Journal of traumatic stress最新文献

Disgust in posttraumatic stress disorder (PTSD) has been relatively underexamined compared to other emotions, although it may be relevant to war-related PTSD given potential exposure to both physical contaminants and moral violations. The present study examined the prevalence of disgust, mental contamination, and compulsive behaviors among veterans seeking PTSD treatment. Participants were 289 military veterans (79.2% male; M_age = 43.82, SD = 13.61) referred for treatment at a U.S. Department of Veterans Affairs PTSD specialty clinic. Veterans completed measures of PTSD symptoms; trauma-related disgust toward others and themselves; feelings of dirtiness in response to thoughts, images, or memories of the trauma (i.e., trauma-cued mental contamination); compulsive behaviors; and time spent washing, cleaning, and/or avoiding feeling dirty. Combat was the most common index trauma (69.9%). Nearly three quarters (74.0%) of veterans endorsed at least moderate disgust toward others, and 61.2% endorsed at least moderate disgust toward oneself; about half (54.4%) endorsed at least moderate mental contamination, and 45.0% endorsed washing, cleaning, and/or avoiding feeling dirty at least 1 hr per day. Disgust toward others, disgust toward oneself, and mental contamination were significantly correlated with PTSD symptoms, rs = .41–.57, ps < .001. Multiple regression analysis indicated that all three predictors were associated with PTSD symptoms, F(3, 274) = 79.68, p < .001, R² = .47, with disgust toward oneself the strongest predictor, β = .30, p < .001. The present study suggests a notable prevalence of disgust, contamination, and time spent avoiding feeling dirty among veterans seeking PTSD treatment.

Many individuals feel compelled to seek reminders of trauma that produce distress outside of a therapeutic context (i.e., “self-trigger”). To better understand this behavior, we examined and categorized the motives behind self-triggering by qualitatively analyzing the free responses of 355 participants to the question, “In your own words, why do you self-trigger?” In Study 1, researchers determined whether previously identified motives could be reliably coded. In Study 2, a separate group of researchers identified motives inductively, without knowledge of the a priori motives. Most a priori motives were reliably identified in Study 1, and both studies revealed a range of additional motives. Across both studies, the most prevalent motives included determining the meaning of one's traumatic event, self-punishment, and efforts to validate one's identity as a trauma survivor. Validation was consistently associated with more frequent self-triggering, Study 1: δ_Cliff = −.19, 95% CI [−.35, −.02]; Study 2: δ_Cliff = −.19, 95% CI [−.32, −.05], whereas the desire to avoid emotional numbness, Study 1: δ_Cliff = .21, 95% CI [.02, .39], or seek arousal, Study 2: δ_Cliff = .22, 95% CI [.06, .37], were associated with less frequent self-triggering. Motives categorized as “unknown” were also associated with less frequent self-triggering, Study 1: δ_Cliff = .35, 95% CI [.08, .56]; Study 2 δ_Cliff = .35, 95% CI [.08, .56]. The findings suggest motives for self-triggering are diverse and may serve different functions—cognitive, interpersonal, moral, physiological, or sexual—depending on the individual, with implications for conceptualizing trauma-related emotional regulation and behavioral responses.

Exposure-based therapies are widely accepted as the gold-standard intervention for both obsessive compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). Despite their co-occurrence, little research has explored exposure-based treatment in individuals who experience both OCD and PTSD. At an academic medical center mental health program, four different treatment approaches combining exposure and response prevention (ERP) and prolonged exposure (PE) therapies were piloted for veterans with co-occurring OCD and PTSD. We present each approach with a brief case study. Two sequential models are discussed: massed PE followed by spaced ERP (Model 1) and ERP “prestart” spaced sessions followed by 1-week massed ERP and then 1-week massed PE (Model 2). Two integrated models are presented: ERP prestart spaced sessions, followed by massed PE with ERP elements integrated (Model 3) and massed ERP with PE integrated (Model 4). The results demonstrate reductions in OCD and PTSD symptom severity for the sequenced treatment, starting with ERP of Model 2, as well as the integrated approaches of Models 3 and 4, which emphasized OCD-related psychoeducation and response prevention prior to beginning imaginal exposure for PTSD. These models showed reliable change (RC) for both OCD (RC = 2.35–4.06) and PTSD (RC: 4.46–7.39). Impacts of these variations in exposure sequencing and spacing are discussed. We provide recommendations for next steps, including systematic research in rigorous and larger-scale studies of exposure-based treatments for co-occurring OCD and PTSD.

