.64, respectively, relative to the low symptom profile, and membership in the PTSD profile was associated with younger age, OR = 0.91, relative to the low symptom profile. The CPTSD profile showed the highest level of posttraumatic maladaptive beliefs. This study yields empirical support for the ICD-11 CPTSD model in prison staff. The results provide additional support for the validity of ITQ measurement of PTSD and CPTSD.

Following the death of a loved one, both approach behaviors related to the deceased (i.e., engagement with feelings, memories, and/or reminders of the deceased) and the avoidance of reminders of the death are theorized to precipitate severe and persistent grief reactions, termed prolonged grief. The "approach-avoidance processing hypothesis" holds that these behavioral tendencies occur simultaneously in prolonged grief disorder (PGD). We tested this hypothesis using a novel free-viewing attention task. Bereaved adults (N = 72, 81.9% female) completed a survey assessing prolonged grief symptoms, depressive symptoms, and lingering attachment and a free-viewing task assessing voluntary attention toward pictures of the deceased and combinations of the deceased with loss-related words (i.e., loss-reality reminders). A main finding was that participants with higher prolonged grief symptom levels, ρ(70) = .32, p = .006, and more lingering attachment, ρ(70) = .26, p = .030, showed stronger attentional focus toward pictures of the deceased. No significant association emerged between either prolonged grief symptom levels or lingering attachment and attention toward loss-reality reminders. The findings suggest that higher prolonged grief symptom levels may be characterized by persisting approach tendencies toward the deceased. Countering excessive proximity-seeking to the deceased in therapy could be beneficial for bereaved adults who show severe and persistent grief reactions.

In this paper, I provide a concise overview of the state of the scientific study of moral injury (MI). I argue that the state of science is immature, characterized by the lack of a paradigmatic theory and a lack of rigor in terms of construct definition and measurement. Because researchers, clinicians, and the media reify the results of empirical and clinical outcome studies that are chiefly exploratory and fraught with internal validity problems, enthusiasm about MI continues to far outweigh scientific and actionable, practice-based knowledge. I posit that the field needs to have epistemic humility about MI, focus on building a paradigmatic model to generate and test hypotheses that will ultimately create knowledge about the causes and consequences of MI, and employ evidence-based assessment and intervention approaches to mitigate and treat the problem. To facilitate research in this area, I summarize the social-functional theory of moral behavior and a new theory of MI based on it. I also make recommendations for future research to advance the field into a normal science, which requires hypothesis-driven research and valid measurement.

Lifetime exposures to potentially psychologically traumatic events (PPTEs) among Royal Canadian Mounted Police (RCMP) cadets starting the Cadet Training Program (CTP) appear lower than exposures reported by serving RCMP, but the prevalence of PPTE exposures during the CTP remains unknown. The current study assessed PPTE exposures during the CTP and examined associations with mental disorders among RCMP cadets. Participants were cadets (n = 449, 24.7% women) from the larger RCMP Longitudinal Study who self-reported critical incidents, PPTE exposures, and mental health disorder symptoms at pretraining and predeployment. Most participants reported no exposures to a PPTE (n = 374, 83.3%) during the CTP. Participants who reported any PPTE exposure (n = 75, 16.7%; i.e., direct or indirect) most commonly reported serious transport accidents, physical assault, and sudden accidental death. The most common direct PPTEs (i.e., "happened to me") during the CTP were physical assault (n = 13), other unwanted or uncomfortable sexual experience (n = 11), and serious transportation accident (n = 8). The total number of PPTE types reported at predeployment was associated with increased odds of screening positive for any mental health disorder, aOR = 1.22, 95% CI [1.01, 1.49], p = .049, and positively associated with mental health disorder symptoms, ps < .001. These results provide the first assessment of PPTE exposure among RCMP cadets during the CTP, indicating that 16.7% of cadets experience PPTEs directly or indirectly. The PPTEs reported by cadets may help inform additional opportunities to further increase safety during training.

Traumatic stress reactions (TSRs) exist on a continuum that includes posttraumatic stress disorder (PTSD), highly comorbid psychopathology, and resilience, highlighting the need for comprehensive and integrative approaches capable of capturing the full spectrum of heterogeneous reactions. Here, we used a transdiagnostic and multidimensional method to characterize clinical phenotypes of TSRs in a nationally representative sample of U.S. military veterans. The Middle-Out Approach was used to evaluate self-reported PTSD, generalized anxiety, major depressive symptoms, and physical and mental functioning to identify discrete latent classes of TSRs and their demographic, military and trauma history, and psychosocial correlates. Cross-sectional data were analyzed from 3,727 U.S. veterans who participated in the National Health and Resilience in Veterans Study. Latent class analysis identified five classes of veterans: low TSR (61.3%), anxious/depressive (16.6%), avoidant arousal (9.2%), dysphoric arousal (8.2%), and high TSR (4.7%). Veterans in the dysphoric arousal and high TSR classes demonstrated lower functioning than other classes, which showed similar levels of moderate-to-high functioning despite symptom differences. Classes distinguished between resilience to PTSD symptoms versus resilience to all symptoms and functioning domains and were differentially associated with demographic characteristics, trauma and military histories, and psychosocial characteristics. The results suggest that veterans exhibit different clinical phenotypes of TSRs, which may help inform etiology, diagnostic subtypes, and personalized treatment. Further, although most veterans with psychopathology experience functional impairment, a sizable subset demonstrates high functioning despite psychopathology symptoms.

Public safety personnel (PSP), such as police officers, firefighters, correctional workers, and paramedics, routinely face work stressors that increase their risk of developing posttraumatic stress disorder (PTSD). PSP may additionally face moral transgressions in the workplace (e.g., witnessing human suffering, working within broken systems), heightening the risk of moral injury (MI) in this population. Research among military personnel and health care workers shows an association between MI and PTSD; however, less is known about the association between these constructs among PSP. Canadian PSP completed an online survey between June 2022 and June 2023, including a demographic questionnaire and measures of PTSD, MI, dissociation, depression, anxiety, stress, and childhood adversity. Latent variable structural equation modeling (SEM) was performed to ascertain the impact of a latent MI construct (i.e., shame, trust violation, functional impairment) on a latent PTSD construct (i.e., intrusions, avoidance, negative alterations in cognition and mood, hyperreactivity, depersonalization, derealization). Sex, age, depression, anxiety, stress, and childhood adversity were included as covariates. A total of 314 PSP were included in the data analysis. A latent variable SEM regressing PTSD onto MI and including covariates accounted for 83.7% of the variance in PTSD. MI was the strongest predictor compared to all covariates and was significantly associated with PTSD symptoms, β = .506, p < .001, above and beyond the impacts of sex, age, depression, anxiety, stress, and childhood adversity. These findings are consistent with research among military members and health care providers and highlight the importance of further exploring MI among PSP.