<div><h3>Introduction</h3><div>Young’s Schema therapy has shown effectiveness in treating individuals diagnosed with Complex Post-Traumatic Stress Disorder (C-PTSD) (Ubico et al., 2025). Dissociative symptoms are frequently observed in this clinical presentation. However, how do they evolve over the course of treatment? To address this, we have developed a psychotherapeutic program that integrates group and individual therapy, grounded in Contextual Schema Therapy (Roediger et al., 2018). This program also draws on key principles from psychotraumatology, particularly the theory of structural dissociation of the personality (Van der Hart et al., 2006). While these theoretical frameworks share certain conceptual foundations, they differ in how they understand dissociation and in the therapeutic strategies they propose. Still, given the well-documented influence of therapeutic alliance and group cohesion on treatment outcomes, the common factors model of psychotherapy may offer a valuable, integrative lens. This raises a central question: What mechanisms of change can be observed in an individual with Complex PTSD undergoing a combined group and individual psychotherapy program?<!--> </div></div><div><h3>Methodology</h3><div>This study employs a mixed-methods design grounded in Fishman’s (2017) pragmatic case study methodology. Standardized instruments were administered at four time points: pre-treatment (T0), mid-group therapy (T1; after 10 sessions), post-group therapy (T2; after 20 sessions), and at a three-month follow-up (T3). Variables assessed encompassed complex post-traumatic stress symptoms, psychoform and somatoform dissociative symptoms, quality of life, and the therapeutic alliance. Group cohesion was evaluated at the conclusion of each of the twenty group sessions. The clinician-researcher also conducted monthly assessments utilizing the Dimensions of Therapeutic Movement Instrument (DTMI) for complex trauma. At the conclusion of therapy (T2), an independent clinical psychologist conducted a research interview to explore various dimensions of change. A thematic analysis (Braun & Clarke, 2006) was conducted to identify emerging themes from the interview.</div></div><div><h3>Results</h3><div>The trajectory of the combined psychotherapy is delineated in detail. By the conclusion of treatment, a substantial reduction in complex post-traumatic symptoms, along with psychoform and somatoform dissociative symptoms, was observed, with these improvements sustained at follow-up. Quality of life also demonstrated notable enhancement. Regarding common therapeutic factors, the therapeutic alliance progressively strengthened throughout the course of treatment. In contrast, group cohesion declined sharply at the tenth session but subsequently improved and stabilized following the resolution of a rupture within the group. The research interview highlighted several therapeutic gains, including symptom reduction, the contribution of group therapy, t
杨氏图式疗法在治疗诊断为复杂创伤后应激障碍（C-PTSD）的个体方面显示出有效性（Ubico et al., 2025）。这种临床表现经常出现分离性症状。然而，它们在治疗过程中是如何演变的呢？为了解决这个问题，我们开发了一种基于情境图式疗法（Roediger et al., 2018）的心理治疗方案，将团体和个人治疗结合起来。该项目还借鉴了心理创伤学的关键原则，特别是人格结构分离理论（Van der Hart et al., 2006）。虽然这些理论框架共享某些概念基础，但它们在如何理解解离和提出的治疗策略方面有所不同。尽管如此，考虑到治疗联盟和团体凝聚力对治疗结果的良好影响，心理治疗的共同因素模型可能提供一个有价值的综合视角。这就提出了一个核心问题：在接受团体和个人联合心理治疗项目的复杂PTSD患者身上，可以观察到什么样的变化机制？本研究采用基于Fishman（2017）实用案例研究方法的混合方法设计。在四个时间点使用标准化工具：治疗前（T0）、组中治疗（T1； 10次治疗后）、组后治疗（T2； 20次治疗后）和三个月随访（T3）。评估的变量包括复杂的创伤后应激症状、精神和躯体形式的分离症状、生活质量和治疗联盟。小组凝聚力在20次小组会议结束时进行评估。临床研究人员还利用治疗运动仪器（DTMI）对复杂创伤进行了每月评估。在治疗结束时（T2），独立的临床心理学家进行了一次研究访谈，以探索变化的各个维度。进行主题分析（Braun & Clarke, 2006）以确定访谈中出现的主题。结果详细描述了综合心理治疗的发展轨迹。治疗结束时，观察到复杂的创伤后症状以及精神和躯体形式的分离症状显著减轻，这些改善在随访中持续存在。生活质量也有显著提高。在共同治疗因素方面，治疗联盟在整个治疗过程中逐渐增强。相比之下，集团凝聚力在第十届会议上急剧下降，但随后在解决集团内部的分裂后有所改善和稳定。研究访谈强调了几项治疗成果，包括症状减轻、团体治疗的贡献、综合方法的价值、对心理功能的深入了解、人际关系的改善、自信心的增强、情绪调节的增强、治疗工具的使用以及治疗关系的核心重要性。这些发现是在现有的关于创伤后和分离症状以及相关合并症的文献的背景下进行检验的。通过结构分离理论和Liotti对创伤性和分离性个体无组织依恋的概念分析了参与者的整合过程。该研究进一步证实了图式治疗技术的有效性，包括椅子工作和意象重写。此外，这些发现与现有的关于常见治疗因素的研究相一致，强调了情绪突出体验在促进心理变化方面的重要性。这一个案研究举例说明了两种有助于转变的治疗方式之间的相互作用和周期性相互作用：个体治疗，侧重于心理过程和创伤处理，团体治疗，侧重于人际动态。局限性和未来方向虽然单例设计限制了研究结果的普遍性，但本研究为未来的研究和临床创新提供了有希望的途径。
