The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military veterans

Imagery Rescripting (ImRs) and Eye Movement Desensitization and Reprocessing (EMDR) as treatment of childhood-trauma related post-traumatic stress disorder (Ch-PTSD) in adults: effects on Schema Modes

Background: Many patients with post-traumatic stress disorder (PTSD) due to childhood trauma (Ch-PTSD) also suffer from comorbid personality pathology. Little is known about the effectiveness of treatments for Ch-PTSD in reducing the comorbid personality pathology. Schema Modes are an operationalization of personality pathology according to schema therapy and can be measured with the Schema Mode Inventory (SMI). Therefore, we evaluated the effects of two treatments for adult patients with Ch-PTSD on Schema Modes.Method: Participants (n = 114) of the Imagery Rescripting and Eye Movement Desensitization and Reprocessing (IREM) Randomized Clinical Trial (Boterhoven de Haan, K. L., Lee, C. W., Fassbinder, E., Voncken, M. J., Meewisse, M., Van Es, S. M., Menninga, S., Kousemaker, M., & Arntz, A. (2017). Imagery rescripting and eye movement desensitization and reprocessing for treatment of adults with childhood trauma-related post-traumatic stress disorder: IREM study design. BMC Psychiatry, 17(1), 1-12, Boterhoven de Haan, K. L., Lee, C. W., Fassbinder, E., van Es, S. M., Menninga, S., Meewisse, M.-L., Rijkeboer, M., Kousemaker, M., & Arntz, A. (2020). Imagery rescripting and eye movement desensitization and reprocessing as treatment for adults with post-traumatic stress disorder from childhood trauma: Randomised clinical trial. The British Journal of Psychiatry, 217(5), 609-615) with Ch-PTSD who filled in the SMI next to other outcomes, were randomly allocated to a 12-session treatment of Imagery Rescripting (ImRs) or Eye Movement Desensitization and Reprocessing (EMDR). The SMI was collected at waitlist, pre-treatment, mid-treatment, posttreatment, and 8-week and 1-year follow-up.Results: For both treatments, patients reported large reductions in the Maladaptive Schema Modes and improvements in the Adaptive Schema Modes (Cohen's d = .94-1.18) from pre-treatment to posttreatment, 8-week follow-up, and 1-year follow-up. No statistically significant differences were found between ImRs and EMDR regarding changes in Schema Modes over time. No significant changes were observed during the waitlist period.Conclusions: ImRs and EMDR showed improvements in Schema Modes when primarily targeting Ch-PTSD. The results indicate the possible value of both treatments in reducing comorbid personality pathology.

Self-compassion mediates treatment effects in MDMA-assisted therapy for posttraumatic stress disorder

Background: Posttraumatic stress disorder (PTSD) is a severe condition often complicated by co-occurring disorders, such as major depression, alcohol use disorder, and substance use disorders. A well-powered phase 3 randomized, placebo-controlled trial has shown that MDMA-assisted therapy (MDMA-AT) may be an effective treatment for severe PTSD. However, the psychological mechanisms driving the therapeutic effects of MDMA-AT remain unclear. One potential mechanism is self-compassion, which is commonly conceptualized as a balance between compassionate self-responding (CS) - encompassing self-kindness, common humanity, and mindfulness - and uncompassionate self-responding (UCS) - encompassing self-judgment, isolation, and over-identification.Objective: This secondary analysis aimed to explore whether MDMA-AT enhances aspects of self-compassion and if changes in self-compassion mediate the therapy's effectiveness in reducing PTSD severity, depressive, and alcohol and substance use symptoms.Method: Eighty-two adults diagnosed with severe PTSD participated in a double-blind trial comparing three sessions of either MDMA-AT or placebo combined with therapy. Measures of PTSD severity, depressive symptoms, alcohol and substance use, and self-compassion were collected at baseline and 18 weeks later.Results: MDMA-AT led to statistically significant improvements in both UCS and CS. Significant improvements were also observed across all six subscales of the Self-Compassion Scale, including self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification, most with large effect sizes. Changes in UCS and CS significantly and fully mediated the effects of MDMA-AT compared to placebo plus therapy in reducing PTSD severity and depressive symptoms. Findings were not significant for alcohol and substance use outcomes.Conclusions: These findings suggest that self-compassion may play a critical role in the therapeutic effects of MDMA-AT. Further research is needed to investigate the role of self-compassion in MDMA-AT to refine and develop more targeted, effective interventions for individuals with PTSD and co-occurring depression.

The pain of PTSD: integrating persistent or chronic pain within emotional processing theory of posttraumatic stress disorder

Background: Posttraumatic stress disorder (PTSD) and chronic pain are devastating conditions that often co-occur. Current understanding of comorbid PTSD and chronic pain is limited, and treatment options are undereffective.Objective: This paper presents a theoretical basis for conceptualising chronic pain symptoms within Emotional Processing Theory (EPT), the foundation for Prolonged Exposure (PE), an effective treatment for PTSD. EPT conceptualises the development and treatment of PTSD using a trauma structure that strongly overlaps with pain's neurobiology.Method: This paper proposes a model of shared aetiology and treatment of comorbid PTSD and chronic pain, emphasising these shared neurobiological underpinnings. Discussion details how the comorbidity is maintained through parallel avoidance processes focused on: (1) trauma memories and reminders in PTSD preventing reduction of negative affect (extinction) and inhibitory learning, and (2) physical pain in chronic pain fuelling increased pain and reduced function.Results: A conceptualisation is presented on how PTSD and chronic pain symptomology can be addressed within the EPT framework, increasing the confidence of providers and patients while addressing an important gap in the literature. Finally, recommendations for providers using PE with patients with PTSD and pain are provided including a case example and treatment plan based on real patients.Conclusions: This model provides a clinically useful understanding of the underlying neurobiology for the co-occurrence of PTSD and chronic pain and offers direction for future research.

Enduring intensity for healing: the patient perspective of intensive outpatient treatment for PTSD

BACKGROUND

Prolonged exposure is widely regarded as a first-line treatment for alleviating symptoms of post-traumatic stress disorder (PTSD); however, it is often associated with high dropout rates and may not always be sufficiently efficacious. Intensified treatment has been suggested as a solution to increase treatment efficacy and reduce dropout rates, but little is known about patients' preferences for this type of treatment.

OBJECTIVE

To investigate patients' experiences of prolonged exposure delivered in an intensive format (iPE).

METHOD

Semi-structured interviews were conducted with 12 participants after completion of iPE.

RESULTS

Thematic analysis of the data yielded one overarching theme 'Brutal Yet Worth It,' accompanied by five subthemes: Building Blocks of Commitment, Strength through collective support, Overcoming challenges of the intensive treatment week, Therapeutic gains of the intensive treatment, and Facilitating and Enabling Treatment Progress. The participants described short-term discomfort and demands, contrasted with the recognition of substantial benefits that extended beyond PTSD symptom reduction. The interplay of individual attributes and experience of social support emerged as crucial factors shaping the experience.