This report was originally a presentation at the 2024 International Society of Traumatic Stress Studies Annual Meeting (Boston, MA, United States) that describes the integration of a trauma-informed approach into a law enforcement–based critical incident review process conducted by the U.S. Department of Justice's Office of Community Oriented Policing Services in response to a 2022 school shooting in Uvalde, Texas. The report focuses on how the review team of nine law enforcement subject matter experts and six Department of Justice staff members used a trauma-informed approach to ensure they would do no harm to the victims, family members, responders, and others as a result of their review process. The team conducted 260 interviews over 54 days and reviewed 14,000 pieces of data. The team followed trauma-informed principles to protect victims and families and to avoid overexposing themselves and risking secondary traumatic stress. The use of a trauma-informed lens had not been part of prior critical incident reviews, which focused almost exclusively on the facts of the actions of law enforcement and lessons learned. Data were obtained from victim and responder agency interviews, law enforcement reports, and audio and video materials of the incident. The resulting findings indicate that although the law enforcement response to the shooting is considered a failure, the trauma-informed approach used in the review helped support victims, responders, community members, and the team conducting the review.

Despite an increase in the number of veterans receiving posttraumatic stress disorder (PTSD) care in the community, little work has examined the coordination and quality of care, particularly as it relates to U.S. Department of Veterans Affairs (VA) standards. To this end, the current project sought to document community care characteristics among veterans receiving outpatient psychotherapy services for PTSD. Specifically, the coordination of care and congruency with VA standards were examined. Data, which were collected over a 2-year period from a VA hospital in the southeastern United States, included 123 PTSD community care consults across 103 unique veterans (M_age = 47.80 years, SD = 12.03; 72.4% Male; 50.4% Black). The majority of consults were new referrals for care (62.6%) due to the clinical service not being available or the average drive time to the nearest VA facility exceeding 30 min (77.2%). Regarding the coordination of care, records were not available for 27.6% of consults. Among veterans with treatment records, most were seen for an intake and psychotherapy (38.2%), followed by intake only and psychotherapy only. Formal diagnostic assessments were not documented in any intake records, with 21.2% of psychotherapy records documenting the use of a first-line treatment for PTSD. Notably, most intake records (56.1%) failed to document any assessment of suicide risk, and no psychotherapy records indicated the loss of a PTSD diagnosis. The findings highlight gaps in the coordination and quality of care, particularly as it relates to VA standards, for veterans receiving PTSD care in the community.

Due to Puerto Rico's location, there is heightened vulnerability to the consequences of natural disasters, contributing to an elevated risk of posttraumatic stress disorder (PTSD). Given PTSD's heterogeneous nature, this study examined whether PTSD factor structure, based on DSM-5 criteria and measured using the PTSD Checklist for DSM-5 (PCL-5), was equivalent across hurricane-exposed Puerto Ricans (n = 596) and non-Latiné White (NLW) individuals (n = 459). Confirmatory factor analysis (CFA) indicated the seven-factor hybrid model of PTSD was the best-fitting structure, χ²(N = 897, 298) = 685.59, CFI = .967, TLI = .958, RMSEA = .054, SRMR = .038. Latent factor correlations (range: .61–.93) supported the distinctiveness of PTSD symptom dimensions. PTSD prevalence estimates varied significantly (DSM-5: 47.8%, hybrid: 28.2%). Multigroup CFA results supported partial scalar invariance, with PCL-5 Item 8 (memory impairment) requiring varying intercepts, χ²(N = 897, 330) = 806.97, p < .001, CFI = .960, TLI = .954, RMSEA = .057, 90% CI [.052, .062], SRMR = .047, BIC = 49,586.9. NHWs reported higher avoidance (ΔM = 0.186), p = .011; negative affect (ΔM = 0.160), p = .028; anhedonia (ΔM = 0.217), p = .002; and dysphoric arousal symptoms (ΔM = 0.187), p = .015, relative to Puerto Ricans. Strong associations between PTSD factors and depression and psychological distress, βs = .57–.82, supported convergent validity. Findings highlight the relevance of the hybrid model for conceptualizing PTSD symptoms among hurricane-exposed populations, with important implications for culturally informed assessment and treatment in Puerto Rican communities.

Providing posttraumatic stress disorder (PTSD) treatment in primary care is a key strategy for increasing treatment access. This qualitative descriptive study examined patients’ perspectives on the effectiveness of written exposure therapy (WET) and antidepressant medications for PTSD delivered in primary care. We interviewed a purposive sample of adult patients with probable PTSD who participated in a pragmatic comparative effectiveness trial in federally qualified health center (FQHC) and Veterans Health Administration (VHA) primary care clinics. The interviews assessed changes experienced during treatment and aspects of treatment that were helpful or could be improved. We analyzed interview transcripts using inductive thematic analysis. Among trial participants who completed interviews (n = 65; FQHC: 46.2%, VHA: 53.8%), 41.5% received WET, 33.8% received medications, and 24.6% received both. Most interviewees reported experiencing positive changes during treatment (e.g., symptoms, habits/activities, empowerment), but some reported experiencing limited changes or negative changes. Interviewees described multiple aspects of WET and medication treatment as helpful (e.g., gaining an understanding of PTSD) and suggested possible improvements (e.g., more WET sessions, more opportunities to talk to clinicians). Some findings were specific to either WET or medications, but most were discussed in relation to both treatment types. The implementation of these treatments in primary care should involve strategies for primary care clinicians to efficiently educate patients about PTSD during both WET and medication treatment, shared decision-making tools that are appropriate for the primary care setting, and effective linkage to specialty mental health care for patients who desire more contact with clinicians.