{"title":"Integrating group and individual psychotherapy for complex PTSD: A pragmatic case study","authors":"Emilie Ubico , Christelle Ziebel , Baptiste Alleaume , Caroline Vieilleribière , Christelle Anglade , Nathalie Duriez","doi":"10.1016/j.ejtd.2025.100593","DOIUrl":"10.1016/j.ejtd.2025.100593","url":null,"abstract":"<div><h3>Introduction</h3><div>Young’s Schema therapy has shown effectiveness in treating individuals diagnosed with Complex Post-Traumatic Stress Disorder (C-PTSD) (Ubico et al., 2025). Dissociative symptoms are frequently observed in this clinical presentation. However, how do they evolve over the course of treatment? To address this, we have developed a psychotherapeutic program that integrates group and individual therapy, grounded in Contextual Schema Therapy (Roediger et al., 2018). This program also draws on key principles from psychotraumatology, particularly the theory of structural dissociation of the personality (Van der Hart et al., 2006). While these theoretical frameworks share certain conceptual foundations, they differ in how they understand dissociation and in the therapeutic strategies they propose. Still, given the well-documented influence of therapeutic alliance and group cohesion on treatment outcomes, the common factors model of psychotherapy may offer a valuable, integrative lens. This raises a central question: What mechanisms of change can be observed in an individual with Complex PTSD undergoing a combined group and individual psychotherapy program?<!--> </div></div><div><h3>Methodology</h3><div>This study employs a mixed-methods design grounded in Fishman’s (2017) pragmatic case study methodology. Standardized instruments were administered at four time points: pre-treatment (T0), mid-group therapy (T1; after 10 sessions), post-group therapy (T2; after 20 sessions), and at a three-month follow-up (T3). Variables assessed encompassed complex post-traumatic stress symptoms, psychoform and somatoform dissociative symptoms, quality of life, and the therapeutic alliance. Group cohesion was evaluated at the conclusion of each of the twenty group sessions. The clinician-researcher also conducted monthly assessments utilizing the Dimensions of Therapeutic Movement Instrument (DTMI) for complex trauma. At the conclusion of therapy (T2), an independent clinical psychologist conducted a research interview to explore various dimensions of change. A thematic analysis (Braun & Clarke, 2006) was conducted to identify emerging themes from the interview.</div></div><div><h3>Results</h3><div>The trajectory of the combined psychotherapy is delineated in detail. By the conclusion of treatment, a substantial reduction in complex post-traumatic symptoms, along with psychoform and somatoform dissociative symptoms, was observed, with these improvements sustained at follow-up. Quality of life also demonstrated notable enhancement. Regarding common therapeutic factors, the therapeutic alliance progressively strengthened throughout the course of treatment. In contrast, group cohesion declined sharply at the tenth session but subsequently improved and stabilized following the resolution of a rupture within the group. The research interview highlighted several therapeutic gains, including symptom reduction, the contribution of group therapy, t","PeriodicalId":29932,"journal":{"name":"European Journal of Trauma & Dissociation","volume":"9 4","pages":"Article 100593"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pre-traumatic stress is characterized by intrusiveness, avoidance, hyper-arousal and alterations of behaviors and cognitions related to future traumatic events that may actually occur. The main tool to self-assess pre-traumatic stress is the Pre-traumatic stress reactions Checklist (PreCL). To date, no study has assessed the psychometric properties of PreCL. In addition, no study has studied the pre-traumatic stress in population under the threat of natural catastrophes and the concurrent underlined mechanisms of these reactions.
Objective
This study aims to analyze the psychometric properties of PreCL, and the underlying mechanisms of pre-traumatic stress reactions in a group of participants living in the Campi Flegrei (Italy), a densely populated area which is cyclically affected by bradyseism and at high risk of volcanic eruptions.
Methods
Recruitment involved 432 participants. Exploratory and Confirmatory Factor Analysis (EFA/CFA) was used to assess and re-define the factorial structure of PreCL. Structural equation model was used to test the mediation effect of intensity and frequency of worry about bradyseism on the relationship between the intolerance of uncertainty’s dimensions and the pre-traumatic stress factors.
Results
From the EFA/CFA, a two-independent factor structure emerged: Pre-traumatic reactive responses (PreCL-R) and Pre-traumatic alterations of mood and cognitions (PreCL-A). The frequency of worry about bradyseism fully mediated the relationship between the prospective intolerance of uncertainty and PreCL-R, while the intensity of worry partially mediates between inhibitory intolerance of uncertainty and PreCL-R. No mediation effect was found for PreCL-A.
Conclusion
This study provides a stable structure of PreCL supporting its use in future research, and insights into the relationship between pre-traumatic reactions, current worry, and intolerance of uncertainty —findings that are relevant for both research and clinical practice.
