Psychological trauma : theory, research, practice and policy最新文献

Objective: Service members and veterans (collectively, "military populations") are more likely to drop out of posttraumatic stress disorder (PTSD) psychotherapies than civilians, especially for trauma-focused treatments (Varker et al., 2021). Yet, it remains unclear whether specific protocols are linked with higher dropout risk, and no meta-analysis has investigated this for military populations. Therefore, this study aimed to conduct a secondary analysis of a large meta-analysis (Penix-Smith et al., 2025) to estimate dropout among specific PTSD treatments in United States military populations.

Method: Overall, 181 articles provided PTSD dropout rates for 232 treatments (N = 124,092 clients) among military populations.

Results: The weighted dropout rate for all PTSD interventions was 25.6%, 95% CI [22.9%, 28.5%] using a random effects model, where dropout significantly differed across treatments, Q(21) = 96.86, p < .001, I² = 98.49. Treatments linked with higher dropout included weekly formats of cognitive processing therapy (CPT; 40.1%), prolonged exposure therapy (PE; 34.7%), and virtual reality exposure therapy (37.2%). Lower dropout was linked with weekly formats of present-centered therapy (PCT; 16.1%), mindfulness-based stress reduction (17.4%), and group-based exposure therapy (6.9%). Intensive outpatient programs (IOPs) yielded the lowest dropout rates overall, even when IOPs included CPT (8.5%) and PE (5.5%).

Conclusions: Together, this study provided dropout benchmarks for specific PTSD treatments and identified treatments with the highest risk for dropout, including weekly CPT and PE. Findings suggest that resources targeting dropout and increasing the reach of treatments with lower dropout risk (e.g., PCT, IOPs) may facilitate psychotherapy engagement among military populations. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Tonic immobility (TI) is an involuntary freeze response sometimes experienced during trauma. The role of perceived substance use in influencing the experience or severity of TI is poorly understood, in part due to measurement difficulties. The goal of this study is to contrast four scoring methodologies and test the measurement invariance of the Tonic Immobility Scale (TIS) comparing sexual assaults that are or are not perceived to be associated with substance use.

Method: A total of 179 young women with sexual assault histories completed the TIS, including an added item querying their belief of whether alcohol or substances were related to their TI symptoms during past assaults. Configural, scalar, metric, and residual invariance models were tested to examine whether the TIS functioned equivalently between substance belief-endorsing and nongroups.

Results: Between-group t tests found that those who perceived substances influenced their TI symptoms (n = 63) reported significantly more paralysis, inability to move, detachment from self, and detachment from environment than no-TI peers (n = 116). We tested measurement invariance of the TIS; only Bados and Peró's Modified TIS-Brief Form model demonstrated excellent fit for configural invariance. The Modified TIS-Brief Form also retained excellent metrics following metric, scalar, and residual invariance testing.

Conclusions: There were differences in the experiences of TI between participants who believed substances impacted their experience of TI and those who did not. Our research suggests that, of the models tested, the Modified TIS-Brief Form may be superior for measuring TI. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Residual symptoms are common following posttraumatic stress disorder (PTSD) treatment. Despite the high prevalence of and poor outcomes associated with co-occurring PTSD and alcohol use disorder (AUD), only one study has examined residual symptoms following psychotherapy in a comorbid sample.

Method: Veterans (N = 71) with PTSD and AUD were randomized to receive prolonged exposure therapy (PE) with placebo (PE + PLA) or topiramate (PE + TOP). PTSD and depressive symptoms were assessed at pre- and posttreatment. Frequency counts were calculated for each residual symptom. Fisher's exact tests examined whether the percentages of participants endorsing residual symptoms differed by treatment condition, loss of PTSD diagnosis, and improvement in heavy drinking.

Results: Residual symptoms were commonly endorsed across PTSD symptom clusters. Participants who received PE + TOP endorsed fewer residual depression (ORs = 0.27-0.30) and PTSD symptoms in the alterations in mood/cognition cluster (ORs = 0.26-0.35) than those who received PE + PLA. Relative to those who retained their PTSD diagnosis, those who lost the diagnosis were less likely to endorse most residual PTSD and depression symptoms. No differences in residual symptoms were observed between those who did and did not improve in their heavy drinking.

