Journal of traumatic stress最新文献

In many parts of the globe, regional professional societies have developed local traumatic stress organizations and have become affiliate societies of the International Society for Traumatic Stress Studies (ISTSS). At the ISTSS 40th Annual Meeting in September 2024, delegates from the ISTSS and five ISTSS-affiliate societies—Asociación Chilena de Estrés Traumático (ACET), the Australasian Society for Traumatic Stress Studies (ASTSS), Deutschsprachige Gesellschaft für Psychotraumatologie (DeGPT), the Japanese Society for Traumatic Stress Studies (JSTSS), and the Korean Society for Traumatic Stress Studies (KSTSS)—gathered for a panel discussion entitled “Roles, Challenges, and Possibilities of ISTSS Affiliated Organizations Around the World: A Panel Discussion.” Each panelist shared insights into their organization's structure, goals, ongoing projects, and challenges in addressing traumatic stress in their regions. These societies shared a collective need for progressing evidence-based treatments for trauma-related conditions and minimizing disparities in care provision, advocacy, and public education. The societies reported differences in health care systems, types of common traumatic events, and geopolitical and socioeconomic characteristics. Given these similarities and differences, the panel agreed on the need for enhancing collaborations within and between societies.

Tetris has been shown to reduce intrusions following exposure to experimentally induced and actual traumatic events. However, no study has systematically investigated whether multiple sessions of Tetris produce greater reductions in intrusions than a single session. In this study, 94 participants (58.5% female) watched a trauma film in the laboratory and were then randomly assigned to one of three groups: no Tetris (inactive control), a single session of Tetris (15 min on Day 1), or multiple sessions of Tetris (15 min per day on Days 1, 2, and 3). Participants recorded film-related intrusions in a daily diary over 1 week. The results showed that the trauma film effectively induced intrusions. In terms of group differences, a single Tetris session was associated with a 22.0% reduction in intrusions compared to the control group, Exp(B) = 0.78; and multiple Tetris sessions were associated with a 13.3% increase in intrusions compared to the control group, Exp(B) = 1.13, and a 45.4% increase compared to the single-session group, Exp(B) = 1.45. However, none of these differences were statistically significant, p = .380. These findings may be partially explained by methodological factors, such as administering Tetris remotely via smartphones without researcher supervision and the repeated use of reminder cues. Alternatively, Tetris may not effectively reduce intrusions when played unsupervised in uncontrolled settings.

Posttraumatic stress disorder (PTSD) is a prevalent and debilitating condition, yet many individuals face substantial barriers to accessing evidence-based interventions. Advances in generative artificial intelligence (AI), particularly large language models (LLMs), have generated optimism about improving access and care. We present five emerging use cases for clinical AI tools in the context of PTSD treatment, some of which were presented as part of a symposium at the 40th Annual Meeting of the International Society for Traumatic Stress Studies. The first two use cases involve AI-assisted training tools. The third use case focuses on an AI-assisted automated fidelity rating system aimed at improving adherence to evidence-based PTSD protocols. The last two use cases feature AI-assisted therapy tools. Although AI-based innovations hold the promise of enhancing the reach and consistency of evidence-based PTSD interventions, they also raise important ethical and safety challenges, including risk of bias, threats to patient privacy, and the question of how to incorporate clinical oversight. Ongoing collaboration among multidisciplinary teams involving clinicians, researchers, and technology developers will be essential to ensuring that AI tools remain patient-centered, ethically sound, and effective.

This commentary expands on Clauss et al.’s (2025) meta-analysis of attention control training (ACT) for posttraumatic stress disorder (PTSD) by situating ACT and related interventions within a broader framework of attentional functioning. Although ACT and attention bias modification (ABM) show promise in targeting specific attentional processes, both neglect key domains, such as divided attention and multisensory regulation, which are often impaired in PTSD. Drawing on neuropsychological and neuroimaging findings, we highlight the need for the application of a multidimensional model of attention that accounts for the complexity of trauma-related attentional dysregulation. Future interventions should integrate a wider range of attentional components to improve clinical relevance and effectiveness.