{"title":"Pre-traumatic stress and environmental hazard in a bradyseism volcanic area. Psychometric properties of the Pre-traumatic stress reactions Checklist (PreCL) and concurrent underline mechanisms of pre-traumatic stress","authors":"Alessia Caffieri , Raffaella Esposito, Giorgia Margherita","doi":"10.1016/j.ejtd.2025.100604","DOIUrl":"10.1016/j.ejtd.2025.100604","url":null,"abstract":"<div><h3>Background</h3><div>Pre-traumatic stress is characterized by intrusiveness, avoidance, hyper-arousal and alterations of behaviors and cognitions related to future traumatic events that may actually occur. The main tool to self-assess pre-traumatic stress is the <em>Pre-traumatic stress reactions Checklist (PreCL).</em> To date, no study has assessed the psychometric properties of <em>PreCL</em>. In addition, no study has studied the pre-traumatic stress in population under the threat of natural catastrophes and the concurrent underlined mechanisms of these reactions.</div></div><div><h3>Objective</h3><div>This study aims to analyze the psychometric properties of PreCL, and the underlying mechanisms of pre-traumatic stress reactions in a group of participants living in the Campi Flegrei (Italy), a densely populated area which is cyclically affected by bradyseism and at high risk of volcanic eruptions.</div></div><div><h3>Methods</h3><div>Recruitment involved 432 participants. Exploratory and Confirmatory Factor Analysis (EFA/CFA) was used to assess and re-define the factorial structure of PreCL. Structural equation model was used to test the mediation effect of intensity and frequency of worry about bradyseism on the relationship between the intolerance of uncertainty’s dimensions and the pre-traumatic stress factors.</div></div><div><h3>Results</h3><div>From the EFA/CFA, a two-independent factor structure emerged: <em>Pre-traumatic reactive responses</em> (PreCL-R) and <em>Pre-traumatic alterations of mood and cognitions</em> (PreCL-A). The frequency of worry about bradyseism fully mediated the relationship between the prospective intolerance of uncertainty and PreCL-R, while the intensity of worry partially mediates between inhibitory intolerance of uncertainty and PreCL-R. No mediation effect was found for PreCL-A.</div></div><div><h3>Conclusion</h3><div>This study provides a stable structure of PreCL supporting its use in future research, and insights into the relationship between pre-traumatic reactions, current worry, and intolerance of uncertainty —findings that are relevant for both research and clinical practice.</div></div>","PeriodicalId":29932,"journal":{"name":"European Journal of Trauma & Dissociation","volume":"9 4","pages":"Article 100604"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145361686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-15DOI: 10.1016/j.ejtd.2025.100608
Karine Veilleux , Miguel M. Terradas , Guadalupe Puentes-Neuman , Olivier Didier , Maxime Labonté
<div><h3>Introduction</h3><div>La maltraitance perpétrée par les principales figures de soins engendre des conséquences sévères sur l’attachement de l’enfant qui risque ainsi de présenter un attachement insécurisant ou désorganisé. Or, la capacité de mentalisation de l’enfant en souffrirait également comme un attachement sécurisant serait propice au développement sain de la mentalisation.</div></div><div><h3>Objectifs</h3><div>La présente recherche exploratoire vise d’abord à détailler et comparer les représentations d’attachement et la capacité de mentalisation entre les deux groupes à l’étude. Elle cible également l’exploration des liens unissant ces mêmes variables en considérant l’ensemble des enfants indépendamment de leur groupe d’appartenance.</div></div><div><h3>Méthode</h3><div>Les deux groupes sont respectivement composés de 35 enfants ayant vécu de la maltraitance et hébergés en contexte de protection de la jeunesse et de 38 enfants issus de la population générale, tous âgés de 7 à 12 ans. Les représentations d’attachement ont été évaluées à l’aide des Histoires d’attachement à compléter (HAC) et d’un entretien semi-structuré (<em>Child Attachement Interview</em> [CAI]). Quant à elle, la capacité de mentalisation de l’enfant a été mesurée à partir des réponses de l’enfant à ce même entretien, grâce à l’échelle de cotation de la capacité de mentalisation.</div></div><div><h3>Résultats</h3><div>Les résultats révèlent des différences significatives entre les deux groupes d’enfants quant à la sécurité d’attachement envers la mère et la capacité de mentalisation. La capacité de mentalisation corrèle significativement et dans le sens attendu avec les mesures des représentations d’attachement à l’étude, à l’exception de l’échelle des HAC concernant les représentations de la mère comme étant rejetante et les échelles du CAI concernant la colère préoccupée envers la mère.</div></div><div><h3>Conclusion</h3><div>Les enfants maltraités ont des représentations d’attachement davantage insécurisantes et une plus faible capacité de mentalisation. Ces résultats enrichissent la compréhension des besoins et des difficultés vécus par les enfants hébergés quant à ces variables et permettent d’ajuster les interventions mises en place. La présence de certaines limites est constatée comme notamment la petite taille de l’échantillon, le fait que les deux groupes d’enfants se distinguent significativement au niveau de l’âge et du sexe de l’enfant et le fait que deux variables ont été mesurées par un même outil. Les implications et les forces de l’étude ainsi que les pistes de recherches futures sont détaillées dans l’article.</div></div><div><h3>Introduction</h3><div>Abuse perpetrated by primary caregivers has severe consequences on the child's attachment, which may lead to insecure or disorganized attachment patterns. Moreover, the child's mentalizing capacity could also be affected, as a secure attachment would be associated with the development of mentaliza