CONCLUSIONS

Participants described the iPE experience as intense and demanding, yet transformative and worthwhile in the interviews. These findings highlight the complex and multifaceted experiences of patients undergoing PE delivered in an intensive format. The findings could offer valuable insights for designing more well-received PTSD treatments, leading to enhancements in the overall quality of intensified treatment approaches.

The impact of types of childhood maltreatment on the severity of PTSD and comorbid personality disorder symptoms

Background: Childhood maltreatment is associated with various psychiatric disorders, including post-traumatic stress disorder (PTSD) and personality disorders (PDs). Previous research has suggested that PTSD and PD are highly comorbid. However, the impact of different types of childhood maltreatment on the severity of PTSD and PD symptoms in a clinical population with PTSD/PD symptoms remains unclear.Objective: We aimed to clarify the role of (a) the overall severity and (b) the severity of subtypes of childhood maltreatment on the severity of (a) PTSD and (b) comorbid PD symptoms.Methods: Data was collected from participants (N = 197) seeking treatment for PTSD with comorbid PD symptoms at a trauma expertise centre in the Netherlands. We assessed childhood maltreatment using the Childhood Trauma Questionnaire-short form (CTQ-sf), PTSD severity with the Clinician-administered PTSD Scale for DSM-5 (CAPS-5), and PD severity with the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD). Data were analyzed using linear and Poisson regression.Results: We found that emotional neglect was the most prevalent form of childhood maltreatment (80.7%), followed by emotional abuse (72.6%). Sexual and emotional abuse shared independent associations with the severity of PTSD. The overall maltreatment severity and emotional abuse were significantly associated with the severity of comorbid borderline PD symptoms. Sexual abuse was significantly associated with the severity of comorbid avoidant PD symptoms. None of the childhood maltreatment types were significantly associated with the severity of comorbid obsessive-compulsive PD symptoms.Conclusions: We demonstrated the relationship between childhood sexual and emotional abuse and PTSD severity in people with PTSD and comorbid PD symptoms. This has important implications since emotional abuse usually does not fulfil the A-criterion required for the diagnosis of PTSD. We recommend routinely assessing emotional abuse in trauma- and PD treatment, and investigating the effectiveness of adapting trauma treatment for emotional abuse.Trial registration: ClinicalTrials.gov identifier: NCT03833453.

The International Trauma Interview (ITI): development of a semi-structured diagnostic interview and evaluation in a UK sample

Background: The International Trauma Interview (ITI) is a structured clinician-administered measure developed to assess posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as defined in the 11th version of the International Classification of Diseases (ICD-11). This study aimed to investigate a psychometric evaluation of the ITI and to finalise the English language version.Method: The latent structure, internal consistency, interrater agreement, and convergent and discriminant validity were evaluated with data from a convenience sample, drawn from an existing research cohort, of 131 trauma exposed participants from the United Kingdom reporting past diagnosis for PTSD or who had screened positively for traumatic stress symptoms. A range of self-report measures evaluating depression, panic, insomnia, dissociation, emotion dysregulation, negative cognitions about self, interpersonal functioning and general wellbeing were completed.Results: Confirmatory factor analysis supported an adjusted second-order two-factor model of PTSD and disturbances in self-organisation (DSO) symptoms, allowing affect dysregulation to also load onto the PTSD factor, over alternative models. The ITI scores showed acceptable internal consistency, and interrater reliability was strong. Findings for convergent and discriminant validity were mostly as predicted for PTSD and DSO domains. Correlations with the ITQ were good but coefficients for the level of agreement of PTSD diagnosis and CPTSD diagnosis between the ITI and the ITQ were weaker, and item level agreement was variable.Conclusion: Results provide support for the reliability and validity of the ITI as a measure of ICD-11 PTSD and CPTSD. Final revisions of the ITI are described.

C-METTA reduces PTSD-related guilt and shame following interpersonal violence

Background: PTSD patients who experienced interpersonal violence are susceptible to trauma-related guilt and shame and often show unsatisfactory treatment response. C-METTA combines cognitive techniques and loving-kindness meditation. It has shown promising effects in reducing trauma-related guilt and shame.Objective: We examined the effectiveness of C-METTA within a quasi-experimental one-group pretest-posttest trial focusing on survivors of interpersonal violence, who suffered from trauma-related guilt and shame. An additional objective was to examine variables potentially associated with lower treatment response (childhood trauma, cumulative trauma, and PTSD chronicity).Method: We treated 25 individuals (age = 19-61, 96% women) with PTSD following interpersonal violence. We predicted that C-METTA would significantly reduce (a) PTSD symptoms (measured by the Clinician Administered PTSD Scale, the PTSD Symptom-Checklist Version 5, and the Posttraumatic Cognitions Inventory), (b) feelings of guilt (measured by the Trauma Related Guilt Inventory) and (c) feelings of shame (measured by the Trauma Related Shame Inventory). To analyse treatment effects, we conducted repeated-measures MANOVAs. Further, we investigated the impact of childhood trauma, cumulative trauma and PTSD chronicity symptoms on treatment effectiveness exploratively via additional MANCOVAs.Results: Analyses showed significant and large effects of C-METTA on reducing PTSD symptoms (ranging from d = 1.12 to d = 1.67), feelings of guilt (d = 1.54) and shame (d = 1.26). Childhood trauma, cumulative trauma and PTSD chronicity did not affect treatment effectiveness.Conclusion: Our findings support previous research concerning the effectiveness of C-METTA and add promising evidence for the effectiveness of C-METTA to reduce PTSD following interpersonal violence. Effectiveness was independent of childhood trauma, trauma-duration and PTSD chronicity. Regression to the mean should be considered as a confounding factor. We suggest more research to support the results. C-METTA might increase PTSD treatment diversity and offer patients a greater bandwidth of options according to their preferences and the respective symptomatology.

Helpful but not enough: exploring participants' experiences of a digital therapist-guided prolonged exposure treatment for PTSD

Background: Post-traumatic stress disorder (PTSD) can be a severe psychiatric condition, and access to timely evidence-based treatment is often limited. Prolonged exposure is recommended as first line treatment in clinical guidelines. There is limited research on how digital formats of prolonged exposure used to increase treatment availability impact user experience. Therefore, we wanted to investigate patients' experiences of prolonged exposure in a therapist-guided internet-delivered format (HOPE; Huddinge Online Prolonged Exposure), as part of an uncontrolled feasibility study.Method: Semi-structured interviews were conducted with a total of 14 participants upon their completion of HOPE.Results: Thematic analysis revealed that participants found HOPE to be helpful and effective, especially valuing the flexibility in the digital treatment format. However, a subset of participants reported that HOPE did not meet their needs entirely, indicating room for improvement and tailoring of treatment to individual preferences and needs.Conclusion: This study represents the first exploration of internet-delivered prolonged exposure therapy within a Swedish psychiatric setting, comprising participants characterized by moderate to severe PTSD and self-rated complex PTSD. The results could help guide the development of more accessible and acceptable treatments for PTSD, ultimately improving treatment quality.

