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

Objective: In a Department of Veterans Affairs collaborative care implementation trial, care managers (CMs) focused on engaging rural Veterans diagnosed with posttraumatic stress disorder in trauma-focused psychotherapies, specifically cognitive processing therapy and prolonged exposure therapy, delivered over telehealth. As part of a summative evaluation, we interviewed Veterans about their experience, especially their interactions with their CM. Because relatively few Veterans initiated a trauma-focused psychotherapy, we specifically asked them about their conversations with CMs to better understand what worked and what did not work with regard to treatment engagement.

Method: We conducted phone interviews with a purposive sample of 43 unique Veterans between 2017 and 2019. We purposively sampled Veterans who reported changes in satisfaction with Veterans Affairs posttraumatic stress disorder services and had experiences with different care modalities and patients who declined to initiate a trauma-focused psychotherapy. Data were analyzed using deductive-inductive content analysis.

Results: Overall, Veterans perceived CMs as helpful in three ways: (a) for care coordination-especially with therapists; (b) as a "voice of concern"-for Veterans' health and daily life; and (c) as a "side counselor"-helping prepare Veterans for appointments and following up after their trauma-focused psychotherapy sessions.

Conclusions: Veterans appreciated many qualities about their CM unrelated to trauma-focused psychotherapy. For those engaging in trauma-focused psychotherapy, CMs played the role of "side counselor" helping them stay engaged in care. Understanding patient perspectives about CMs' roles can help other types of providers understand how to best engage patients in trauma-focused psychotherapies. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Exposure to chronic structural stressors (e.g., poverty, community violence, and discrimination) exacerbates posttraumatic stress disorder (PTSD) symptoms and reduces how adolescents benefit from trauma-focused interventions. However, current evidence-based PTSD interventions seldom include concrete guidance regarding how to target chronic structural stressors in care.

Method: This study utilized qualitative thematic analysis of audio-recorded PTSD therapy sessions with 13 racially diverse, low socioeconomic status adolescents to elucidate (a) how often adolescents disclose chronic structural stressors in therapy, (b) the types of chronic structure stressors that are disclosed, and (c) the context in which chronic structural stressors are disclosed and the content of these disclosures.

Results: 77% of adolescents disclosed at least one chronic structural stressor and that the presence of stressors exacerbated psychological distress, reduced treatment engagement, and decreased perceptions of intervention effectiveness.

Conclusions: Our findings suggest that there is a missed opportunity to improve the effectiveness of treatment for PTSD by incorporating intervention elements that directly target structural stressors. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Individuals with histories of complex psychological trauma, such as those with dissociative disorders, are often high utilizers of inpatient services and thus warrant further research attention. The present study sought to examine whether treatment on a specialized inpatient trauma unit was associated with improvements in adaptive functioning, emotion regulation, and dissociation among patients experiencing complex posttraumatic and dissociative symptoms.

Method: This study used archival data collected as part of treatment provided to inpatients (N = 54), the majority of whom had a dissociative disorder, at a specialized trauma disorders unit to analyze differences in scores between intake and discharge on measures of adaptive functioning, emotion regulation, and dissociation.

Results: Adaptive functioning and emotion regulation were significantly improved at discharge compared to intake, t(299) = -11.28, p < .001; t(305) = 8.54, p < .001, respectively, with very large effect sizes (d = 1.60; d = 1.20), and there was a significant decrease, t(311) = 2.15, p = .032, d = .30, in dissociative absorption.

Conclusions: Our findings suggest that inpatient treatment modeled after expert consensus treatment guidelines is associated with significant improvements in adaptive functioning and emotion regulation and reduced dissociative absorption in individuals experiencing severe and acute complex posttraumatic and dissociative symptoms. Appropriate screening and symptom-specific treatment of complex posttraumatic and dissociative symptoms are recommended to improve outcomes for this population during inpatient hospital admission. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Evidence-based treatments are urgently needed for individuals with trauma-related dissociation (TRD), including severe dissociative disorders, the dissociative posttraumatic stress disorder (PTSD) subtype, and complex PTSD (International Classification of Diseases-10). TRD is strongly associated with severe trauma, a more refractory treatment course, and high suicidality and nonsuicidal self-injury. We evaluated changes in symptoms and adaptive capacities in individuals with high TRD through participation in an adjunctive online program based on the Finding Solid Ground (FSG) psychoeducational program.

