Journal of traumatic stress最新文献

Written exposure therapy (WET) has emerged as a promising treatment for posttraumatic stress disorder (PTSD) with the potential to overcome common barriers to engagement. Several facets of WET lend themselves particularly well for adaptation to a group setting, yet few studies have examined WET in such formats. The objective of the present study was to present preliminary feasibility, acceptability, and clinical outcome data from a quality improvement project conducted in an outpatient psychiatry clinic that included patients who engaged in a virtual WET group. Participants were 28 adults from six WET group cohorts that occurred between January 2024 and March 2025. Overall attendance was strong (78.2%), with 67.9% of participants completing at least five of the six weekly sessions. Patient satisfaction ratings were high (80.0%), and 86.7% of participants indicated that they would recommend the group to other individuals struggling with trauma symptoms. Acceptability ratings were also largely supportive of the virtual (vs. in-person) and group (vs. individual) formats. There were large effect sizes for pre–post improvement in PTSD symptoms (PCL-5: M = 52.6 vs. 33.0), d = 1.39, and depressive symptoms (PHQ-9: M = 14.2 vs. 9.9), d = 0.86, among participants who completed the group. Our study provides preliminary data suggesting the feasibility and acceptability of a virtual WET group delivered in a naturalistic community setting, with strong attendance and high patient satisfaction. There is significant benefit to standardizing a group-based WET protocol and substantiating clinical benefits through a fully powered randomized controlled clinical trial.

Suicide is one of the leading causes of death among military personnel, and help-seeking is crucial to combating it. Research has not yet investigated the role that potentially morally injurious events (PMIEs), particularly betrayal, may play in moderating the effect of battlefield experiences on these variables. Data from 694 U.S. Army personnel, all of whom had at least one combat deployment, were analyzed to examine battlefield life-threatening experiences (LTEs), suicidal ideation, help-seeking behavior, PMIEs, depressive symptoms, anxiety symptoms, posttraumatic stress disorder (PTSD) symptoms, and aggression. Analyses revealed a significant interaction between LTEs and betrayal-type PMIEs predicting both a higher likelihood of suicidal thoughts and planning, relative risk ratio = 1.729, z = 2.13, p = .034, 95% confidence interval (CI) [1.043, 2.863], and help-seeking from fewer sources, incident rate ratio = 0.927, z = −2.26, p = .024, 95% CI = [0.868, 0.990]. These effects held even when controlling for depressive symptoms, anxiety symptoms, PTSD symptoms, and aggression. The findings suggest that betrayal-type PMIEs have a significant moderating effect on the impact of LTEs on suicidal ideation and help-seeking behavior, and this effect cannot be explained by the experience of the other four measured symptoms of psychological distress.

This commentary examines the application of Bonanno and Westphal's (2024) three axioms of resilience to military contexts. Drawing on international research, we evaluate evidence supporting the three propositions: resilience is the predominant outcome following trauma exposure, multiple factors contribute modestly to resilience, and resilience emerges from flexible self-regulation. We demonstrate how these axioms manifest in military populations, who face unique operational stressors with, at times, limited access to conventional coping resources. We propose methodological approaches for measuring resilience longitudinally across individual and organizational domains and discuss implications for military training that focuses on developing diverse coping strategies rather than bolstering single traits. The commentary emphasises the value of a data-driven approach wherein military personnel act as their own scientists, systematically evaluating whether a coping strategy is working and adapting accordingly. We highlight the critical interdependence between individual and organizational resilience in maintaining mental health among military personnel who face repeated trauma exposure.

Despite elevated rates of psychopathology, refugees underutilize mental health services. Mental health self-stigma is a prominent barrier to accessing psychological support; however, there is limited research on intervention approaches to reduce self-stigma among refugees. The present study aimed to provide further support for the Tell Your Story (TYS) intervention in reducing self-stigma and increasing help-seeking among Arabic-speaking male and female refugees. In this randomized controlled trial (RCT), 67 Arabic-speaking refugees with self-stigma and at least subthreshold posttraumatic stress symptoms (PTSS) were randomly allocated to the TYS group or waitlist control group. At baseline, postintervention, and 3-month follow-up, participants completed assessment measures indexing measures of self-stigma (related to symptoms and help-seeking) and help-seeking (intentions and behavior). Poisson regression analyses revealed that participants in the TYS group demonstrated more help-seeking behavior at 3-month follow-up than those in the waitlist control group, Hedges’ g = 0.67. However, linear mixed models showed that the waitlist control group demonstrated larger decreases in PTSD-related self-stigma across time, T2: g = 0.07, T3: g = 0.04, whereas no significant group differences were observed for self-stigma related to help-seeking. Although the findings were mixed and suggest a need for further investigation in a larger RCT with a sample of refugee men and women, the results provide support for the intervention's utility in expanding one's help-seeking network in a population with low treatment uptake.