Children's exposure to trauma is a ubiquitous stressor associated with severe adjustment problems. Although mental health services can effectively reduce this distress, families often spend months waiting for treatment. Beyond timely access to care, the needs and concerns of families on the waitlist for trauma-focused treatment are unknown. In the present study, we addressed this gap by conducting interviews with key participant groups: adult caregivers with a child on the waitlist for trauma-focused services (n = 16) and providers of trauma-focused treatment (n = 17). Participants completed semistructured interviews on the needs and concerns of families on the waitlist for trauma-focused mental health services for their child. Interview transcripts were analyzed using a combination of deductive and inductive thematic analysis. Consolidated thematic coding yielded four themes related to waitlist concerns: waitlist duration, worsening symptoms, family not feeling supported, and safety. Six additional themes emerged related to waitlist needs: parenting services, psychoeducation on trauma, check-ins on well-being and status, case management, financial resources, and referrals to other services. The results suggest that both caregivers and providers are largely aligned in their perspectives of the needs and concerns of families on the waitlist for trauma-focused treatment. Several of the identified needs could be addressed by low-intensity interventions delivered by paraprofessionals. The accessibility and appropriateness of providing support to families on the waitlist for treatment should be explored.

Individuals with higher potentially morally injurious event (PMIE) exposure often exhibit elevated levels of negative posttraumatic cognitions (NPCs). Researchers have argued that individuals with moral injury (MI) following PMIE exposure experience more prescriptive NPCs than those without MI. As these prescriptive NPCs may be harder address using cognitive processing therapy (CPT), first-line posttraumatic stress disorder (PTSD) treatments may not fully address MI. This study evaluated the impact of PMIE exposure on NPC trajectories during intensive CPT for PTSD. We examined NPC trajectories in a group of 738 service members and veterans (SMVs) who participated in a 2-week CPT-based intensive PTSD treatment program. Time was a significant predictor of the Posttraumatic Cognitions Inventory (PTCI) score trajectory over treatment, p < .001. The interaction between time and PMIE exposure also significantly predicted PTCI trajectories, p = .008, such that higher PMIE exposure was related to higher PTCI scores during the first half of treatment; however, by the end of treatment, PTCI scores were visually similar regardless of PMIE exposure. The PTCI subscales (Negative Cognitions About the Self, Negative Cognitions About the World, and Self-Blame) were also analyzed and resulted in similar associations with time and PMIE exposure as well as with PTCI total score. These findings suggest that intensive CPT appears to be effective in reducing NPCs in SMVs regardless of PMIE exposure. Therefore, even when patients report PMIE exposure, CPT clinicians should continue identifying and targeting NPCs.

Posttraumatic stress disorder (PTSD) is a common psychopathological outcome of sexual assault. Peritraumatic tonic immobility (TI; involuntary “freezing”) during sexual assault has been linked with worsened PTSD symptoms, yet little research has examined these effects longitudinally. The present study aimed to examine the effects of TI on the severity of PTSD symptoms, negative posttraumatic cognitions (NPC), and dissociative symptoms over 1 year among 112 female survivors of sexual assault aged 16–30 years. Multilevel linear regressions evaluated the effects of time since sexual assault, TI severity, and their interaction on the severity of PTSD symptoms, NPC (total, blame, self, world), and dissociative symptoms. Results indicated that TI severity was associated with increased NPC, β = .22, p = .018, and dissociative symptom severity, β = .65, p = .037, but not PTSD symptom severity, β = .25, p = .116; these associations remained consistent over time. Given the salience of NPCs, individuals seeking care for TI-associated sexual trauma may benefit from interventions that can reduce NPCs (e.g., prolonged exposure, cognitive processing therapy). Further evaluating these treatments’ utility in reducing dissociation may be of particular benefit to individuals with a history of TI reactions during trauma. Finally, coercive rape tactics were associated with increased PTSD symptoms, β = .48, p = .002, whereas forcible, β = −.04, p = .805, and drug- or alcohol-facilitated rape tactics, β = .35, p = .285, were not, indicating the importance of assessing verbal coercion in research and clinical work with individuals who have experienced sexual assault.