Method: We provide an interim report on an ongoing, randomized controlled trial of FSG on an international sample of 291 outpatients with dissociative identity disorder, dissociative PTSD, other specified dissociative disorders, complex PTSD, or dissociative disorder, unspecified (International Classification of Diseases-10). Outpatient therapists continued to provide psychotherapy. Participants were randomly assigned to either receive immediate access to FSG or be on a 6-month waitlist before accessing FSG. We did not exclude for suicidality, nonsuicidal self-injury, recent or concurrent hospitalization, or substance abuse.

Results: Although initially comparable on outcome measures, at 6 months into the study, the Immediate FSG group showed significant improvement in emotion regulation, PTSD symptoms, self-compassion, and adaptive capacities in comparison to the Waitlist group. At 12 months, the Immediate group showed large effect size changes in these areas compared to study entry (|g|s = 0.95-1.32). The Waitlist group showed comparable improvements after accessing the FSG program for 6 months.

Conclusions: This randomized controlled trial demonstrates that adding FSG to psychotherapy of individuals with TRD results in improvements in emotion regulation, PTSD symptoms, self-compassion, and adaptive functioning. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Posttraumatic stress disorder (PTSD) and more complex posttraumatic symptomatology (i.e., dissociative PTSD [D-PTSD] and complex PTSD [CPTSD]) are differently described in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) and the International Classification of Diseases (11th ed.; ICD-11). Although the choice of system may affect diagnostic prevalence rates and treatment outcome, less is known about the more complex symptoms and their associated risk factors.

Method: To investigate both D-PSTD and CPTSD in Northern Irish military veterans (n = 436) using latent class analysis and associated risk factors to gain a deeper understanding of the potential implications of applying one diagnostic system instead of the other.

Results: The latent class analyses revealed a DSM-5 four-class solution and an ICD-11 five-class solution with both a highly symptomatic D-PTSD class (27.52%) and CPTSD class (27.9%) identified. Similar associations with risk factors were found across the diagnostic systems (e.g., medium to strong effect sizes for prior traumatic exposure, depression, anxiety, dissociation, and alcohol use).

Conclusions: Both D-PTSD and CPTSD appear to be highly prevalent among Northern Irish veterans, and interestingly, similar effect sizes were found for the investigated risk factors for highly symptomatic groups across diagnostic systems. Research is needed to determine the generalizability of the results. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

One in three women 15 years and older will experience interpersonal violence (IpV), including physical or sexual violence, at some point in their life. While the general psychological benefits of religion and spirituality (RS) are well known, research has not thoroughly examined RS coping and psychological outcomes in IpV-exposed women. When evaluating generational differences in RS concepts, literature reveals concepts such as God image vary across generation; however, literature does not address generational differences in RS coping, particularly in IpV-exposed women.

Objective: This study seeks to examine the psychological outcomes and religious coping styles of women who are exposed to IpV as it relates to generational differences.

Method: A national stratified convenience sample of women in the United States (N = 1,165) was recruited online using the Qualtrics crowdsourcing service. Participants (n = 538) who reported having experienced interpersonal violence (i.e., sexual assault, physical assault, assault with a weapon) were designated as the IpV group. Those (n = 627) who reported no exposure to these events were designated as a no IpV comparison group (Non-IpV).

Results: Several two-way analyses of variance revealed that there was a statistically significant interaction between generations and IpV for depression, F(2, 1159) = 3.78, p = .023, anxiety, F(2, 1159) = 4.77, p = .009, stress, F(2, 1159) = 4.10, p = .017, and positive religious coping, F(2, 1,159) = 3.57, p = .028.

Conclusions: These results suggest that generational differences may exist in psychological outcomes and RS coping in women who have experienced IpV compared to comparison groups. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Given the high prevalence of posttraumatic stress disorder (PTSD) symptoms in incarcerated forensic populations, this meta-analysis estimated the efficacy of interventions in this field and explored predictors of intervention outcomes.

Method: Twelve randomized controlled trials of psychological interventions for PTSD symptoms in incarcerated forensic populations were included. A combined Hedges's g effect size was synthesized, quality assessments and risk of bias analyses were performed, and publication bias was assessed. Gender and type of control group were explored as predictors.

Results: Thirteen comparisons from 12 studies were included in the main analysis. A small to medium combined effect size (g = 0.43, p = .005) was found at posttreatment. The type of control group (p = .156) and gender (p = .953) did not predict outcomes. When we analyzed the available follow-up data (k = 5), the effect was nonsignificant (g = 0.36, p = .123). Study quality was poor and risk of bias high, and studies of first-line PTSD treatments were not found in the literature.