Systemic inflammation and metabolic syndrome components in threshold/subthreshold posttraumatic stress disorder and food addiction in a Polish community sample

Background: Posttraumatic stress disorder (PTSD) is associated with metabolic syndrome and various addictive behaviours. Food addiction (FA) is associated with obesity, and individuals with PTSD have higher rates of FA than those without. It is unclear whether addictive-like eating patterns contribute to the metabolic dysfunction in PTSD.Objective: We examined the relative contributions of PTSD, FA, and sex - as well as their interactive effects - to the systemic inflammation (CRP) and metabolic syndrome components (MetS: waist circumference, glucose, triglycerides, HDL cholesterol, insulin) in a general population of the Upper Silesia region in Poland.Method: N = 187 participants (52.7% women) completed Yale Food Addiction Scale 2.0 (FA symptoms count), Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) semi-structured interview (PTSD or other trauma and stressor-related disorder (OTSR) diagnosis presence), anthropometric assessment, and phlebotomy in a fasted state.Results: A series of hierarchical linear regressions indicated that greater number of FA symptoms had a significant effect on greater waist circumference, while PTSD/OTSR diagnosis had a significant effect on higher insulin levels. Sex did not moderate these relationships.Conclusions: It appears that dysregulated eating patterns are associated with greater abdominal obesity, but not with metabolic dysfunction. PTSD/OTSR, but not FA, contributes to greater insulin levels. The average metabolic indices were within normal limits reflecting a non-clinical nature of the sample. Future longitudinal studies should examine whether detection of and intervention for PTSD/OTSR symptoms may be a strategy for preventing progression of metabolic dysfunction.

Predicting treatment outcome for complex posttraumatic stress disorder using the personalized advantage index

ABSTRACTBackground: Ample studies have demonstrated the effectiveness of psychotherapy for posttraumatic stress disorder (PTSD). However, large individual variation in treatment outcome remains unsolved and treatment options for complex posttraumatic stress disorder (CPTSD) are debated. There is a need for exploring methods for matching patients with treatment they will most likely benefit from.Objective: To develop a personalized advantage index (PAI) based on relevant clinical and demographic predictors of outcome from exposure therapy and skills-training for CPTSD.Method: Data from a previous randomized controlled trial (RCT) in 92 patients with a CPTSD diagnosis was used to compare Prolonged Exposure (PE; n = 32) and Skills Training in Affective and Interpersonal Regulation (STAIR; n = 60). Outcome measures were clinician-assessed and self-reported PTSD symptoms. Predictors of outcome in PE and STAIR were identified separately from sixty-one candidate variables using random forest and bootstrap procedures. Relevant predictors were then used to calculate PAI and retrospectively identify optimal versus suboptimal treatment in a leave-one-out cross-validation approach.Results: In PE, somatoform dissociation, depression, suicidal ideation, and reduced physical health predicted worse outcome. In STAIR, interpersonal problems, total PTSD symptom severity, intrusions, elevated guilt, and psychoticism predicted worse outcome, while being a witness to trauma predicted better outcome. Allocation to optimal treatment according to the PAI was associated with large improvements in clinician-assessed (Cohen's d = 0.83) and moderate improvement in self-rated (Cohen's d = 0.60) PTSD symptoms as compared to allocation to suboptimal teatment.Conclusions: Using the PAI in personalizing psychological treatment for CPTSD is a promising approach to improve treatment benefits. Further research on larger samples and external validation of the PAI is needed.

Validation of a clinician-administered diagnostic measure of ICD-11 PTSD and complex PTSD: the International Trauma Interview in a clinical sample of military veterans

Background: The International Trauma Interview (ITI) is the first clinician-administered diagnostic tool developed to assess posttraumatic stress disorder (PTSD) and Complex PTSD (CPTSD), both recently recognized in the ICD-11. The current study aims to test the construct and discriminant validity of the ITI in a population of treatment-seeking veterans.Method: 124 Danish veterans seeking psychological treatment were interviewed by a group of trained clinicians for ICD-11 PTSD and CPTSD before beginning treatment at the Military Psychological Department in the Danish Defense. A series of confirmatory factor models were estimated in order to identify the extent to which latent variable operationalizations provide potential explanations for the associations between symptoms.Results: Results indicate that symptoms of CPTSD, as measured by the ITI, are best represented by a single higher-order factor. We also found that a bifactor model provided adequate fit to the data. The commonly identified two-factor higher-order model was rejected due to the lack of discriminant validity between PTSD and DSO. The higher order model was found to explain associations between symptoms of CPTSD and symptoms of depression, stress, anxiety, and well-being.Conclusion: The ITI does not fit a two-factor higher-order model in a sample of treatment-seeking Danish veterans. Rather, a single higher order factor shows excellent fit, and is found to explain associations between ITI symptoms and other internalizing symptoms.

The diagnostic accuracy of PTSD assessment instruments used in older adults: a systematic review

Background: As the number of older adults increases worldwide, understanding their mental health is crucial, including the impact of traumatic experiences that can lead to posttraumatic stress disorder (PTSD). However, validated screening and diagnostic instruments for PTSD in older adults are limited.Objective: We sought to provide a comprehensive summary of the diagnostic accuracy of PTSD screening and diagnostic instruments used in older adults (Mage ≥ 60 years).Method: A systematic search of MEDLINE, EMBASE, PsycINFO and Web of Science databases was conducted for January 1980 through 10 January 2025. Studies that focused on the psychometric properties of PTSD instruments in older adults were included.Results: Out of 21,197 publications screened, only 40 studies including 24 instruments met the eligibility criteria. Only seven were conducted with participants from the general population or primary care patient samples. There were 14 relevant studies in the last ten years, with only six based on the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) criteria. Validation studies conducted in non-Western and/or non-English speaking older adult samples are rare.Conclusions: There is a shortage of validation studies of PTSD screening and diagnostic tools in the general older adult population. We recommend using the Clinician-Administered PTSD Scale for DSM-5 in clinical practice. It is the gold standard for assessing current and lifetime PTSD in the general population. Further research is required to establish evidence-based clinical cut-off scores and cross-cultural validity for PTSD screening in different populations of older adults. Future studies should also assess measures that consider the multimorbidity in this population (e.g. cognitive impairment and other psychiatric or medical disorders) and are easy to administer in clinical practice.

Attention bias variability as a cognitive marker of PTSD: A comparison of eye-tracking and reaction time methodologies

Identification of reliable behavioral markers for posttraumatic stress disorder (PTSD) can offer objective measures beyond self-reports to aid in diagnosis, treatment, and prevention. Attention bias variability (ABV), defined as fluctuations in attention toward or away from threat-related stimuli, has been associated with PTSD. Reaction time-based ABV (RT-ABV) has been extensively studied and shown to be linked with PTSD symptomatology. An eye-tracking-based ABV index (ET-ABV) was only recently introduced, and results show that it may be associated with trauma exposure rather than with PTSD symptoms. However, these two ABV types have yet to be studied within the same sample. The current study explored the association between trauma exposure, PTSD symptom severity, and ABV measures, applying both the classic RT-ABV and the new ET-ABV in the same sample. Participants with PTSD (n = 41), trauma-exposed healthy controls (TEHC; n = 71), and non-trauma-exposed healthy controls (HC; n = 38) completed an eye-tracking free-viewing matrix task and a response-based dot-probe task using the same threat-related stimuli (angry faces) across tasks. Results indicate that both RT-ABV and ET-ABV were significantly higher in participants with PTSD compared to participants in the TEHC and HC groups, with no significant difference between the latter groups. Additional analyses indicate that although moderately correlated, each of the ABV measures explains unique portions of the variance in PTSD severity. This study replicates and extends prior findings on the association between ABV and PTSD and highlights the potential of ET-ABV as a novel and reliable marker for PTSD severity.

