Journal of traumatic stress最新文献

Military sexual assault (MSA) survivors are particularly likely to engage in sexual risk-taking, or sexual behaviors that may result in sexually transmitted infections or unintended pregnancy. Theory suggests that posttraumatic cognitions, including negative thoughts about the self, negative thoughts about the world, and self-blame, may be a salient factor related to sexual risk-taking in this population. Further, sex differences have been observed in both posttraumatic cognitions and sexual risk-taking. In this secondary analysis of web-based survey data collected from U.S. service members and veterans (N = 400, 50.0% male), we hypothesized that posttraumatic cognitions would be positively associated with sexual risk-taking and that sex would moderate this effect. The moderation model significantly predicted sexual risk-taking, R² = .19, F(6, 391) = 15.60, p < .001, and the effect of posttraumatic cognitions on sexual risk-taking significantly differed by sex, B = 0.13 (SE = .05), p = .009, such that it was stronger for male survivors, B = 0.22 (SE = .03), p < .001, than female survivors, B = 0.09 (SE = .04), p = .019. Exploratory post hoc moderation analyses revealed a similar pattern for both negative thoughts about the self and self-blame, whereas negative thoughts about the world did not differ by sex. The results point to the potential utility of cognitive-based therapies in reducing sexual risk-taking after MSA, particularly among male survivors, and highlight the importance of investigating psychological and interpersonal outcomes in this population. This study provides a vital contribution to the small literature base regarding male MSA survivors.

Many survivors of sexual assault experience both psychological effects and problems with social functioning. App-based interventions are a promising means to extend the reach of early interventions and, thereby, reduce the risk of psychopathology, but their impact on social functioning is unknown. This is an analysis of secondary social functioning outcomes from a pilot randomized clinical trial of a coached app-based early intervention (THRIVE) for survivors of unwanted sexual contact that occurred within the last 10 weeks. The THRIVE app involved daily cognitive behavioral activities targeting posttraumatic stress and alcohol misuse and as-needed relationally focused exercises; weekly phone coaching supported app use. Adult women (N = 41) with past-10-week unwanted sexual contact and elevated posttraumatic stress and heavy drinking were randomized to receive either the THRIVE app or a symptom monitoring app. Participants were invited to use their respective app daily for 21 days and attend weekly coaching calls. Self-report assessments tracked changes in outcomes from baseline to postintervention and 3-month follow-up. Relative to participants in the control condition, those in the intervention condition showed larger increases in perceived support from friends, d = 0.85, and decreases in conformity drinking motives, d = -0.81, at 3-month follow-up. The results suggest that THRIVE may be a promising strategy to improve social functioning in sexual assault survivors. Future research on THRIVE should examine the mechanisms of these changes.

Adverse childhood experiences (ACEs) are strongly associated with increased risk of externalizing problems. Despite their prevalence in military populations, limited research links ACEs to longitudinal externalizing problem trajectories during military service transition. This study aimed to identify distinct trajectories of externalizing problems (deviant behavior, alcohol use, and drug use) in U.S. Army National Guard recruits and examine how baseline ACEs predict membership in higher-risk trajectories during the transition to military service. A longitudinal cohort of 707 Army National Guard recruits was assessed before basic combat training and at four follow-ups over 18 months. Growth mixture modeling was used to identify distinct trajectories for deviant behavior, alcohol use, and drug use, whereas logistic regression analyses were conducted to examine associations between baseline ACEs and trajectory group membership. For each domain, we identified distinct trajectory patterns beyond stable-low: decreasing-increasing and increasing-decreasing deviant behavior trajectories, stable-high and increasing alcohol use trajectories, and a variable drug-users trajectory. Relative to stable-low class membership, higher ACE scores were associated with increased odds of membership in the decreasing-increasing, OR = 1.26, 95% CI [1.12, 1.41], and increasing-decreasing, OR = 1.26, 95% CI [1.15, 1.37], deviant behavior; stable-high alcohol, OR = 1.13, 95% CI [1.03, 1.25]; and drug-users, OR = 1.19, 95% CI [1.11, 1.28], trajectories. Specific ACEs uniquely predicted higher-risk trajectories. These findings suggest that ACEs may have longitudinal effects on the unfolding of externalizing symptom trajectories among military recruits, highlighting the need to address preexisting developmental vulnerabilities when examining pathways to psychopathology during significant life transitions.

Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment widely used for youth experiencing symptoms related to posttraumatic stress disorder (PTSD). This study used both cross-sectional and cross-lagged panel network (CLPN) analyses to examine changes in PTSD symptom networks following TF-CBT and explore their clinical relevance. Using data from a statewide implementation of TF-CBT, we constructed PTSD symptom networks for 652 youth (M_age = 12.47 years, 57.5% girls, 21.9% youth of color) who completed TF-CBT and provided both pre- and posttreatment data. At pretreatment, central symptoms included detachment, psychological and physiological reactions, and negative cognitions. Although the overall connectivity between symptoms significantly increased after treatment, p = .003, the symptom structure remained stable. CLPN analyses identified symptoms with high predictive influence (out-expected influence [out-EI]: physiological reactions, negative emotional state, and diminished interests) and susceptibility to influence (in-EI: internal and external avoidance, nightmare, detachment). Pretreatment centrality, B = 0.07, p < .001, and in-EI, B = 0.72, p = .003, but not out-EI, B = -0.04, p = .633, were associated with larger overall pre-post symptom reductions, controlling for baseline symptom severity. Improvements in symptoms with high pretreatment centrality, B = 1.17, p = .011), and in-EI centrality, B = 0.34, p = .568, but not out-EI centrality, B = 0.34, p = .568, were related to posttreatment psychosocial functioning over and above peripheral symptoms. These results offer preliminary evidence on how symptoms change during treatment, providing insight for understanding change mechanisms of TF-CBT and further refining youth trauma treatment.

Cognitive dysfunction is a hallmark of posttraumatic stress disorder (PTSD). Although treatments effectively reduce core PTSD symptoms, limited research has examined whether associated cognitive impairments improve following treatment. This study investigated cognitive changes in veterans receiving treatment for PTSD and explored the associations between cognitive improvement and PTSD symptom reduction. U.S. veterans (N = 85) with clinically significant PTSD symptoms were randomized to receive either cognitive processing therapy (CPT; n = 44) or Sudarshan Kriya yoga (SKY; n = 41) in a noninferiority trial. Cognitive function was assessed pre- and posttreatment using the Cambridge Neuropsychological Test Automated Battery. PTSD symptoms were assessed using the Clinician-Administered PTSD Scale (CAPS-5). Following treatment, participants showed significant improvements in episodic visual memory, d = 0.51, p < .001; motor learning, d = 0.57, p < .001; and visual sustained attention, d = 0.37, p = .005. There were no significant differences in cognitive improvement between the CPT and SKY groups. Changes in overall cognitive function were significantly correlated with PTSD symptom reductions across both treatment groups. Regardless of treatment, cognitive function improved alongside PTSD symptom reduction. These findings provide evidence that treating PTSD not only alleviates PTSD symptoms but may also improve associated cognitive function.

Dysregulated anger is a prevalent concern for veterans with posttraumatic stress disorder (PTSD) and is associated with negative psychosocial outcomes. The tendency to perceive ambiguous interpersonal situations as hostile, also known as hostile interpretation bias, is associated with problematic anger. In the present study, we report on a feasibility randomized control trial (RCT) that sought to evaluate the feasibility and acceptability of the Mobile Anger Reduction Intervention (MARI) mobile application (app), which utilizes interpretation bias modification techniques to modify hostile interpretation bias in veterans with PTSD. Veterans with PTSD and elevated anger (N = 30) were randomly assigned to use either the MARI app (n = 16) or a mindfulness app (n = 14) for 4 weeks. Participants completed self-report questionnaires assessing anger, PTSD and depressive symptoms, suicidal ideation, and functional impairment at pretreatment, posttreatment, and 3-month follow-up assessments. The primary outcomes were acceptability and feasibility. Clinical outcomes were secondary. All a priori feasibility and acceptability benchmarks for the MARI app were met or exceeded, indicating that the app is an acceptable intervention for veterans with PTSD, and additional research of the intervention is feasible. Participants in the MARI condition demonstrated large reductions in hostile interpretation bias, d = -1.12, and moderate reductions in past-week anger, d = -0.65, and trait anger, d = -0.72, from pretreatment to posttreatment. Given the demonstrated feasibility and acceptability of the MARI app, in addition to the observed clinical improvements, a larger RCT of MARI for veterans with PTSD is warranted.