A randomized clinical trial was conducted comparing the effectiveness of motivational interviewing (MI) versus MI with trauma-informed affirmative care (AC; i.e., MI+AC) to reduce adverse psychiatric symptoms and facilitate entry into formal mental health services for sexual and gender minority (SGM) men who experienced sexual trauma. The sample consisted of SGM men who were survivors of sexual trauma (N = 354, M_age = 35 years, range: 18–75 years, 41.8% racial/ethnic minority), screened positive for depression, and were not actively engaged in mental health treatment. Participants were randomly assigned to one of two conditions (MI or MI+AC), each consisting of six online group sessions delivered by trained peers with lived experience of sexual trauma. Trained peers delivered both versions of MI as intended, with high fidelity and competence (independently rated), and assessments occurred at baseline, posttreatment, and 2- and 4-month follow-ups. SGM men in both conditions reported decreases in depression and increases in mental health service utilization, but there were no between-group differences in these outcomes over time. However, the results demonstrated superior efficacy of MI+AC regarding reducing posttraumatic stress disorder symptoms, B = −1.13, ΔR² = .001, p = .039, and barriers to health care seeking compared to MI, B = −2.00, ΔR² = .002, p = .009. These data support the value of enhanced AC that centers trauma and minority stress in treatment.

At the 2024 annual meeting of the International Society for Traumatic Stress Studies, a panel of three esteemed scientists participated in a discussion of the history and impact of research focused on military veterans who served during the Vietnam War era and the legacy this work has had on the field of traumatic stress in the half-century since that time. Dr. Terence Keane has been at the forefront of traumatic stress research since the beginning and has guided the development of assessment measures, evidence-based treatment for posttraumatic stress disorder (PTSD), and the field's understanding of the nature and impact of traumatic stress symptomatology. Dr. Kathryn Magruder has contributed to the understanding of the epidemiology of PTSD and related disorders and played a critical role in examining the long-term health and well-being of women Vietnam veterans. Dr. Frank Weathers has led the development and revisions of multiple measures, including the PTSD Checklist and the Clinician-Administered PTSD Scale, the gold-standard tools for the screening and diagnosis of PTSD. The panel members’ experience is wide-ranging, encompassing the study of the etiology of PTSD, contributions to large-scale epidemiological studies of PTSD, multisite clinical trials, and a focus on the reliable assessment of trauma exposure and PTSD symptoms. These individuals are leaders in the field who, over the course of their careers, have contributed in important ways to the understanding of trauma and PTSD. This panel discussion offered a retrospective review of the development of the traumatic stress field, with a focus on research specifically conducted with Vietnam veterans and the lessons learned from working with this important cohort of veterans.

The South Asian diaspora is one of the largest racial/ethnic diasporas in the world. Limited psychological research and practice have focused on the traumatic experiences of South Asian individuals in this diaspora, and even less work has examined how these traumatic experiences are inextricably linked with historical and ongoing colonial context; migration and displacement; and intersectional identity based on religion, race, gender, nationality, and more. Additionally, scant research has focused on tangible solutions to these grave gaps in mental health care—how to best disseminate and implement culturally congruent interventions, enhance policy for trauma-informed work, and best attend to the culturally informed needs of South Asian mental health trainees. This narrative review examines the current psychological literature on trauma among South Asian individuals in the diaspora from a translational perspective. We review (a) South Asian history using a trauma-focused lens, (b) the types and prevalence of traumatic experiences, (c) trauma interventions, (d) trauma-related dissemination and implementation efforts, and (e) trauma-informed policy initiatives. We note from the outset that due to the limited work on the diaspora, much of this review inadvertently also reviews extant work on trauma among South Asians residing in South Asia, which is distinct but related to diasporic experiences. Recommendations for the traumatic stress field, community members and lay providers, and implications for the training of South Asian students preparing for careers in mental health are discussed.