A Cross-Sectional Analysis of Traumatic Experiences, Post-Traumatic Stress Disorder Symptoms and Chronic Pain in Northern Ireland

BACKGROUND

Chronic pain and post-traumatic stress disorder (PTSD) are frequently comorbid and are associated with more significant pain-related disruption than chronic pain alone. It is not clear if these disruptions are due to traumatic experience or specific symptoms related to PTSD.

METHODS

This issue was evaluated in a large sample (N = 1367) of individuals with chronic pain presenting for treatment at an interdisciplinary pain rehabilitation service. As a secondary objective, the comorbidity of chronic pain and PTSD in Northern Ireland (NI) was also examined given high regional prevalence rates. Participants completed a PTSD screening measure, along with measures of pain interference, social functioning, pain anxiety, pain self-efficacy, pain intensity and depression.

RESULTS

Screening indicated that 46.4% had never experienced a traumatic event, 22.5% had experienced a traumatic event but screened negative for PTSD and 31.1% screened positive for PTSD. Following identification of covariates, a Multivariate Analysis of Covariance examined differences in dependent measures by PTSD category, which yielded a similar pattern of results across measures. The group that screened positive for PTSD reported worse functioning and more disruptions in comparison to the other two PTSD groups, with the latter groups not differing on any measure.

CONCLUSIONS

These analyses indicate that poorer functioning was not associated with trauma exposure alone; rather, it was experienced in association with PTSD symptoms. Further, comorbidity rates of PTSD and chronic pain in this NI dwelling sample were at the high end of the range in relation to previous work and exceeded past year regional prevalence estimates.

SIGNIFICANCE

PTSD assessment in those with chronic pain may be best served by evaluating the impact of these experiences on function, rather than focusing on the traumatic experiences in isolation. Further, there is scope to develop integrated chronic pain and PTSD treatments.

Using speech analysis in virtual agent conversations to differentiate PTSD patients from control participants

Diagnosing posttraumatic stress disorder (PTSD) remains challenging due to clinical overlap with conditions like depression and patients' reluctance to disclose symptoms. This study analyzed pre-existing data to investigate whether speech features extracted from semi-structured interviews with a virtual avatar could enhance traditional diagnostic approaches by utilizing automated voice analysis, which can detect nuances beyond human hearing, potentially improving sensitivity and specificity in diagnosing PTSD. Leveraging the DAIC-WoZ dataset (Gratch et al., 2014), which includes 142 dialogues (average length: 954 s) between participants and a virtual avatar, we extracted content and acoustic features from transcripts and audio recordings. Group comparisons aimed to identify differences between PTSD and non-PTSD participants, as well as distinctions between PTSD participants with and without comorbid depression. Key findings revealed that PTSD participants expressed more negative sentiment in their speech (η²=0.82, p < 0.001) and used less frequent words (η²=0.65, p < 0.001) compared to controls. To demonstrate the utility of speech features, classification models were developed to differentiate PTSD and control participants. A linear model with twenty-one speech features (balanced accuracy = 0.70) outperformed a model based solely on demographic data (balanced accuracy = 0.53). Subgroup analyses found no significant differences in speech features between PTSD participants with and without comorbid depression. These results suggest that automated speech analysis, facilitated by virtual avatars, can identify linguistic markers of PTSD, potentially aiding diagnosis and reducing barriers to disclosure. However, further research is needed to generalize these findings and explore their utility in clinical practice.

Preliminary Insights Into the Relationship Between the Gut Microbiome and Host Genome in Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) may develop following trauma exposure; however, not all trauma-exposed individuals develop PTSD, suggesting the presence of susceptibility and resilience factors. The gut microbiome and host genome, which are interconnected, have been implicated in the aetiology of PTSD. However, their interaction has yet to be investigated in a South African population. Using genome-wide genotype data and 16S rRNA (V4) gene amplicon sequencing data from 53 trauma-exposed controls and 74 PTSD cases, we observed no significant association between the host genome and summed abundance of Mitsuokella, Odoribacter, Catenibacterium and Olsenella, previously reported as associated with PTSD status in this cohort. However, PROM2 rs2278067 T-allele was significantly positively associated with the summed relative abundance of these genera, but only in individuals with PTSD and not trauma-exposed controls (p < 0.014). Polygenic risk scores generated using genome-wide association study summary statistics from the PGC-PTSD Overall Freeze 2 were not predictive of gut microbial composition in this cohort. These preliminary results suggest a potential role for the interaction between genetic variation and gut microbial composition in the context of PTSD, underscoring the need for further investigation.

Find your rhythm and regulate: Breath-synced vibration feedback during breath-focused mindfulness reduces respiration variability in trauma-exposed adults

Stress and anxiety are associated with increased autonomic arousal, including altered respiration. Breath-focused mindfulness meditation can reduce stress and anxiety, but trauma-exposed adults with dissociation have difficulty engaging in this practice. Our ongoing clinical trial examines if vibration-augmented breath-focused mindfulness (VABF) can improve outcomes and increase engagement. Here, we tested if VABF reduces respiration rate (RR) or respiration variability (RV), and examined associations between RR, RV, and emotion ratings. 128 trauma-exposed adults (mean age = 30.21 years) with elevated dissociation volunteered and completed at least 50 % of intervention visits. Participants were randomized to one of four mindfulness meditation interventions: VABF (n = 34); breath-focus only (n = 33); vibration only (n = 34); open awareness (no vibration or breath-focus, n = 27). Results from linear mixed-effects models showed that VABF decreased RV across visits while all the other interventions showed increased RV across visits (p = .008; ηp2 = .014), and RV was positively associated with both anxiety and anger ratings (ps < .001; rs > .125). Findings suggest RV is a meaningful metric for examining regulatory processes in clinical populations with elevated autonomic arousal and negative emotionality. They also show that RV is modifiable through VABF, which holds significant promise as an intervention to improve regulatory processes in trauma-exposed populations.

