Journal of traumatic stress最新文献

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.

Mobile health applications (apps) are increasingly used to reduce mental health problems. However, few effective apps are available for bereaved adults. Recently, a randomized controlled trial demonstrated the short-term beneficial effects of access to the My Grief app in mitigating symptoms of prolonged grief and posttraumatic stress in bereaved parents. The present study examined the long-term outcomes of app access and their predictors in a longitudinal survey of participants who had access to the My Grief app. We assessed symptoms of prolonged grief (PG-13), posttraumatic stress (PCL-5), and depressive symptoms (PHQ-9) at 3-, 6-, and 12-month follow-up assessments. Potential predictors of symptom change included baseline symptom levels, sociodemographic and loss-related variables, rumination (UGRS), negative grief-related cognitions (GCQ-SF), avoidance processes (DAAPGQ), and self-reported app use reported at each follow-up. Significant small-to-moderate reductions in prolonged grief, posttraumatic stress, and depressive symptoms were observed in people with app access at most follow-ups, ds = 0.26–0.66. For each symptom type, more severe baseline symptoms significantly predicted larger symptom reductions, Bs = 0.37–0.55. Lower baseline negative grief-related cognitions significantly predicted larger 3-month prolonged grief, B = −0.15, and posttraumatic stress symptom reductions, B = −0.23. Lower baseline anxious avoidance significantly predicted larger 3-month depressive symptom reductions, B = −0.23. Self-reported app use did not significantly predict symptom changes. Participants with access to the My Grief app experienced decreased symptom levels over a 1-year period. Specific cognitive behavioral processes (avoidance, negative cognitions) appear to be implicated in the short-term effects of app access.

Posttraumatic stress disorder (PTSD) poses a significant mental health challenge in postconflict Azerbaijan. This study explored the effectiveness of cognitive processing therapy (CPT) in this context, addressing a critical gap in psychotherapeutic interventions for PTSD. The study employed an intent-to-treat (ITT) analysis to assess the impact of CPT on PTSD and depressive symptoms, evaluate sustainability over 3 months, and examine changes in psychosocial functioning and well-being. A single-arm, open-label pilot dissemination project was conducted from October 2022 to April 2023. Participants (N = 103) underwent CPT led by local clinicians trained by U.S. experts. Measures included the PTSD Checklist for DSM-5 (PCL-5), Patient Health Questionnaire–9 (PHQ-9), World Health Organization Well-Being Index (WHO-5), and Brief Inventory of Psychosocial Functioning (B-IPF). Post-CPT, significant reductions were observed in PTSD symptoms, ΔM_{baseline–posttreatment} = −35.9, p < .001, d = 3.56, and depressive symptom, ΔM _{baseline–posttreatment} = −12.9, p < .001, d = 2.91. Sustained improvements in PTSD symptoms were noted at the 3-month follow-up assessment. Psychosocial functioning notably improved posttreatment ΔM _{baseline–posttreatment} = −5.6, p < .001, d = 0.75, and well-being showed a significant increase, ΔM _{baseline–posttreatment} = 7.1, p < .001, d = 1.52. This pilot trial highlights CPT's effectiveness in alleviating PTSD and depressive symptoms, improving psychosocial functioning, and enhancing well-being. Despite limitations, the findings suggest that CPT is a promising psychotherapeutic intervention for PTSD in Azerbaijan, warranting further research with larger samples and extended follow-up periods.

In this study, our aims were to (a) examine the associations between adverse childhood experiences (ACEs; i.e., childhood maltreatment, household challenges, and peer victimization) and resilience, adjusting for sociodemographic variables, and (b) test the moderating effect of emotional regulation on the association between childhood maltreatment ACEs and resilience in Royal Canadian Mounted Police (RCMP) cadets. Study data were from the RCMP Study. Participants were Cadets (N = 597, 75.0% men) who underwent a full assessment before the Cadet Training Program (CTP). Logistic regression models were used to estimate the associations between ACEs and resilience while adjusting for sociodemographic variables and to test the moderating effect of emotional regulation; adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated. Several childhood maltreatment ACEs were associated with decreased resilience among cadets after adjustment for sociodemographic covariates: physical abuse, aOR = 0.26, 95% CI [0.10, 0.68]; emotional abuse, aOR = 0.28, 95% CI [0.10, 0.79]; neglect, aOR = 0.22, 95% CI [0.09, 0.55]; exposure to intimate partner violence, aOR = 0.18, 95% CI [0.04, 0.73]; and peer victimization, aOR = 0.30, 95% CI [0.12, 0.76]. The interaction between exposure to any childhood maltreatment ACE and emotional suppression, as assessed using the Emotion Regulation Questionnaire, was significantly associated with low resilience scores, aOR = 0.94, 95% CI [0.89, 0.99]. The current results underscore the critical importance of mitigating the adverse impact of childhood maltreatment ACEs on resilience processes among cadets before the CTP.

This article introduces a special section of the Journal of Traumatic Stress devoted to new research investigating and addressing the associations among trauma exposure, posttraumatic stress disorder (PTSD), comorbid conditions, and aging. As the global population is rapidly aging, it is critical to advance understanding of the long-term health implications of trauma, PTSD, and comorbid conditions, including impacts on health, functioning, and well-being across the life course. In addition to understanding these trauma-related risks in varying populations, it is important to evaluate potential sources of resilience as well as to consider implications for health care services, including trauma-informed care, in the context of aging. This opening article introduces themes reflected in this collection of new scientific manuscripts examining a range of relevant questions and populations, which collectively contribute to this important and growing area of research in the traumatic stress field.

Although there is considerable data to support the efficacy of several treatments for trauma-related disorders, the traumatic stress field continues to struggle with adequate implementation and uptake of such treatments in real-world settings, which greatly contributes to persistent health disparities in these disorders. Task-shifting, or the ability to train frontline providers in evidence-based treatments for psychological disorders following traumatic events in various local and global community settings, may be one avenue to improve the translatability, scalability, and sustainability of effective traumatic stress treatments. In this paper, we describe a range of implementation and training efforts to bring efficacious treatments for trauma-related disorders beyond the bedside and directly into the communities that could benefit the most. Our descriptions cover the training methodologies utilized and the fidelity measurement of efforts to train frontline providers in several distinct global settings, namely Chile, Portugal, Greece, the Caribbean, and Somaliland. In addition, we describe a large-scale, city-wide implementation and evaluation of providers’ fidelity to evidence-based traumatic stress treatment within a major U.S. city for further exemplification around how task-shifting can happen at a larger, systemic, top-down level. In our descriptions, we also critically examine the challenges our teams have encountered when doing such work and highlight successful strategies that could facilitate the reduction of inequities in traumatic stress treatment worldwide.