{"title":"Représentations d’attachement et capacité de mentalisation d’enfants d’âge scolaire hébergés en contexte de protection de l’enfance et issus de la population générale","authors":"Karine Veilleux , Miguel M. Terradas , Guadalupe Puentes-Neuman , Olivier Didier , Maxime Labonté","doi":"10.1016/j.ejtd.2025.100608","DOIUrl":"10.1016/j.ejtd.2025.100608","url":null,"abstract":"<div><h3>Introduction</h3><div>La maltraitance perpétrée par les principales figures de soins engendre des conséquences sévères sur l’attachement de l’enfant qui risque ainsi de présenter un attachement insécurisant ou désorganisé. Or, la capacité de mentalisation de l’enfant en souffrirait également comme un attachement sécurisant serait propice au développement sain de la mentalisation.</div></div><div><h3>Objectifs</h3><div>La présente recherche exploratoire vise d’abord à détailler et comparer les représentations d’attachement et la capacité de mentalisation entre les deux groupes à l’étude. Elle cible également l’exploration des liens unissant ces mêmes variables en considérant l’ensemble des enfants indépendamment de leur groupe d’appartenance.</div></div><div><h3>Méthode</h3><div>Les deux groupes sont respectivement composés de 35 enfants ayant vécu de la maltraitance et hébergés en contexte de protection de la jeunesse et de 38 enfants issus de la population générale, tous âgés de 7 à 12 ans. Les représentations d’attachement ont été évaluées à l’aide des Histoires d’attachement à compléter (HAC) et d’un entretien semi-structuré (<em>Child Attachement Interview</em> [CAI]). Quant à elle, la capacité de mentalisation de l’enfant a été mesurée à partir des réponses de l’enfant à ce même entretien, grâce à l’échelle de cotation de la capacité de mentalisation.</div></div><div><h3>Résultats</h3><div>Les résultats révèlent des différences significatives entre les deux groupes d’enfants quant à la sécurité d’attachement envers la mère et la capacité de mentalisation. La capacité de mentalisation corrèle significativement et dans le sens attendu avec les mesures des représentations d’attachement à l’étude, à l’exception de l’échelle des HAC concernant les représentations de la mère comme étant rejetante et les échelles du CAI concernant la colère préoccupée envers la mère.</div></div><div><h3>Conclusion</h3><div>Les enfants maltraités ont des représentations d’attachement davantage insécurisantes et une plus faible capacité de mentalisation. Ces résultats enrichissent la compréhension des besoins et des difficultés vécus par les enfants hébergés quant à ces variables et permettent d’ajuster les interventions mises en place. La présence de certaines limites est constatée comme notamment la petite taille de l’échantillon, le fait que les deux groupes d’enfants se distinguent significativement au niveau de l’âge et du sexe de l’enfant et le fait que deux variables ont été mesurées par un même outil. Les implications et les forces de l’étude ainsi que les pistes de recherches futures sont détaillées dans l’article.</div></div><div><h3>Introduction</h3><div>Abuse perpetrated by primary caregivers has severe consequences on the child's attachment, which may lead to insecure or disorganized attachment patterns. Moreover, the child's mentalizing capacity could also be affected, as a secure attachment would be associated with the development of mentaliza","PeriodicalId":29932,"journal":{"name":"European Journal of Trauma & Dissociation","volume":"9 4","pages":"Article 100608"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-03DOI: 10.1016/j.ejtd.2025.100610
Anne Versluis , Nienke Peters-Scheffer , Carlo Schuengel , Liesbeth Mevissen , Ad de Jongh , Robert Didden
Background
This study explored the experiences of individuals with mild intellectual disability (MID: IQ 50–70) or borderline intellectual functioning (BIF: IQ 70–85), post-traumatic stress disorder (PTSD), and severe behavioural problems, with brief Intensive EMDR therapy delivered by a team of rotating therapists.
Purpose
Preliminary research indicates that Intensive EMDR therapy with a team of rotating therapists is effective in treating PTSD in individuals with MID-BIF. To optimise treatment outcomes, it is important to understand how they experience this treatment format.
Methods
In-depth semi-structured interviews were conducted with three adults with MID-BIF and severe behavioural problems, before and after therapy. Interviews with three professional caregivers (before and after therapy), three EMDR therapists (after therapy), and field notes were used to contextualise the experiences of the participants.
Results
Interpretative phenomenological analysis (IPA) revealed that participants started Intensive EMDR therapy with rotating therapists holding high expectations. One participant discontinued early, two completed treatment, and all reported positive experiences with both the intensive format and therapist rotation model. The intensity was seen to support continuity and engagement, particularly compared to weekly therapy sessions. Minimal involvement of the (professional) support systems was also observed.
Conclusions
Participants with MID-BIF and severe behavioural problems generally reported positive experiences with brief Intensive EMDR therapy delivered by a team of rotating therapists.
本研究探讨了轻度智力残疾（MID: IQ 50-70）或边缘性智力功能障碍（BIF: IQ 70-85）、创伤后应激障碍（PTSD）和严重行为问题患者的经历，由一个轮转治疗师团队提供简短的强化EMDR治疗。目的：初步研究表明，在轮换治疗师团队的指导下，强化EMDR治疗可有效治疗中期bif患者的PTSD。为了优化治疗效果，重要的是要了解他们如何体验这种治疗形式。方法采用半结构化深度访谈法，对3名患有中度行为障碍和严重行为问题的成年人在治疗前后进行访谈。对三名专业护理人员（治疗前后），三名EMDR治疗师（治疗后）的访谈，以及现场记录用于将参与者的经历背景化。结果解释现象学分析（IPA）显示，参与者在轮转治疗师的高期望下开始强化EMDR治疗。一名参与者提前停止治疗，两名完成治疗，所有参与者都报告了强化形式和治疗师轮转模式的积极体验。强度被认为支持连续性和参与性，特别是与每周一次的治疗相比。还观察到（专业）支助系统极少参与。结论：中度bif和严重行为问题的参与者普遍报告了由轮换治疗师团队提供的简短强化EMDR治疗的积极体验。
