Journal of traumatic stress最新文献

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.

Cognitive processing therapy (CPT) targets maladaptive beliefs called “stuck points,” which are typically assessed using standardized measures (e.g., the Posttraumatic Cognitions Inventory [PTCI]). This study examined whether changes in person-specific individualized stuck points (ISPs) were associated with reductions in self-reported and clinician-rated posttraumatic stress disorder (PTSD) symptoms and whether ISPs predicted PTSD severity beyond general stuck points (GSPs) measured using the PTCI. Adults (N = 57) with PTSD received 1-week massed virtual CPT via one of two randomized controlled trials. ISPs were tracked, and ISP belief strengths were rated after every other session and at 1- and 3-month follow-ups. Linear mixed-effects models examined associations between ISP changes and self-reported (PTSD Checklist for DSM-5 [PCL-5]) and clinician-rated PTSD (Clinician-Administered PTSD Scale for DSM-5 [CAPS-5]) symptom reductions, adjusting for baseline depression, gender, age, and treatment condition. Participants showed large reductions in PTSD symptoms from baseline to 1-month follow-up, M_{PCL-5 reduction} = 29.4, d = 2.02; M_{CAPS-5 reduction} = 10.49, d = 0.72. Average ISP belief strength decreased by 50.2% during treatment and up to 1-month follow-up, d = 2.75. Higher numbers of ISPs also predicted reduced PCL-5 scores, p = .021, R² = .02. However, when controlling for PTCI score, ISPs no longer significantly predicted PTSD symptom change, ps = .352–.534, whereas PTCI scores remained significant predictors, p < .001. ISP reductions were associated with PTSD symptom improvements but did not predict outcomes beyond PTCI-assessed GSPs. Tracking ISPs may still be valuable for tailoring therapy and enhancing patient engagement.

The neuroendocrine profile of aggressive adolescents shows inconsistencies, potentially influenced by trauma exposure. Specifically, the hypothalamic–pituitary–adrenal (HPA)–oxytocinergic circuitry may vary among aggressive youth based on past trauma exposure, with a positive interplay between cortisol and oxytocin in those with higher levels of trauma, as a result of the simultaneous hormone release to cope with trauma-related stress. To explore this hypothesis, this study collected saliva samples at three time points (morning, afternoon, and evening) over 2 consecutive days from male adolescents (N = 57, M_age = 17.95 years, SD = 2.44) in residential youth care facilities. In addition, the Childhood Trauma Questionnaire was administered to assess the presence and frequency of trauma exposure. A linear mixed-effects model showed a significant interaction effect, B = 0.06, p = .015, ΔR² = .013, with simple-slope analysis showing a positive association between cortisol and oxytocin in residential youth with higher levels of childhood trauma exposure, B = 0.08, p = .007, but not those with lower levels of trauma exposure, consistent with our predictions. These findings suggest a possible compensatory mechanism in response to trauma and emphasize the need to consider trauma exposure when further investigating the neuroendocrine profile of aggression.

This article is based on a Lifetime Achievement Award lecture delivered at the 40th Annual Meeting of the International Society for Traumatic Stress Studies in Boston (Massachusetts, United States) in September 2024. Understanding traumatic memory involves integrating clinical observations with a wide range of knowledge from philosophy, cognitive and social psychology, and neuroscience. I present definitions of traumatic memory; distinguish voluntary from involuntary forms, such as flashbacks; and introduce relevant concepts that can situate the clinical symptom within a wider framework. The distinction between flashbacks and standard episodic memory has important implications, and I discuss how the methods used to study traumatic memory can preserve it. Using this same perspective, I then review emerging evidence concerning the nature, neural underpinnings, and origin of traumatic memories. The final section reviews some significant unanswered questions for the future. These include the impact of traumatic memories on the experience of self and the implications of delayed onsets for postulating a family of posttraumatic stress disorders with different underlying mechanisms.

The prevalence of posttraumatic stress disorder (PTSD) among women is over twice that of men, but the underlying mechanisms for these differences remain poorly understood. This study introduces a novel approach to examining gender and PTSD, moving beyond the binary group labels of male and female to explore the summative impact of gender-linked sociocultural factors. Using supervised machine learning, we modeled gender from theoretical and empirically selected predictors reflecting the roles, relationships, and institutional facets of gender. This model produced continuous gender scores reflecting the social circumstances typical of male (lower scores) or female (higher scores) individuals. We then examined how well these scores were associated with past-year PTSD among trauma-exposed men and women (N = 23,936) and compared effects to those obtained using binary sex. The results revealed a clear dose–response relationship between the social circumstances typical of female gender and past-year PTSD. Main effects for gender scores, adjusted odds ratio (aOR) = 4.03, 95% CI [2.64, 6.15], were substantially larger than main effects for binary sex, aOR = 2.69, 95% CI [1.96, 3.68], z = 2.30, p = .021, even after accounting for trauma exposure and other risk factors. This study highlights the importance of quantitative approaches that move beyond binary comparisons of male and female to better elucidate sociocultural determinants of traumatic stress.

Anger is a natural, adaptive emotion that is culturally accepted in military settings. Problematic anger (i.e., intense anger paired with significant distress and functional impairment linked to) is gaining attention in military and veteran populations. This study examined problematic anger in 882 Canadian Armed Forces personnel and veterans referred to a specialized mental health clinic. Intake assessments included measures of anger, psychological conditions, and military and demographic variables. Approximately 63% of participants reported problematic anger. Respondents who endorsed problematic anger had higher rates of posttraumatic stress disorder (PTSD) symptom severity, d = 1.06; depression, d = 0.82; anxiety symptom frequency, d = 0.94; and harmful drinking, d = 0.36, ps < .001, compared to those who did not. Sequential linear regression analyses demonstrated that PTSD symptom severity, B_adjusted = 0.18, 95% CI [0.16, 0.20], R² = .37, and anxiety symptom frequency, B_adjusted = 0.55, 95% CI [0.49, 0.61], R² = .33, accounted for the largest proportion of the variance in problematic anger symptom severity. This is the first study to report on problematic anger in a Canadian military/veteran context, and the results suggest that almost two thirds of veterans endorsed problematic anger, which is higher than previously reported prevalence rates. This study is a starting point for better understanding risk and vulnerability factors for problematic anger among Canadian military personnel and veterans and clarifying the associations among problematic anger, PTSD, and anxiety symptoms. Implementing standardized screening for problematic anger may improve diagnostic precision, treatment planning, and outcomes.