Conclusions: A few studies suggest that PTSD treatment may improve symptoms in incarcerated forensic populations, at least temporarily. Follow-up data are still too scarce to draw conclusions about long-term outcomes. Findings of this study indicate that methodologically rigorous outcome research in these populations is needed, with a specific focus on first-line PTSD treatments, long-term efficacy, measurement of recidivism, as well as addressing comorbid conditions given the common complex clinical and social needs in this population. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Prolonged Exposure for Primary Care (PE-PC) leverages an opportunity to provide evidence-based posttraumatic stress disorder (PTSD) care in the PC setting where many veterans present for services and can greatly increase treatment access. However, such acute, short-term intervention may not be effective for all PTSD patients.

Method: We analyzed data from a randomized clinical trial evaluating PE-PC to determine who may or may not benefit from PE-PC. We identified both PTSD symptom and general functioning trajectories for veterans with chronic PTSD in Veterans Administration primary care settings.

Results: For PTSD symptoms, four trajectory patterns emerged, and for functional impairment, three emerged. Demographics, treatment expectancy, and credibility did not predict PTSD symptom or functional impairment trajectories. While baseline depression severity and functioning were initially predictive, only baseline PTSD symptoms were predictive of PTSD symptom trajectories once this variable was considered. Similarly, while baseline depression and PTSD severity were initially predictive of functional trajectories, only baseline function was predictive of function trajectories once this variable was included.

Conclusion: PE-PC may be particularly appropriate and effective for veterans presenting to primary care with moderate PTSD symptoms or functional impairment. Replication and examination of trajectories in a larger effectiveness sample is warranted. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Dissociative symptoms are prevalent and are associated with considerable impairments. There are ongoing debates regarding how to conceptualize these phenomena. This study examined whether dissociative symptoms could be explained by coping and emotion regulation strategies.

Method: We conducted a secondary analysis of data from a randomized controlled trial. A total of 115 Hong Kong Chinese adults completed standardized self-report assessments of trauma exposure, dissociative symptoms, coping, and emotion regulation at baseline. They provided data regarding dissociative symptoms again after 2 months.

Results: After controlling for baseline dissociative symptoms and trauma exposure, baseline active coping (β = -.157, p = .035) and dysfunctional coping (β = .227, p = .005) predicted more subsequent dissociative symptoms at follow-up. Furthermore, baseline dysfunctional coping mediated the relationship between trauma exposure and subsequent dissociative symptoms.

Conclusions: This study provides insights into the ongoing debate concerning factors that could contribute to dissociation. As dysfunctional coping could particularly predict dissociative symptoms, we call for future studies to evaluate whether coping skills training could effectively prevent and treat dissociative symptoms. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Royal Canadian Mounted Police (RCMP) are among the public safety sectors reporting the highest exposures to diverse potentially psychologically traumatic events (PPTEs), which contribute to the risk of developing mental health disorders. Current increases in prevalence of mental health disorders among RCMP are substantial and warrant updated prevalence estimates of PPTE exposures. The objective of the present study was to provide updated estimates of lifetime PPTE exposures among RCMP and assess for associations with mental disorders and sociodemographic variables.

Method: Participants (n = 1,348) completed a survey assessing self-reported sociodemographic information, PPTE exposures as measured by the Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) Extended, and mental health disorder symptoms.

Results: Participants reported exposure to more PPTE types (∼13) than previous samples of RCMP (∼11) and public safety personnel (PSP) (∼11). Prevalence for all the PPTE types was statistically significantly higher for the current sample than previously reported samples of PSP and RCMP, and higher than the Canadian general population. Participants reported highest exposures through any modality (i.e., directly or indirectly) to sudden violent death (98.3%), physical assault (97.9%), serious transport accident (97.0%), sudden accidental death (96.7%), and assault with a weapon (93.7%). Most PPTEs were statistically significantly associated with screening positive for posttraumatic stress disorder, major depressive disorder, generalized anxiety disorder, social anxiety disorder, and panic disorder, but not alcohol use disorder.

Conclusion: Increased PPTE exposures reported by current participants compared to a previous sample of RCMP, coupled with the observed associations between PPTE exposures and mental health disorders, highlights the need for further resources and support for RCMP to mitigate and manage the impact of PPTEs. (PsycInfo Database Record (c) 2025 APA, all rights reserved).