{"title":"Brief intensive EMDR therapy with rotating therapists: Experiences of adults with mild intellectual disability or borderline intellectual functioning, PTSD, and severe behavioural problems","authors":"Anne Versluis , Nienke Peters-Scheffer , Carlo Schuengel , Liesbeth Mevissen , Ad de Jongh , Robert Didden","doi":"10.1016/j.ejtd.2025.100610","DOIUrl":"10.1016/j.ejtd.2025.100610","url":null,"abstract":"<div><h3>Background</h3><div>This study explored the experiences of individuals with mild intellectual disability (MID: IQ 50–70) or borderline intellectual functioning (BIF: IQ 70–85), post-traumatic stress disorder (PTSD), and severe behavioural problems, with brief Intensive EMDR therapy delivered by a team of rotating therapists.</div></div><div><h3>Purpose</h3><div>Preliminary research indicates that Intensive EMDR therapy with a team of rotating therapists is effective in treating PTSD in individuals with MID-BIF. To optimise treatment outcomes, it is important to understand how they experience this treatment format.</div></div><div><h3>Methods</h3><div>In-depth semi-structured interviews were conducted with three adults with MID-BIF and severe behavioural problems, before and after therapy. Interviews with three professional caregivers (before and after therapy), three EMDR therapists (after therapy), and field notes were used to contextualise the experiences of the participants.</div></div><div><h3>Results</h3><div>Interpretative phenomenological analysis (IPA) revealed that participants started Intensive EMDR therapy with rotating therapists holding high expectations. One participant discontinued early, two completed treatment, and all reported positive experiences with both the intensive format and therapist rotation model. The intensity was seen to support continuity and engagement, particularly compared to weekly therapy sessions. Minimal involvement of the (professional) support systems was also observed.</div></div><div><h3>Conclusions</h3><div>Participants with MID-BIF and severe behavioural problems generally reported positive experiences with brief Intensive EMDR therapy delivered by a team of rotating therapists.</div></div>","PeriodicalId":29932,"journal":{"name":"European Journal of Trauma & Dissociation","volume":"9 4","pages":"Article 100610"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-03DOI: 10.1016/j.ejtd.2025.100609
Federica Visco-Comandini , Carolina Papa , Allison Uvelli , Francesco Mancini , Erica Pugliese
Objective
Imagery Rescripting (ImRs) has emerged as a promising, evidence-based intervention to process traumatic experiences. No prior review has systematically examined its application for Post Traumatic Stress Disorder (PTSD) and Complex PTSD (C-PTSD). Furthermore, there still is not a clear understanding of mechanisms of change involved in ImRs, which are crucial for trauma-focused treatments. This review addresses this gap by summarizing the effectiveness and change processes of ImRs in PTSD and C-PTSD.
Method
A systematic search was conducted across PubMed, Scopus, Web of Science, and PsycINFO. Eligible studies were published in English or Italian, included clinical populations aged 18 or older, and used experimental or quasi-experimental designs.
Results
Twenty-four studies met inclusion criteria. Across randomized, clinical, and multiple-baseline studies, ImRs was associated with consistent reductions in trauma-related symptoms, showing treatment effects consistent with its targeting of core transdiagnostic processes—modifying aversive memory representations in PTSD and fostering integration and emotional safety in C-PTSD.
Conclusions
This review offers a focused synthesis of the evidence of ImRs for trauma-related disorders, highlighting its potential as a brief, powerful clinical intervention operating through distinct mechanisms of change across varying symptom profiles.
目的意象处方（ImRs）已成为一种有前途的、基于证据的创伤经历处理干预手段。目前尚无文献系统地研究其在创伤后应激障碍（PTSD）和复杂创伤后应激障碍（C-PTSD）中的应用。此外，对于imr的变化机制仍然没有明确的认识，而imr对创伤治疗至关重要。本文通过总结ImRs在PTSD和C-PTSD中的有效性和变化过程来弥补这一空白。方法系统检索PubMed、Scopus、Web of Science和PsycINFO。符合条件的研究以英语或意大利语发表，纳入18岁或以上的临床人群，并采用实验或准实验设计。结果24项研究符合纳入标准。在随机、临床和多基线研究中，ImRs与创伤相关症状的持续减少有关，显示出与其针对核心跨诊断过程的治疗效果一致——在PTSD中改变厌恶记忆表征，在C-PTSD中促进整合和情绪安全。本综述重点综合了创伤相关障碍的ImRs证据，强调了其作为一种简短、强大的临床干预手段的潜力，这种干预手段通过不同症状特征的不同改变机制运作。
{"title":"Rewriting trauma: A systematic review of treatment effects of imagery rescripting for PTSD and complex PTSD","authors":"Federica Visco-Comandini , Carolina Papa , Allison Uvelli , Francesco Mancini , Erica Pugliese","doi":"10.1016/j.ejtd.2025.100609","DOIUrl":"10.1016/j.ejtd.2025.100609","url":null,"abstract":"<div><h3>Objective</h3><div>Imagery Rescripting (ImRs) has emerged as a promising, evidence-based intervention to process traumatic experiences. No prior review has systematically examined its application for Post Traumatic Stress Disorder (PTSD) and Complex PTSD (C-PTSD). Furthermore, there still is not a clear understanding of mechanisms of change involved in ImRs, which are crucial for trauma-focused treatments. This review addresses this gap by summarizing the effectiveness and change processes of ImRs in PTSD and C-PTSD.</div></div><div><h3>Method</h3><div>A systematic search was conducted across PubMed, Scopus, Web of Science, and PsycINFO. Eligible studies were published in English or Italian, included clinical populations aged 18 or older, and used experimental or quasi-experimental designs.</div></div><div><h3>Results</h3><div>Twenty-four studies met inclusion criteria. Across randomized, clinical, and multiple-baseline studies, ImRs was associated with consistent reductions in trauma-related symptoms, showing treatment effects consistent with its targeting of core transdiagnostic processes—modifying aversive memory representations in PTSD and fostering integration and emotional safety in C-PTSD.</div></div><div><h3>Conclusions</h3><div>This review offers a focused synthesis of the evidence of ImRs for trauma-related disorders, highlighting its potential as a brief, powerful clinical intervention operating through distinct mechanisms of change across varying symptom profiles.</div></div>","PeriodicalId":29932,"journal":{"name":"European Journal of Trauma & Dissociation","volume":"9 4","pages":"Article 100609"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-05DOI: 10.1016/j.ejtd.2025.100595
Jan Gysi, Anonymous
Background
Despite Switzerland’s legal obligation to provide specialised services for survivors of violence, substantial treatment gaps remain for individuals with complex trauma-related disorders, particularly those diagnosed with dissociative identity disorder (DID). This study examines the impact of negative and sensationalistic media coverage in the Swiss-German context (2021–2024) on their access to care.