Evaluating the ICD-11 PTSD and Complex PTSD Constructs: A Meta-Analytic Confirmatory Factor Analysis of the International Trauma Questionnaire

The International Trauma Questionnaire (ITQ) is a widely used diagnostic tool for post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). Although findings are mixed, investigations of the ITQ's internal structure have most often supported a six-factor first-order model and a two-factor second-order model. This study utilized meta-analytic factor analysis to investigate the ITQ's latent structure. A systematic search of PsycINFO, Web of Science, PubMed, MEDLINE, Cochrane, Scopus, CINAHL, and ProQuest Dissertations was conducted, with 57 studies (total N = 43,066) included in the final analysis. A two-stage meta-analytic structural equation modeling approach was implemented which pooled correlation matrices and performed confirmatory factor analyses. The two-factor second-order model demonstrated good fit, emphasizing its clinical relevance. However, a seven-factor correlated first-order model demonstrated superior fit, consistently outperforming other models across ITQ versions, symptom severity levels, English versus translated versions, and both PTSD and non-PTSD samples. This model indicates that CPTSD encompasses a broad range of symptoms and specifically that the distinction between affective hyperactivation and hypoactivation is important to progress the construct validity of CPTSD. Additionally, reliability analyses revealed limited internal consistency at the subscale level. These findings highlight the need for comprehensive assessments and refined item content to enhance CPTSD measurement.

Cost-effectiveness of massed versus spaced trauma-focused treatment as first-line treatment for post-traumatic stress disorder in adults with multiple trauma exposure: protocol for a single-blind non-inferiority randomised controlled trial

INTRODUCTION

Post-traumatic stress disorder (PTSD) is a serious disorder that burdens individuals and society. The current standard of first-line treatment for PTSD is spaced trauma-focused treatment (S-TFT), involving weekly sessions. While effective, S-TFT may take relatively long to complete, especially in patients exposed to multiple potentially traumatic events (PTEs). Massed trauma-focused treatment (M-TFT), involving increased session frequency, potentially results in faster symptom reduction and restoration of quality of life, as well as in a reduction of societal costs. However, M-TFT is not recommended as first-line treatment. This paper describes the research protocol of a single-blind, multicentre randomised controlled trial (RCT) aimed at investigating: (1) the clinical and cost-effectiveness of M-TFT versus S-TFT in employed, multiply traumatised patients who seek first-line treatment for PTSD and (2) predictive and moderating factors related to treatment response.

METHODS AND ANALYSIS

186 participants are recruited from five centres and will be included if they are ≥18 years old, meet criteria for a Diagnostic and Statistical Manual of Mental Disorders Fifth Edition PTSD diagnosis based on ≥two PTEs, seek treatment for the first time and are employed. Patients with specified comorbid disorders and insufficient Dutch language proficiency are excluded. Participants are randomised to 800 min of either M-TFT or S-TFT. M-TFT consists of two once-weekly preparatory sessions, 10 twice-daily sessions of prolonged exposure, eye movement desensitisation and reprocessing therapy for 2 weeks and two once-weekly closing sessions. S-TFT consists of weekly sessions of one of five evidence-based treatment interventions. Outcomes are assessed at baseline and at 7 weeks, 17 weeks, 6 months and 9 months after baseline. Primary outcomes are clinical effectiveness in terms of PTSD symptom severity and cost-effectiveness based on quality of life measures and societal costs. Data will be analysed with linear mixed models.

ETHICS AND DISSEMINATION

This study protocol was approved by the Medical Ethics Review Board of the Amsterdam University Medical Center (NL86057.018.24). Participants will provide informed consent before enrolment in the trial. Results will be published in peer-reviewed journals and will be released to clinicians, patient groups and the general community.

TRIAL REGISTRATION NUMBER

This protocol is registered at Overview of Medical Research in the Netherlands (OMON; trial register number 56960) and ClinicalTrials.gov (NCT06700590).

Augmentation of trauma-focused psychotherapy for post-traumatic stress disorder: a protocol for a systematic review and meta-analysis

INTRODUCTION

Despite the established status of trauma-focused psychotherapy (TFP) as a first-line treatment for post-traumatic stress disorder (PTSD), a substantial proportion of individuals do not achieve clinically significant improvement or discontinue treatment. Exploring augmentation strategies to enhance treatment outcomes is essential to reduce the overall burden PTSD puts on individuals and society. This protocol outlines a systematic review and meta-analysis of randomised controlled trials (RCTs) evaluating the efficacy of non-pharmacological augmentation strategies in addition to TFP for PTSD treatment.

METHODS AND ANALYSIS

We comprehensively searched PubMed, Embase, CENTRAL, PTSDpubs, PsycArticles, PsycINFO, PSYNDEX and CINAHL for RCTs without restrictions on publication dates or languages in October 2024. Study screening is currently ongoing. Additionally, we will perform forward and backward searches of the included studies and relevant reviews. Two reviewers will independently screen and select studies, extract data and assess the risk of bias. We will conduct a narrative review to qualitatively synthesise data and a meta-analysis to quantitatively compare the treatment efficacy of augmented TFP with TFP alone or TFP plus placebo. Primary outcomes will be both symptom severity and response rates. The secondary outcome will be dropout rates. We will explore sources of between-study heterogeneity and potential moderators through subgroup and meta-regression analyses. We will assess the overall quality of the included studies with the Grading of Recommendations Assessment, Development, and Evaluation system.

ETHICS AND DISSEMINATION

Ethical approval is not required. We intend to publish results in a peer-reviewed journal and provide materials and data through the Open Science Framework.

PROSPERO REGISTRATION NUMBER

CRD42024549435.

Effectiveness of Psychotherapy for Post-Traumatic Stress Disorder in Subjects Suffering from Traumatic Brain Injuries After Motor Vehicle Accidents

Background and Objectives: PTSD and traumatic brain injury (TBI) frequently co-occur in survivors of combat exposure, blasts, assaults, or motor vehicle accidents (MVAs), yet the impact of TBI on the psychotherapy outcomes for PTSD, especially in civilians, remains underexplored and frequently underestimated. Methods: This study focused on analysis of the effectiveness of psychotherapies (trauma-focused: prolonged exposure (PE); non-trauma-focused: self-efficacy-focused cognitive therapy (SEF-CT)) in individuals with PTSD, comparing those with and without TBIs. The data of 45 PTSD patients with TBIs were drawn from a clinical trial cohort, with a total of 134 completing treatment. PTSD symptoms were assessed pre- and post-treatment using CAPS-5 and PDS-5. Cognitive functioning was measured via tests of fluid and crystallized intelligence. ANCOVA models examined the level of post-treatment PTSD symptoms with the control of pretreatment symptoms and the effects of TBI, treatment type, gender, age, education, time since the MVA, and level of cognitive functioning. Results: Both psychotherapies were equally effective in reducing PTSD symptoms, regardless of TBI status. The early initiation of treatment predicted better outcomes in non-TBI patients but not in those with TBIs. The TBI participants who began treatment earlier exhibited lower fluid intelligence scores, suggesting mild cognitive impairments that may have moderated the therapy benefits. Conclusions: Patients with PTSD and TBIs can benefit from both trauma-focused and non-trauma-focused CBT. While earlier intervention is beneficial for patients with PTSD alone, cognitive impairments may reduce this advantage in those with TBIs.