Hypertension is a known risk factor for cardiovascular disease, a leading cause of death for older adults. Posttraumatic stress disorder (PTSD) may increase the likelihood of developing hypertension; however, little is known about this association in older adult male and female veterans. To better understand the ways in which aging and biological sex impact the link between PTSD and hypertension, the present study used data from two cohorts of older adult Vietnam Era veterans (women: N = 4,104, M_age = 67.4 years; men: N = 5,767, M_age = 61.9 years). Veterans completed a telephone structured clinical interview assessing lifetime PTSD and self-reported hypertension diagnosis, age of onset, and past-year treatment. Weighted logistic regression analyses adjusted for relevant covariates revealed an association between PTSD and a higher likelihood of hypertension in male veterans, OR = 1.57, 95% CI [1.30, 1.91]. There was no association between lifetime PTSD and hypertension in female veterans, OR = 0.93; 95% CI [0.77, 1.11]. Exploratory secondary analyses suggested an association between PTSD and hypertension onset in early and middle adulthood in men. PTSD was not associated with past-year hypertension treatment. Overall, these findings suggest that PTSD may contribute to hypertension risk in older adult male veterans, which has important implications for their long-term cardiovascular health. The association between PTSD and hypertension may differ across the lifespan and for male and female veterans. Additional prospective research is needed to confirm these findings and further clarify the association between PTSD and hypertension to inform veteran clinical care.

Posttraumatic stress disorder (PTSD) is associated with both cognitive deficits and an increased risk of dementia. Few studies, however, have examined the association between PTSD and cognitive decline in the context of parameters important to brain aging, including health conditions and genetics (e.g., APOE Ɛ4 status). National Alzheimer's Coordinating Center data were used to investigate the associations between lifetime PTSD status and working memory, immediate and delayed episodic memory, and executive functions over 7 years in 11,961 older adults with (n = 179) and without PTSD. Inverse probability weighting was used to mitigate confounding variables. Linear mixed-effects models were fit to weighted data. Sex, race, and APOE Ɛ4 status were examined as moderators. Lifetime PTSD was associated with an additional 0.031 standard deviations of decline in working memory annually, B = −0.031, 95% CI [−0.055, −0.007]. There was no significant PTSD x Time interaction for other cognitive domains. Sex moderated the associations between PTSD and working memory, B = 0.067, SE = 0.03, and delayed recall, B = 0.063, SE = 0.03, such that, among individuals with PTSD, men demonstrated faster decline than women. APOE Ɛ4 moderated the associations between PTSD and delayed recall, B = −0.106, SE = 0.03, and executive functions, B = 0.061, SE = 0.02; among individuals with PTSD, APOE Ɛ4 carriers showed faster and slower decline, respectively, than noncarriers. PTSD in older adults is associated with accelerated decline in working memory. Men and/or APOE Ɛ4 carriers may be important targets for early cognitive decline prevention.

This paper is an edited transcript of a plenary panel held at the 2024 Annual Meeting of the International Society for Traumatic Stress Studies (ISTSS) in Boston, Massachusetts, United States. The panel comprised Drs. Mark Creamer (moderator), Richard Bryant (convenor), Amy Lehrner, Barbara O. Rothbaum, Joseph I. Ruzek, and Paula P. Schnurr. Bringing together clinicians and researchers with a diverse range of views, the panel sought to explore some of the pressing issues confronting the field. Following opening comments, the discussion addressed topics such as: “What is covered under the rubric of ‘psychedelics’?,” “Is there too much hype?,” “What is the role of psychotherapy?,” “What are the putative mechanisms of change?,” and “What are the key ethical issues?” Audience questions were followed by brief closing comments. Despite disagreements, there was a high level of consensus that psychedelic-assisted psychotherapy represents an exciting possibility for people living with posttraumatic stress disorder who have not responded to existing evidence-based treatments. Equally, there was agreement that considerably more rigorous research is required before definitive conclusions can be drawn regarding the specific components and efficacy of these approaches. Ethical concerns, particularly regarding accessibility, will present a significant challenge for provider organizations.