Method
An anonymous online survey (n = 201) collected self-reported data on therapy discontinuation, waiting times, and psychiatric hospital admissions. Statistical analyses explored associations between a DID diagnosis and perceived changes in service provision.
Results
Participants with DID reported significantly higher rates of therapy discontinuation by providers, refusal of admission to clinics, and prolonged waiting times compared to other diagnostic groups. Many also perceived a deterioration in care that coincided with increased media attention and public debate.
Conclusion
The findings highlight persistent structural deficits in the mental health care of individuals with DID in Switzerland. These gaps appear to have been exacerbated by stigmatising media narratives. Addressing these issues requires improved professional training, trauma-informed public discourse, and the meaningful inclusion of experts by experience in both research and service development.
{"title":"Between stigma and gaps in care: The impact of media discourses on the treatment situation of individuals with DID in Switzerland","authors":"Jan Gysi, Anonymous","doi":"10.1016/j.ejtd.2025.100595","DOIUrl":"10.1016/j.ejtd.2025.100595","url":null,"abstract":"<div><h3>Background</h3><div>Despite Switzerland’s legal obligation to provide specialised services for survivors of violence, substantial treatment gaps remain for individuals with complex trauma-related disorders, particularly those diagnosed with dissociative identity disorder (DID). This study examines the impact of negative and sensationalistic media coverage in the Swiss-German context (2021–2024) on their access to care.</div></div><div><h3>Method</h3><div>An anonymous online survey (<em>n</em> = 201) collected self-reported data on therapy discontinuation, waiting times, and psychiatric hospital admissions. Statistical analyses explored associations between a DID diagnosis and perceived changes in service provision.</div></div><div><h3>Results</h3><div>Participants with DID reported significantly higher rates of therapy discontinuation by providers, refusal of admission to clinics, and prolonged waiting times compared to other diagnostic groups. Many also perceived a deterioration in care that coincided with increased media attention and public debate.</div></div><div><h3>Conclusion</h3><div>The findings highlight persistent structural deficits in the mental health care of individuals with DID in Switzerland. These gaps appear to have been exacerbated by stigmatising media narratives. Addressing these issues requires improved professional training, trauma-informed public discourse, and the meaningful inclusion of experts by experience in both research and service development.</div></div>","PeriodicalId":29932,"journal":{"name":"European Journal of Trauma & Dissociation","volume":"9 4","pages":"Article 100595"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-08DOI: 10.1016/j.ejtd.2025.100615
Anna Gerge
Objective
To (i) describe a deep brain reorienting group intervention (DBR-GI), and (ii) explore whether the deep brain reorienting (DBR) method as a group intervention ameliorates countertransference reactions and distress in psychotherapists who provide trauma therapies. Distress that potentially otherwise could lead to vicarious traumatization.
Methods
All participants in this small, naturalistic study (n = 32) were experienced trauma psychotherapists in ongoing group supervision. They were offered an opportunity to process their reactions to relational difficulties and/or distress related to their clinical work with DBR-GI during consultation hours and all signed informed consent. The participants’ self-assessed experiences of discomfort before and after DBR processing were measured with the Subjective Units of Distress Scale (SUDS). They also provided verbal and written statements regarding their experiences after the DBR-GI intervention.
Results
SUDS ratings/values related to participants’ experiences of discomfort before and after the DBR-GI moment were significantly changed, p < 0000 (binomial calculation). The subjective ratings were aligned with the participants’ summarized verbal and written statements, where worry and unease changed towards a (re)gained felt sense of embodied freedom, presence, agency and clarity, including reduced transference reactions.
Conclusions
Preliminary results are promising. Potentially, DBR-GI seems to diminish trauma-generated countertransference and related reactions, also when used as a group intervention. New knowledge concerning which groups of clinicians who benefit from the intervention needs to be further enhanced and implemented in consultation/supervision. Whether or not DBR-GI is a helpful method during supervision of more inexperienced colleagues and if the group adaptation of DBR offers a possibility in work with clients should be investigated.