It is widely postulated that problematic sexual behavior (PSB) of preteen children may be the result of posttraumatic stress symptoms (PTSS) secondary to child sexual abuse (CSA). Several studies have examined the potential associations between PSB and PTSS, but this is the first meta-analytic synthesis of the relevant research. A total of 16 effect sizes, derived from 12 studies, were included in the analysis. The results suggest a significant association between PSB and PTSS, r = .35, p < .001, and significant heterogeneity was observed among the effect sizes, Q = 469.69, p < .001. However, moderator analyses failed to demonstrate that the link between PSB and PTSS was stronger among samples composed of children with a history of sexual abuse, β = .12, Z = 0.75, p = .456. Additional moderator analyses failed to find any variables that clearly impacted the association between PSB and PTSS. These results are discussed from both theoretical and empirical perspectives, and suggestions for further research are provided.

Institutional betrayal can occur when an organization fails to prevent or respond appropriately to traumatic events perpetrated within its ranks. This experience of violated trust can exacerbate posttraumatic stress disorder (PTSD) symptoms and related sequelae. The primary aim of this quality assurance project was to preliminarily assess whether our standard treatment approach and treatment dosing (single-treatment protocol, 12–15 sessions) was sufficient for patients presenting with institutional betrayal. We compared outcomes for individuals presenting for care following institutional betrayal events (n = 57) with outcomes for a control group of randomly selected nonbetrayed patients (n = 57). Individuals who endorsed a history of sexual abuse were excluded to better isolate the impact of institutional betrayal versus interpersonal factors. Betrayed individuals were more likely to leave treatment before the third session, Cramer's V = .206, particularly betrayed men, Cramer's V = .303, and betrayed Black patients, Cramer's V = .155. Betrayed patients who remained in treatment required additional and different treatment protocols to meet their goals (e.g., written exposure therapy plus cognitive processing therapy [CPT] vs. CPT alone; prolonged exposure [PE] plus CPT vs. CPT alone), Cramer's V = .276. Nevertheless, repeated-measures analyses of variance demonstrated a significant decrease in PTSD, η_p² = .61, and depressive symptoms, η_p² = .52, regardless of betrayal trauma history. Although evidence-based treatments can help many individuals, these findings raise clinically significant concerns and underscore the detrimental effect of institutional betrayal, justifying future research to improve patient retention in treatment for this specific presentation.

Posttraumatic stress disorder (PTSD) is a debilitating condition that disproportionately impacts service members (SMs). Interoception interventions that target malleable, transdiagnostic risk factors for PTSD, such as the acceptance of uncomfortable internal sensations, may serve as potential options for military providers. The current study evaluated the efficacy of Reconnecting to Internal Sensations and Experiences (RISE)—an empirically supported interoception training focused on accepting and managing internal sensations—in reducing PTSD symptom severity. Active-duty SMs and veterans (N = 100) with probable PTSD were randomized to receive RISE or Healthy Habits (active control). Participants completed four weekly 30-min training modules, as well as survey assessments (PTSD symptom severity, not worrying/acceptance of uncomfortable internal sensations) at baseline, posttreatment, and 1-month follow-up. Mediation analysis evidenced a significant direct effect of RISE on improvements in not worrying/acceptance at posttreatment, B = 0.51, and not worrying/acceptance on reductions in PTSD symptom severity at follow-up, B = −3.76. Despite no direct effect of condition on PTSD symptoms, B = 2.66, a significant indirect effect was observed through improvements in not worrying/acceptance, B = −1.91, such that RISE led to increased not worrying/acceptance, which, in turn, was associated with decreases in PTSD symptom severity. These findings support acceptance of internal sensations as a key mechanism of change for improving PTSD. Further, the results provide preliminary evidence for RISE as a viable PTSD treatment supplement for SMs and provide preliminary support for the use of transdiagnostic tools developed with considerations for military cultural stigma and logistical concerns.