Moral Injury, Mental Disorders, and Suicidal Behavior Among Health Professionals During the COVID-19 Pandemic: A Network Analysis

During extreme conditions such as the COVID-19 pandemic, health professionals were susceptible to mental health issues. A series of network analyses were performed to explore the relationship between moral injury and depressive symptoms, anxiety symptom, PTSD symptom, and suicidal behaviors in 14,993 health professionals. Depressive symptoms were identified as the main pathway through which moral injury led to suicidal behavior, and betrayal was the most significant bridge symptom for moral injury with PTSD, anxiety, and depressive symptoms. The symptom profiles of MI associated with the common mental outcomes included betrayal, self-condemnation, and feeling punished by God. The most central mental symptoms of health professionals were irritability, nervousness, and feeling afraid. It is crucial to implement targeted measures addressing the bridge symptoms of moral injury and the core symptoms of anxiety to prevent and treat mental health consequences among health professionals.

The efficacy of elevating anandamide via inhibition of fatty acid amide hydrolase (FAAH) combined with internet-delivered cognitive behavioral therapy in the treatment of post-traumatic stress disorder: a randomized, placebo-controlled clinical trial

Post-traumatic stress disorder (PTSD) is a severe mental health disorder with limited treatment options. Gold standard treatment includes cognitive behavioral therapies (CBT) that incorporate exposure to traumatic memories to facilitate extinction. CBT can be effective in PTSD, but effects are incomplete and symptoms are prone to spontaneous return. Pharmacologically facilitating fear extinction could potentiate the effects of exposure-based therapy. Here, we explored whether targeting the endocannabinoid (eCB) system, a neuromodulatory system critically involved in fear extinction, would promote the efficacy of exposure-based CBT. Specifically, we tested the effects of elevating the eCB ligand anandamide (AEA) via inhibition of its main degradative enzyme, fatty acid amide hydrolase (FAAH). In this double-blind, placebo-controlled study, patients with PTSD (N = 100; 85 women) were randomized to the FAAH inhibitor (FAAHi) JNJ-42165279 (25 mg b.i.d.) or placebo for 12 weeks. In weeks 5-12, all participants completed an internet-delivered CBT that included exposure-based modules. The primary outcome was clinician-assessed PTSD symptom severity (CAPS-5). Secondary outcomes included self-reported symptoms of PTSD, depression, anxiety, and sleep quality. Blood samples were taken to measure levels of drug and eCBs. Overall, PTSD symptoms improved over time. While FAAHi increased AEA levels, there was no effect of FAAHi on PTSD symptoms or any secondary measure. FAAHi combined with internet-delivered CBT did not improve PTSD symptoms to a greater extent than internet-delivered CBT alone. Thus, FAAH inhibition does not appear to be a suitable adjunct treatment for enhancing CBT in PTSD. This study was registered as Eudra-CT 2020-001965-36.

Medicinal cannabis in the management of anxiety disorders: A systematic review

BACKGROUND

With rising anxiety disorder diagnoses, many individuals are seeking alternatives to standard pharmacotherapies, like medicinal cannabis. This systematic review focuses exclusively on anxiety-related disorders and examines a wide range of cannabis-based preparations and interventions.

METHOD

We searched MEDLINE, EMBASE, CINAHL, and PsycInfo (October-December 2023) for peer-reviewed empirical studies, excluding case series, case studies, and review papers. Inclusion criteria were studies on adults (18+ years) diagnosed with anxiety-related disorders, examining the efficacy or effectiveness of medicinal cannabis. Studies on recreational cannabis or cannabis-use-disorder were excluded. The MASTER and QualSyst tools were used to assess bias.

RESULTS

Fifty-seven studies met the inclusion criteria: 40 % cohort (n = 23), 30 % randomised controlled trials (n = 17), 18 % cross-sectional (n = 10), 12 % qualitative or other designs (n = 7). The MASTER scale revealed a high risk of bias, with a mean score of 62.9 (out of 100) due to inadequate reporting. Among the 13 highest-quality studies, 70 % (n = 9) reported a positive improvement for disorders including generalised anxiety disorder (GAD), social anxiety disorder (SAD), and post-traumatic stress disorder (PTSD). 30 % (n = 4) reported a negative result for conditions like obsessive-compulsive disorder, trichotillomania, test anxiety and SAD. Over 90 % of all studies, including lower quality studies, reported positive outcomes for CBD and THC-based cannabis. However, 53 % (n = 30) either omitted, or included self-reported data on either form and/or dosage.

CONCLUSION

Medicinal cannabis demonstrates potential in reducing anxiety symptoms, but the long-term benefits and overall impact on quality of life remain unclear. Further high-quality, longitudinal research with standardised dosing is needed.

Acupuncture for Anxiety, Depression, and Sleep in Veterans with Combat-Related Posttraumatic Stress Disorder: A Randomized Controlled Trial

Objective: Current interventions for anxiety, depression, and insomnia are efficacious, yet effectiveness may be limited by side effects and/or high withdrawal rates. Other desirable treatment options are needed. Many veterans and civilians are turning to acupuncture as an emerging therapy. Our objective was to conduct a more definitive study comparing verum with sham acupuncture (minimal needling). Methods: A two-arm, single-blinded randomized controlled trial (RCT) hypothesizing that both verum and sham acupuncture are effective and the effects of verum are superior to those of sham acupuncture. We recruited subjects from a single outpatient-based site, the Tibor Rubin VA Medical Center, Long Beach, CA, USA. A total of 93 treatment-seeking combat Veterans with posttraumatic stress disorder (PTSD), aged 18-55, were allocated to groups by adaptive randomization, and 71 participants completed the intervention protocols. Verum and sham were both offered as 1 h sessions, twice a week, and participants were allowed 15-weeks to complete up to 24 sessions. This was a secondary analysis from a larger study about the efficacy of acupuncture for PTSD. Outcomes for the current study were pre- to post-intervention change in the Hamilton Anxiety Rating Scale, Beck Depression Inventory, and Pittsburgh Sleep Quality Index. Outcomes were assessed pre-, mid-, and post-treatment. General Linear Models comparing within- and between-group results were analyzed in both intention-to-treat (ITT) and treatment completer models. Results: In total, 85 males and 8 females, with a mean age of 39.2 (median = 37.0), were randomized. For anxiety, the verum acupuncture showed a large treatment effect (d = 1.3), whereas sham acupuncture showed a moderate effect (d = 0.9). There was no statistical difference between the verum and sham acupuncture groups. Similar effects were found for depression and insomnia symptoms. Withdrawal rates were low. Conclusions: Both verum and sham acupuncture were efficacious in the treatment of anxiety, depression, and insomnia in a population of veterans with PTSD. However, there was no clinical difference between the verum and sham acupuncture groups. These data build on extant literature and suggest that further research on the clinical implementation and durability of acupuncture for anxiety, depression, and insomnia is warranted.

PTSD and epigenetic aging: a longitudinal meta-analysis

BACKGROUND

Posttraumatic stress disorder (PTSD) has been associated with advanced epigenetic age cross-sectionally, but the association between these variables over time is unclear. This study conducted meta-analyses to test whether new-onset PTSD diagnosis and changes in PTSD symptom severity over time were associated with changes in two metrics of epigenetic aging over two time points.