{"title":"Deep brain reorienting group intervention (DBR-GI) as a tool for transforming embodied countertransference reactions and potential vicarious traumatization in trauma therapists","authors":"Anna Gerge","doi":"10.1016/j.ejtd.2025.100615","DOIUrl":"10.1016/j.ejtd.2025.100615","url":null,"abstract":"<div><h3>Objective</h3><div>To (i) describe a deep brain reorienting group intervention (DBR-GI), and (ii) explore whether the deep brain reorienting (DBR) method as a group intervention ameliorates countertransference reactions and distress in psychotherapists who provide trauma therapies. Distress that potentially otherwise could lead to vicarious traumatization.</div></div><div><h3>Methods</h3><div>All participants in this small, naturalistic study (<em>n</em> = 32) were experienced trauma psychotherapists in ongoing group supervision. They were offered an opportunity to process their reactions to relational difficulties and/or distress related to their clinical work with DBR-GI during consultation hours and all signed informed consent. The participants’ self-assessed experiences of discomfort before and after DBR processing were measured with the Subjective Units of Distress Scale (SUDS). They also provided verbal and written statements regarding their experiences after the DBR-GI intervention.</div></div><div><h3>Results</h3><div>SUDS ratings/values related to participants’ experiences of discomfort before and after the DBR-GI moment were significantly changed, <em>p</em> < 0000 (binomial calculation). The subjective ratings were aligned with the participants’ summarized verbal and written statements, where worry and unease changed towards a (re)gained felt sense of embodied freedom, presence, agency and clarity, including reduced transference reactions.</div></div><div><h3>Conclusions</h3><div>Preliminary results are promising. Potentially, DBR-GI seems to diminish trauma-generated countertransference and related reactions, also when used as a group intervention. New knowledge concerning which groups of clinicians who benefit from the intervention needs to be further enhanced and implemented in consultation/supervision. Whether or not DBR-GI is a helpful method during supervision of more inexperienced colleagues and if the group adaptation of DBR offers a possibility in work with clients should be investigated.</div></div>","PeriodicalId":29932,"journal":{"name":"European Journal of Trauma & Dissociation","volume":"9 4","pages":"Article 100615"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-04DOI: 10.1016/j.ejtd.2025.100594
Ali Mohammadzadeh , Somayeh Gholizadeh , Zahra Heyran Sangestani
Background
This study examined cognitive emotion regulation in patients with schizophrenia and major depression, focusing on the impact of dissociative experiences.
Methods
A total of 140 patients were categorized into four groups based on diagnosis and dissociation level: schizophrenia with low and high dissociation, and major depression with low and high dissociation. Participants completed the Dissociative Experiences Scale (DES) and the Cognitive Emotion Regulation Questionnaire (CERQ). Data were analyzed using multivariate analysis of variance (MANOVA) to compare emotion regulation strategies across the groups.
Results
The study found that patients with high dissociative symptoms in both disorders relied more heavily on maladaptive emotion regulation strategies and less on adaptive strategies compared to their low dissociation counterparts. Notably, schizophrenia patients with high dissociation showed greater use of maladaptive strategies than depressed patients with high dissociation.
Conclusion
The findings indicate that dissociative experiences exacerbate emotion regulation difficulties, particularly in schizophrenia, where maladaptive strategies such as suppression and experiential avoidance are more pronounced. The study underscores the need for targeted therapeutic interventions addressing both dissociative symptoms and emotion regulation deficits to improve clinical outcomes in these populations.
{"title":"Comparison of emotion regulation between patients with schizophrenia and major depression across levels of dissociative experiences","authors":"Ali Mohammadzadeh , Somayeh Gholizadeh , Zahra Heyran Sangestani","doi":"10.1016/j.ejtd.2025.100594","DOIUrl":"10.1016/j.ejtd.2025.100594","url":null,"abstract":"<div><h3>Background</h3><div>This study examined cognitive emotion regulation in patients with schizophrenia and major depression, focusing on the impact of dissociative experiences.</div></div><div><h3>Methods</h3><div>A total of 140 patients were categorized into four groups based on diagnosis and dissociation level: schizophrenia with low and high dissociation, and major depression with low and high dissociation. Participants completed the Dissociative Experiences Scale (DES) and the Cognitive Emotion Regulation Questionnaire (CERQ). Data were analyzed using multivariate analysis of variance (MANOVA) to compare emotion regulation strategies across the groups.</div></div><div><h3>Results</h3><div>The study found that patients with high dissociative symptoms in both disorders relied more heavily on maladaptive emotion regulation strategies and less on adaptive strategies compared to their low dissociation counterparts. Notably, schizophrenia patients with high dissociation showed greater use of maladaptive strategies than depressed patients with high dissociation.</div></div><div><h3>Conclusion</h3><div>The findings indicate that dissociative experiences exacerbate emotion regulation difficulties, particularly in schizophrenia, where maladaptive strategies such as suppression and experiential avoidance are more pronounced. The study underscores the need for targeted therapeutic interventions addressing both dissociative symptoms and emotion regulation deficits to improve clinical outcomes in these populations.</div></div>","PeriodicalId":29932,"journal":{"name":"European Journal of Trauma & Dissociation","volume":"9 4","pages":"Article 100594"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-08-25DOI: 10.1016/j.ejtd.2025.100590
Aurore Roland
Introduction
Research on nightmares and psychiatric disorders has predominantly focused on post-traumatic stress disorder (PTSD). This case report aims to explore the impact of treating post-traumatic nightmares on obsessive compulsive disorder (OCD) symptoms that emerged following a traumatic experience.
Case
A woman in her mid-twenties with PTSD, post-traumatic nightmares and OCD symptoms was treated with exposure, relaxation and rescripting therapy (ERRT). This therapy consists of altering one’s nightmares and repeatedly imagining the new dream during wakefulness, supplemented with sleep hygiene, time-in-bed restriction, stimulus control, exposure to the nightmares and relaxation techniques.
Results
The results indicate that utilizing ERRT for Laura's post-traumatic nightmares has resulted in the remission of PTSD, comorbid OCD symptoms, nightmares, insomnia symptoms and stress, along with a significant reduction in anxiety.
Conclusion
This case study illustrates that treating post-traumatic nightmares through ERRT in an individual with comorbid post-traumatic OCD symptoms is feasible and can positively impact both nightmares and OCD symptoms. The underlying mechanism is hypothesized to be that improving sleep enhances both fear extinction learning and emotion regulation—two processes known to be impaired in OCD. In this particular case, the reduction in evening hyperarousal and anxiety, resulting from the time-in-bed restriction, likely also contributed to a decrease in obsessive thoughts.