There is no established guidance on how many days of posttraumatic stress disorder (PTSD) assessments are sufficient to capture reliable and stable estimates of intraindividual mean (iM) and variability (intraindividual standard deviations [iSD]) in intensive longitudinal studies. Thus, this study examined the reliability and short-term stability of daily PTSD symptoms measured using the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). Participants (N = 70, M_age = 30.44 years, SD = 12.78 72.9% female) completed the PC-PTSD-5 for 21 consecutive days before and after attending four intervention sessions. To examine reliability, generalizability coefficients assessing systematic consistency across days (Rc) and single-day reliability (R1F) were calculated. To examine short-term stability in each phase, we calculated reference iMs and iSDs from 21 days for the preintervention and postintervention phases. We used (a) correlation coefficients (stable: r > .80) and mean absolute differences (stable: < .25) to compare these reference estimates, with estimated values ranging from 2-21 days per participant, and (b) bias and agreement using Bland-Altman analyses. Results indicate that the PC-PTSD-5 yielded varying intraindividual variability estimates in the short term, Rcs_pre = .45-.67, Rcs_post = .40-.55, but good single-day reliability, R1Fs_pre = .72-.78, R1Fs_post = .77-.82. Assessing PTSD using the PC-PTSD-5 for 7-11 days could produce iM and iSD estimates comparable to 21 days. Overall, the PC-PTSD-5 was more reliable for capturing between-person differences than within-person fluctuations. Intensive longitudinal studies could use 7-11 days of daily PC-PTSD-5 assessments to capture stable estimates of average and variable PTSD symptoms.

Written exposure therapy (WET) is a brief, evidence-based treatment for posttraumatic stress disorder (PTSD) that has demonstrated effectiveness in a variety of settings, mostly within the United States. The pilot study described here examined the feasibility, acceptability, and effectiveness of WET in Azerbaijan, where access to evidence-based trauma-focused treatments is limited. Patients diagnosed with PTSD (N = 62) received five weekly sessions of WET delivered by trained clinicians. Self-report measures were used to assess PTSD and depressive symptoms, as well as maladaptive beliefs, at pre- and posttreatment. Working alliance was also assessed using the patient version of the Brief Revised Working Alliance Inventory (BR-WAI). Treatment dropout was low, with only four participants (6.4%) dropping out. Treatment outcome findings indicated that there were significant decreases in PTSD symptoms, d = 1.84; depressive symptoms, d = 1.43; and maladaptive beliefs, d = 0.85. At posttreatment, most (87.1%) participants showed a reliable reduction in PTSD symptoms, and 71.0% met the criteria for clinical recovery. Working alliance moderated PTSD symptom reductions, with stronger agreement on goals and tasks associated with larger reductions in PTSD symptoms, B = -0.18, p = .049. Exploratory analyses revealed that reductions in maladaptive trauma-related beliefs were significantly associated with reductions in PTSD symptoms, B = -0.46, p < .001. Overall, the findings suggest that WET is both feasible and acceptable to implement in Azerbaijan. Moreover, WET was effective, with large treatment effects observed. These findings support the broader implementation of WET in low-resource settings.

In September 2017, Category 4 Hurricane Maria devastated Puerto Rico (PR). This cross-sectional study evaluated the long-term mental health outcomes among women who were pregnant during or became pregnant shortly after (i.e., within 3 months) hurricane exposure. The HELiOS Study cohort recruited 187 mother-child dyads. Mothers reported prenatal hurricane-related experiences (threat, injury, property loss) and completed assessments of posttraumatic stress disorder (PTSD), perceived stress, and depressive symptoms. Maternal probable depression (19.5%), probable PTSD (21.4%), and moderate-to-severe stress (66.1%) were prevalent 12-54 months postpartum. Linear regression models showed that property damage/loss predicted depressive, B = 0.290, p = .007, and PTSD symptoms, B = 0.893, p = .001, and injury predicted higher depressive, B = 0.546, p = .039, and PTSD symptoms, B = 1.979, p = .003. Prehurricane depression also predicted higher depressive, B = 1.927, p = .035, and PTSD symptoms, B = 4.628, p = .046, whereas total trauma count was associated with PTSD symptoms, B = 1.905, p = .003, and perceived stress, B = 0.803, p = .007. Mothers interviewed closer to the hurricane were more likely to report PTSD symptoms, B = 5.001, p = .021. Married, B = -10.706, p = .038, and cohabitating women, B = -10.948, p = .035, reported lower perceived stress. Hurricane-related experiences during pregnancy can have negative long-term effects on maternal mental health. Single mothers and pregnant women with a history of trauma exposure and/or depression may have a heightened risk of adverse postdisaster mental health outcomes.

We thank Litz (2025) for his thoughtful commentary and shared commitment to improving posttraumatic stress disorder care through the transparent use of observational outcome data. The proposed reporting checklist offers a timely framework for enhancing interpretive clarity and hypothesis generation. Our study incorporated many of these elements and was designed as a descriptive, noncomparative analysis aligned with learning health system goals. We acknowledge the importance of careful framing to avoid overinterpretation and support the broader call for standardized reporting practices. Measurement-based care remains central to Cohen Veterans Network's approach, and we welcome continued dialogue to advance responsible data use and iterative quality improvement across systems.