METHODS

We conducted meta-analyses of the association between change in PTSD diagnosis and symptom severity and change in epigenetic age acceleration/deceleration (age-adjusted DNA methylation age residuals as per the Horvath and GrimAge metrics) using data from 7 military and civilian cohorts participating in the Psychiatric Genomics Consortium PTSD Epigenetics Workgroup (total N = 1,367).

RESULTS

Meta-analysis revealed that the interaction between Time 1 (T1) Horvath age residuals and new-onset PTSD over time was significantly associated with Horvath age residuals at T2 (meta β = 0.16, meta p = 0.02, p-adj = 0.03). The interaction between T1 Horvath age residuals and changes in PTSD symptom severity over time was significantly related to Horvath age residuals at T2 (meta β = 0.24, meta p = 0.05). No associations were observed for GrimAge residuals.

CONCLUSIONS

Results indicated that individuals who developed new-onset PTSD or showed increased PTSD symptom severity over time evidenced greater epigenetic age acceleration at follow-up than would be expected based on baseline age acceleration. This suggests that PTSD may accelerate biological aging over time and highlights the need for intervention studies to determine if PTSD treatment has a beneficial effect on the aging methylome.

Network Analysis of Temporomandibular Disorder Pain and Subject-Based Bruxism in Post-Traumatic Stress Disorder Patients

BACKGROUND

Post-traumatic stress disorder (PTSD) is a psychosocial factor of interest in the multifactorial aetiology of temporomandibular disorder (TMD) pain, awake bruxism (AB) and sleep bruxism (SB).

OBJECTIVE

To investigate direct and indirect associations between post-traumatic stress disorder (PTSD), TMD pain, AB, SB and demographic and psychological variables using network analysis.

METHODS

The study sample included 597 subjects recruited from a specialised centre for the treatment of PTSD. Network analysis was performed using a Mixed Graphical Model and included variables of self-reported TMD pain, self-reported AB, self-reported SB, age, sex, PTSD symptom severity, mood disorders, anxiety disorders and insomnia severity. These variables were visualised in the network model as nodes connected by edges, representing individual associations.

RESULTS

The network model revealed a triangular positive association between TMD pain, AB and SB. AB also displayed a positive connection with anxiety disorders, while PTSD symptom severity was linked to insomnia, mood disorders and anxiety disorders. Age and sex did not significantly influence the network structure, although a negative association was observed between these variables, indicating younger ages among female subjects.

CONCLUSION

TMD pain, AB and SB were strongly associated with each other in subjects with PTSD. The presence of anxiety disorders emerged as a bridge factor, connecting the triangular positive association between TMD pain, AB and SB with psychological conditions (PTSD severity, insomnia severity, mood disorders).

Tracking individualized stuck points in cognitive processing therapy: The amount of change matters

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, MPCL-5 reduction = 29.4, d = 2.02; MCAPS-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.

Changes in Psychological and Relationship Dimensions of Sexuality After Trauma Focused Therapy in Women with Interpersonal Child Abuse Related PTSD

Women with posttraumatic stress disorder (PTSD) often report problems with sexuality. Relationship dimensions and psychological dimensions of sexuality seem to be impaired. We examined whether trauma focused therapies improve relationship and psychological dimensions of sexuality. In a randomized controlled trial that took part between 2014 and 2016 in Germany, N = 193 cisgender women with PTSD after child abuse (mean age = 36.3 years) completed the Multidimensional Sexuality Questionnaire, assessing psychological dimensions of sexuality and the Resources in Sexuality and Partnership, assessing relationship dimensions of sexuality. PTSD was assessed via Clinician Administered PTSD Scale for DSM-5. Assessments took part in the beginning and after Dialectical Behavior Therapy for PTSD or Cognitive Processing Therapy. Using hierarchical linear modeling, changes in psychological and relationship dimensions of sexuality from beginning to post treatment were assessed, also the association between PTSD symptom reduction and reduction in psychological and relationship dimensions. From beginning to post treatment, relationship dimensions of sexuality improved (p < .01; Cohen's d = .36). PTSD symptom reduction moderated this effect. The psychological dimension sexual satisfaction increased (p < .05; Cohen's d = .32), sexual anxiety (p < .001; Cohen's d = ‒.51) and sexual depression (p < .001; Cohen's d = ‒.44) decreased. PTSD symptom reduction moderated these effects. Sexual esteem and sexual motivation did not change after therapy. Our results suggest that relationship dimensions and some psychological dimensions of sexuality can improve after trauma focused therapy. Other psychological dimensions like sexual esteem might need specific therapeutic interventions to improve.

A Randomized Clinical Trial of Prolonged Exposure Therapy With and Without Topiramate for Comorbid PTSD and Alcohol Use Disorder

OBJECTIVE

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co-occur. Prolonged exposure (PE) is an effective treatment for PTSD but shows smaller effects in patients with co-occurring AUD. Topiramate may help reduce alcohol use and PTSD symptoms. This double-blind, placebo-controlled outpatient clinical trial compared 12 sessions of PE plus either topiramate or placebo.

METHODS

One hundred U.S. veterans (mean age=45 years [SD=12], 84% men) with PTSD+AUD were randomly assigned to 16 weeks of treatment with PE+topiramate (up to 250 mg) or PE+placebo to examine effects on alcohol use and PTSD severity at posttreatment assessment and at 3- and 6-month follow-ups.

RESULTS

Percent heavy drinking days decreased significantly for both conditions but did not differ between groups. PTSD scores were lower in the PE+topiramate group than in the PE+placebo group at posttreatment assessment, but not at follow-ups. The same patterns were observed for loss of PTSD diagnosis and meaningful PTSD symptom change. Change in secondary outcomes (depression, quality of life) did not differ between conditions.

CONCLUSIONS

PE+topiramate was associated with a greater reduction in PTSD symptoms than PE+placebo during active treatment. The addition of topiramate led to more rapid and pronounced PTSD symptom reduction, which may be of benefit to patients. Because effects of topiramate were not maintained at longer-term follow-up, extending time on topiramate or additional strategies to prolong such effects may be useful. Topiramate did not show added benefit to PE for percent heavy drinking days or secondary outcomes.

How-To Study Dissociative Symptoms in a Broad Range of Mental Disorders: A Methodological Primer

Dissociative symptoms constitute a transdiagnostic phenomenon not only characterizing dissociative disorders but also occurring across a broad range of other mental disorders such as posttraumatic stress disorder or borderline personality disorder. In the latter disorders, dissociative symptoms such as depersonalization, derealization, or gaps in awareness significantly burden patients' wellbeing and functioning. Many efforts have been undertaken to better understand these debilitating symptoms. However, empirical findings have not yet converged in many areas (e.g., considering neurobiological correlates or effects of dissociative psychopathology on treatment outcome), which might partially be due to the heterogeneity and limitations of employed methodology. Here, we critically review the current state-of-the-art methodology in dissociation research, comparing methods to assess dissociative symptoms, provoke dissociative symptoms in the laboratory, select the participant sample, and consider critical sample characteristics. Discussing the informative value and limits of various standard and novel methodological approaches, we aim to provide information and nuanced guidance for future research. By these means, we aim to raise and harmonize standards in dissociation research and enable researchers of all career stages to enter, navigate, and make a significant and lasting contribution to research on dissociative symptoms in a broad range of mental disorders, ultimately contributing to a better understanding of dissociative psychopathology.