{"title":"Remission of PTSD and comorbid OCD symptoms through psychotherapy for nightmares: A case report","authors":"Aurore Roland","doi":"10.1016/j.ejtd.2025.100590","DOIUrl":"10.1016/j.ejtd.2025.100590","url":null,"abstract":"<div><h3>Introduction</h3><div>Research on nightmares and psychiatric disorders has predominantly focused on post-traumatic stress disorder (PTSD). This case report aims to explore the impact of treating post-traumatic nightmares on obsessive compulsive disorder (OCD) symptoms that emerged following a traumatic experience.</div></div><div><h3>Case</h3><div>A woman in her mid-twenties with PTSD, post-traumatic nightmares and OCD symptoms was treated with exposure, relaxation and rescripting therapy (ERRT). This therapy consists of altering one’s nightmares and repeatedly imagining the new dream during wakefulness, supplemented with sleep hygiene, time-in-bed restriction, stimulus control, exposure to the nightmares and relaxation techniques.</div></div><div><h3>Results</h3><div>The results indicate that utilizing ERRT for Laura's post-traumatic nightmares has resulted in the remission of PTSD, comorbid OCD symptoms, nightmares, insomnia symptoms and stress, along with a significant reduction in anxiety.</div></div><div><h3>Conclusion</h3><div>This case study illustrates that treating post-traumatic nightmares through ERRT in an individual with comorbid post-traumatic OCD symptoms is feasible and can positively impact both nightmares and OCD symptoms. The underlying mechanism is hypothesized to be that improving sleep enhances both fear extinction learning and emotion regulation—two processes known to be impaired in OCD. In this particular case, the reduction in evening hyperarousal and anxiety, resulting from the time-in-bed restriction, likely also contributed to a decrease in obsessive thoughts.</div></div>","PeriodicalId":29932,"journal":{"name":"European Journal of Trauma & Dissociation","volume":"9 4","pages":"Article 100590"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-05DOI: 10.1016/j.ejtd.2025.100600
Dr Bronwyn Milkins , Prof Helen Milroy , Dr Maryam Boutrus , Dr Giulia Pace , Prof Jeneva L. Ohan
Background
Dissociation is often distressing, yet how affected adolescents manage dissociation in their daily lives is not well understood.
Objective
This study aimed to describe the strategies adolescents use to manage dissociative symptoms from the perspective of adolescents themselves, their parents, and their clinicians.
Methods
Semi-structured interviews were conducted with 13 participants: 6 female adolescent patients (aged 14–17 years, M = 15.67) from an outpatient psychiatric service in Western Australia, 3 parents, and 4 clinicians. Reflexive thematic analysis was conducted.
Results
Findings were consistent across adolescents, parents, and clinicians. Four main themes reflecting the varied strategies adolescents use to cope with dissociation were developed: Coping Needs to be Right for Me (theme 1); Being with a Trusted Person Helps Me (theme 2) with subthemes Just be Here with Me and Be Here and Help Me Process My Feelings; Gradually Re-Engaging with the Present Moment Helps Me (theme 3); and Sometimes I Cope by Zoning Out Even More (theme 4).
Conclusions
This is the first study to explore how adolescents cope with dissociation. All but one of the strategies were helpful in reducing dissociation duration or intensity, with some being within the adolescent’s control and some relying on trusted others to implement. Some coping strategies described by participants emphasized relational needs and developmental stage, suggesting that downward extension of adult interventions for adolescents may be inappropriate. Findings can guide the development of tailored interventions for dissociation in adolescents, ultimately improving clinical outcomes for this population.
{"title":"“Wait with me until it’s over”: A reflexive thematic analysis of adolescents’ coping with dissociation","authors":"Dr Bronwyn Milkins , Prof Helen Milroy , Dr Maryam Boutrus , Dr Giulia Pace , Prof Jeneva L. Ohan","doi":"10.1016/j.ejtd.2025.100600","DOIUrl":"10.1016/j.ejtd.2025.100600","url":null,"abstract":"<div><h3>Background</h3><div>Dissociation is often distressing, yet how affected adolescents manage dissociation in their daily lives is not well understood.</div></div><div><h3>Objective</h3><div>This study aimed to describe the strategies adolescents use to manage dissociative symptoms from the perspective of adolescents themselves, their parents, and their clinicians.</div></div><div><h3>Methods</h3><div>Semi-structured interviews were conducted with 13 participants: 6 female adolescent patients (aged 14–17 years, <em>M</em> = 15.67) from an outpatient psychiatric service in Western Australia, 3 parents, and 4 clinicians. Reflexive thematic analysis was conducted.</div></div><div><h3>Results</h3><div>Findings were consistent across adolescents, parents, and clinicians. Four main themes reflecting the varied strategies adolescents use to cope with dissociation were developed: <em>Coping Needs to be Right for Me</em> (theme 1); <em>Being with a Trusted Person Helps Me</em> (theme 2) with subthemes <em>Just be Here with Me</em> and <em>Be Here and Help Me Process My Feelings; Gradually Re-Engaging with the Present Moment Helps Me</em> (theme 3); and <em>Sometimes I Cope by Zoning Out Even More</em> (theme 4).</div></div><div><h3>Conclusions</h3><div>This is the first study to explore how adolescents cope with dissociation. All but one of the strategies were helpful in reducing dissociation duration or intensity, with some being within the adolescent’s control and some relying on trusted others to implement. Some coping strategies described by participants emphasized relational needs and developmental stage, suggesting that downward extension of adult interventions for adolescents may be inappropriate. Findings can guide the development of tailored interventions for dissociation in adolescents, ultimately improving clinical outcomes for this population.</div></div>","PeriodicalId":29932,"journal":{"name":"European Journal of Trauma & Dissociation","volume":"9 4","pages":"Article 100600"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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