Journal of traumatic stress最新文献

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.

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.