Conclusions: The residual symptoms most likely to persist may depend on the treatment being evaluated; topiramate may have unique effects on depressionogenic symptoms while patients are taking the medication. Residual symptoms may signal a need for additional treatment if they are distressing/functionally impairing. More work is needed to understand whether symptoms are maintained or continue to improve longitudinally. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Although the scientific literature on traumatic stress is large and growing, most psychologists have only a cursory knowledge of this science. Most have no formal training in, nor apply evidence-based psychosocial treatments for, trauma-related disorders. Sixty experts took part in the 2013 New Haven Trauma Competencies consensus conference and developed a comprehensive model of trauma-focused, empirically informed competencies (knowledge, skills, and attitudes), which were approved by the American Psychological Association (APA) as part of their official education and training in 2015. This article represents a consensus revision to those competencies that were approved by the APA in 2025. This model contains broad foundational and functional competencies in the areas of trauma-focused and trauma-informed scientific knowledge, psychosocial assessment, psychosocial interventions, professionalism, and relational and systems competencies, as well as 11 cross-cutting competencies. These updated trauma competencies can provide the basis for future training of a trauma-informed mental health workforce. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: The pathway from childhood maltreatment to aggression is complex, with preliminary research identifying that the shame coping styles of Attack Other and Withdrawal may mediate this relationship. Using a cross-sectional research design, the aim of this study is to further investigate the influence of shame coping styles on the relationship between childhood maltreatment and trait aggression and whether this relationship differs by gender.

Method: A panel sample of 430 Australian participants (53% female, M_age = 45 years) completed an anonymous online survey measuring participant demographics, experiences of childhood maltreatment (Childhood Trauma Questionnaire-Short Form), shame coping styles (the Compass of Shame Scale), and trait aggression (Buss-Perry Aggression Questionnaire-Short Form).

Results: For men, childhood maltreatment had a direct effect on each shame coping style as well as trait aggression; however, no indirect effects were present. For women, childhood maltreatment had direct effects on shame coping styles and trait aggression. This relationship was partially mediated by the Attack Other coping style (β = 0.08, p = .006). No other indirect effects were present.

Conclusions: The findings of this study show the potential effect of childhood maltreatment on aggression and shame coping styles but also highlight that gender may influence this relationship. There is a clear need indicated for interventions that support people who have experienced maltreatment to understand how shame is interwoven within their emotional traits and their coping styles and give them tools to deal with other people in social interactions. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: While social support is believed to be a critical factor in posttrauma recovery, support interactions occur in context. Relatively few studies have examined public willingness to offer assistance to survivors, despite the potential for stereotypes about trauma and different exposure events to influence support. The present study examined the associations of stereotype endorsement and exposure event on willingness to offer support to hypothetical survivors.

Method: University students (N = 223) completed online measures evaluating trauma stereotypes, state affect, and social desirability. Students attended a later lab session (M = 2.4 weeks) to rate willingness to offer friendship, emotional support, and practical support to hypothetical survivors of combat, disaster, motor vehicle, and sexual trauma. Bayesian regression was used to examine the unique effects of stereotype endorsement, vignette, social desirability, and state affect on ratings of support.

Results: Stereotype endorsement predicted less willingness to offer friendship to survivors (OR = 0.53). Participants were less willing to offer friendship to combat veterans relative to survivors of sexual assault (OR = 3.84), accident (OR = 3.53), and disaster (OR = 3.32), with similar results for emotional support (assault: OR = 2.20; accident: OR = 2.45; disaster: OR = 2.23). Practical support was lower for combat relative to accident (OR = 1.55) and sexual assault (OR = 2.06) scenarios. Support ratings tended to be higher for trauma vignettes versus modal response to scenarios depicting nontrauma stressors.

Conclusions: Trauma-related stigma and the type of exposure event may hold associations with support engagement in survivor communities. Results may hold implications for interventions looking to incorporate resources from potential support networks. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Public safety personnel (PSP) are likely to encounter multiple traumatic events and are thus more likely to develop posttraumatic stress disorder than the general population. It is important, then, to identify modifiable factors that increase the risk for posttraumatic stress disorder so that preventative treatments may be developed. Anxiety sensitivity (AS; the fear of physiological arousal sensations) has been identified as one such potential modifiable risk factor. However, research on the longitudinal, reciprocal association between AS and posttraumatic stress symptoms (PTSS) in those experiencing multiple traumas is limited. The aim of the present study was to investigate the association between AS and PTSS in PSP over the course of 1 year.

Method: PSP (N = 272) recruited via social media completed self-report measures of PTSS, trauma exposure, and AS at baseline, 6 months, and 1 year.

Results: Cross-lagged panel analysis did not reveal cross-lagged associations between AS and PTSS. Instead, only Wave 2 trauma exposure negatively predicted Wave 3 PTSS.