There is a need to improve psychological interventions for first responders and veterans with posttraumatic stress disorder (PTSD). We conducted an open trial integrating explicit case formulation (CF) within cognitive processing therapy (CPT) in a sample primarily composed of first responders (N = 29). Participants attended weekly CPT sessions with explicit CF, where CF guided deviations (if required) from standard CPT delivery (CPT-CF). PTSD diagnosis and self-reported PTSD symptoms, depressive symptoms, and quality of life utility scores were key variables assessed at pretreatment, posttreatment, and 3-month follow-up for all participants. Of the 28 participants who started therapy, 23 completed treatment. Intent-to-treat analyses indicated significant reductions and sizeable effects at posttreatment for clinician-rated and self-reported PTSD outcomes, g = 2.48–2.50, and self-reported depressive symptoms, g = 1.37, and quality of life, g = 0.99. Effects for secondary variables ranged from small (alcohol misuse: g = 0.32) to large (sleep, g = 0.71; anger, g = 0.74; unhelpful trauma beliefs: g = 1.11). Clinical gains were maintained at 3-month follow-up. Among the 23 participants available at follow-up, 82.6% (n = 19) met good end-state functioning for PTSD, and none met the criteria for PTSD. Seven participants had moderate-to-major deviations from CPT during treatment but largely demonstrated similar outcomes to those who did not. The study replicates prior CPT-CF work among civilians, finding it to be acceptable to participants and not diluting positive outcomes of standard CPT. Future research requires randomized trials and an expansion of this approach with other trauma populations.

Exposure to traumatic events is associated with biases in the perception of emotional facial expressions. By bridging research on trauma exposure and emotion recognition, the present study investigated the impact of war-related trauma on the recognition of facial expressions of emotions in a sample of war trauma–exposed refugees (N = 108) from West Asian countries. Through a forced-choice facial emotion recognition experiment, we assessed how trauma exposure and face gender influenced accuracy and biases in identifying six primary emotions. Participants judged facial expressions of anger, sadness, fear, disgust, surprise, and happiness displayed by a set of 240 faces corresponding to 20 female and 20 male models from the Karolinska Directed Emotional Faces dataset. Expressions consisted of short videos showing each face's transition from neutral to full emotion. The results showed impaired recognition of negative emotions, with fear being the least accurately recognized emotion, suggesting the avoidance of negative affective states as a coping mechanism putatively associated with war-related trauma. For main effects, partial eta-squared effect sizes ranged from .159 to .573, and effect sizes for interaction effects ranged from .027 to .189, with most effects being in the medium-to-large range. Furthermore, the biases in emotion recognition observed in the present study may reflect gender stereotypes and social norms that shape how individuals perceive and interpret emotional expression in men and women.

Treating posttraumatic stress disorder (PTSD) in military-affiliated populations, including veterans, active duty service members, and their families, remains a significant challenge in the mental health field. Most research on PTSD treatment outcomes has been conducted in controlled trials or within VA and military settings, limiting its generalizability to other clinical environments. This study examined treatment outcomes for 2,717 military-affiliated clients receiving treatment for PTSD within a community mental health network. Treatments included cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR), or prolonged exposure (PE), with outcomes measured using the PTSD Checklist for DSM-5 (PCL-5) throughout treatment. Clients who attended at least four sessions showed substantial symptom reductions for CPT (ΔM = 19.3), d = 0.98; EMDR (ΔM = 16.6), d = 0.86; and PE (ΔM = 17.4), d = 0.87, all of which exceeded improvements seen with other treatments (ΔM = 12.6), d = 0.71. Analyses of clinically meaningful change thresholds showed similar results across treatments, with 51.9% of CPT, 47.8% of EMDR, and 53.1% of PE clients experiencing a PCL-5 score reduction of at least 18 points after four or more sessions. Dropout prior to four sessions was notable, with 27.5%–40.1% of clients across treatment groups discontinuing treatment before reaching this threshold. Overall, the findings provide real-world evidence supporting the effectiveness of CPT, EMDR, and PE in military-affiliated populations and validate their continued use in community mental health settings.