Conclusions: Findings may be due to strong autoregressive associations (e.g., baseline PTSS predicting future PTSS) or may indicate that the association between AS and PTSS is more difficult to disentangle in populations that have already experienced multiple traumatic events. Future research should investigate this association among PSP who have yet to be exposed to potentially traumatic events to further elucidate whether AS is a risk factor worth intervention (or not) in this population. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Hypervigilance is a symptom of posttraumatic stress disorder usually defined in terms of behaviors such as environment scanning and planning escape routes. The objective of Study 1 was to develop a new measure to assess the extent to which individuals employ a specifically emotional form of hypervigilance. The aim of Study 2 was to investigate whether emotional hypervigilance is associated with posttraumatic quality of life in addition to the known effects of symptoms and experiential avoidance.

Method: Study 1 presents the development and initial testing (N = 275) of the Emotional Vigilance and Awareness Questionnaire (EVAQ). In Study 2, a nonclinical sample (N = 162) completed an online survey comprising the EVAQ, measures of posttraumatic symptoms, posttraumatic quality of life, and experiential avoidance.

Results: In Study 1, factor analyses resulted in a 12-item scale, which showed good psychometric properties in unifactorial and three factorial forms. Subscales reflected vigilance to emotion change, emotion awareness, and conscious emotion monitoring. The EVAQ showed incremental validity against the Brief Hypervigilance Questionnaire and positive associations with established measures of low mood and negative affect. In Study 2, EVAQ scores showed significant associations with experiential avoidance and posttraumatic quality of life.

Conclusions: The EVAQ is a valid and reliable new measure for assessing hypervigilance and hyperawareness of emotion, an overlooked factor in posttraumatic symptomology, particularly when considered as a unifactorial construct. The EVAQ may be useful in research and therapeutic settings with individuals who disengage with distressing emotions and present avoidant behavior. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: The research on posttraumatic stress disorder and psychosis has now shown that these experiences can be bidirectional and actually potentiate each other. This scientific knowledge provides the field invaluable insight about points of prevention for either condition so that the risk for onset of the other mental health challenge does not occur, as well as diverse information for when the experiences are fully comorbid. In this article, a conceptual model is provided outlining practical conceptual and clinical applications.

Method: By using an innovative conceptual model, this article provides more insight about understanding and using the literature we know to inform prevention of co-occurrence and a diverse approach when both disorders are present in comorbidity, actually potentiating each other, and how to then address the situation holistically, rather than in silos.

Results: Using the innovative conceptual model, this article is able to help systems and providers move toward more effective treatment of the bidirectionality of posttraumatic stress disorder and psychosis holistically and equally rather than treating either of the conditions solely, in silos, or treating one condition over the other, as this is a risk that is reductionistic and negates the true capabilities of our clinical interventions. Practical clinical applications are provided as part of this conceptual piece.

Conclusion: This conceptual model is innovative as common practice in many settings is to still prioritize one diagnosis, and this failure in treatment falls short of adequately targeting every element that makes up the complexity of experience for individuals who experience comorbid posttraumatic stress disorder and psychosis. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Dissociation is a common but underrecognized sequelae of trauma exposure. We investigated Australian psychologists' training in dissociation, assessment practices, and accuracy in identifying dissociation symptoms.

Method: Participants in this cross-sectional study of Australian psychologists (N = 280) were recruited through publicly available email addresses, graduate psychology programs, and social media. Participants estimated the percentages of their clients who had experienced trauma and had dissociative symptoms, their confidence in assessing and treating trauma and dissociation, their training in trauma and dissociation, and their dissociation screening practices. Participants were also asked to identify dissociation symptoms (per the Dissociative Experiences Scale-II and Somatic Dissociation Questionnaire-5) from a list of trauma-related symptoms.

Results: Although 99% of participants reported treating trauma-exposed clients, only 59.6% and 41.1% reported formal training in trauma or dissociation during their psychology qualification, respectively. One in five participants correctly identified all psychoform and somatoform symptoms as dissociation. Accurately identifying psychoform dissociation symptoms was associated with confidence in treating dissociation (p = .048) and having informal peer consultation on dissociation (p = .032). Accurately identifying somatoform dissociation was associated with confidence assessing (p = .006) and treating (p = .009) dissociation and having completed professional development on dissociation (p = .047).

Conclusions: Most psychologists demonstrated inaccuracies in their knowledge of dissociation, which raises concern that dissociation may not be recognized in clinical practice and thus go untreated. Training on dissociation should be incorporated into psychology curricula, particularly at the graduate level, and accessible, cost-effective professional development programs for practicing clinicians are needed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).