Exploring post-traumatic stress among patients at a clinic for orofacial pain and dysfunction

OBJECTIVE

To explore the associations between traumatic events and post-traumatic stress on the one hand, and painful TMD, awake bruxism and sleep bruxism on the other.

METHODS

At a clinic for Orofacial Pain and Dysfunction, 701 patients completed self-report screening questionnaires between May 2023 and November 2024. On the basis of these data, we calculated descriptive characteristics, including the prevalence of PTSD. We tested our hypotheses using univariate and multivariate logistic regression analyses and Spearman's correlations and partial correlations.

RESULTS

The prevalence of PTSD (9.0 %) was higher (p < .001) than the general population's prevalence (3.8 %). The presence of PTSD was associated with the presence of painful TMD and awake bruxism. When no PTSD was present, there was no association between the three orofacial conditions and the experience of a traumatic event. Post-traumatic stress symptoms were significantly correlated to awake bruxism.

CONCLUSION

The presence of PTSD in this clinical sample was associated with the presence of painful TMD and awake bruxism. The presence of a reported potentially traumatic event without PTSD was not associated with painful TMD or awake bruxism. Finally, when examining symptom severity, the severity of awake bruxism was correlated to post-traumatic stress symptoms.

CLINICAL RELEVANCE

Increased knowledge about the role of post-traumatic stress in the aetiology of these orofacial conditions may enable tailoring treatment to these specific patient groups, and thus to increase the likelihood of treatment success.

Questionable utility of the Montreal Cognitive Assessment (MoCA) in detecting cognitive impairment in individuals with comorbid PTSD and SUD

Posttraumatic stress disorder (PTSD) is frequently comorbid with substance use disorder (SUD) in individuals seeking treatment for substance use. Further, SUD and PTSD are individually associated with cognitive impairment (CI) and poor treatment outcomes. Despite the frequent use of the Montreal Cognitive Assessment (MoCA) as a screening tool for CI, the validity of the MoCA has not been established in individuals with comorbid SUD-PTSD. We assessed the criterion validity of the MoCA in 128 participants seeking inpatient medically-assisted detoxification using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) as a reference for CI. The correlation between the RBANS and MoCA was weaker in those with SUD-PTSD (r = .32) relative to SUD alone (r = .56). Receiver operating characteristic (ROC) curves demonstrated that the MoCA had moderate-to-high ability to discriminate CI in individuals with SUD alone, with an area under the ROC curve of .82 (95% CI .69-.92) and optimal cutoff score of ≤23. However, in individuals with comorbid SUD-PTSD, the ROC analysis was not significant. Results suggest that PTSD, when comorbid with SUD, reduces the criterion-related validity of the MoCA. We recommend exercising caution when classifying CI in individuals with SUD-PTSD using the MoCA and suggest reducing the cutoff score to ≤23 in order to limit the rate of false-positive CI diagnoses in SUD-PTSD populations.

Exploring the dissociative subtype of PTSD: The role of early-life trauma, cortisol, and inflammatory profiles

Post-traumatic stress disorder (PTSD) is a heterogeneous mental health condition, characterized by diverse symptom profiles and biological underpinnings. A dissociative subtype of PTSD has been identified, though the potential risk factors and underlying neurobiology are yet to be understood. The current study comprised Canadian Armed Forces (CAF) members and Veterans with a history of deployment, and with diagnoses of non-dissociative (n = 31) and dissociative subtypes of PTSD (n = 19), in addition to non-deployed healthy controls (n = 14). Participants completed questionnaires assessing clinical symptoms and experiences of trauma, and provided saliva and blood samples for cortisol and inflammatory marker assessments. Individuals with dissociative PTSD displayed elevated PTSD and depression symptom severity, and greater reports of specific forms of childhood trauma compared to individuals with non-dissociative PTSD and controls. Morning cortisol was elevated in both PTSD groups compared to controls, however the PTSD groups did not differ from one another. Evening cortisol concentrations were elevated in both PTSD groups compared to controls, and in the dissociative PTSD subtype compared to the non-dissociative PTSD subtype when controlling for depression symptoms. PTSD diagnostic group moderated the relationship between awakening cortisol levels and PTSD symptom severity, such that the non-dissociative PTSD group displayed a negative correlation between awakening cortisol levels and PTSD symptom severity, while no significant relation was identified in the dissociative PTSD group. C-reactive protein (CRP) levels did not differ across diagnostic groups when accounting for body mass index (BMI). However, CRP positively correlated with depressive symptoms only among individuals with dissociative PTSD. Together, examining PTSD subtypes may help inform more effective and personalized treatment strategies in the future.

Trauma-related guilt, shame, and trauma type among patients with co-occurring PTSD and SUD

BACKGROUND

Substance use disorder (SUD) frequently co-occurs with posttraumatic stress disorder (PTSD). Feelings of shame and guilt are associated with either disorder but have not been studied in patients with both disorders. Index trauma characteristics are associated with PTSD severity and trauma-related shame. This study examines the effects of trauma-related guilt and shame, and index trauma on SUD and PTSD severity in a clinical sample of individuals with co-occurring SUD and PTSD.

METHODS

Participants were SUD-treatment-seeking patients with co-occurring PTSD (N = 209) who completed the Clinician-Administered PTSD scale for Diagnostic and Statistical Manual of Mental Disorders (DSM-5; CAPS-5), Alcohol Use Disorder Identification Test (AUDIT), Drug Use Disorders Identification Test (DUDIT), Trauma-Related Guilt Inventory (TRGI) and Trauma-Related Shame Inventory (TRSI). Regression analyses examined the predictive values of PTSD severity, trauma-related guilt, and shame on alcohol and drug use problems, and the predictive values of trauma-related guilt and shame on PTSD severity. One-way ANOVA and follow-up t-tests examined the effects of index trauma on PTSD severity and trauma-related shame.

RESULTS

PTSD severity was significantly associated with drug use disorder (DUD) severity and showed a curvilinear relationship to alcohol use disorder (AUD) severity. Trauma-related guilt was not significantly associated with SUD severity, while trauma-related shame was significantly associated with DUD severity (but not AUD severity). Both trauma-related guilt and shame were significantly associated with PTSD severity; however, only trauma-related shame showed an independent association. Interpersonal (especially sexual) index traumas were associated with increased trauma-related guilt and shame, while childhood index traumas were associated with increased PTSD severity.

CONCLUSIONS

Trauma-related guilt and shame might be important focus points in PTSD treatment, but for SUD problems, this study only showed an association between trauma-related shame and drug use problems. Trauma-related shame seems to be a more important treatment focus point than trauma-related guilt in the treatment of PTSD. It becomes particularly relevant for interpersonal index traumas (especially sexual trauma). Childhood traumas require attention in SUD-PTSD co-occurrence, given the higher severity of PTSD.

A meta-analysis of the association of death anxiety with psychological distress and psychopathology

Death anxiety (DA), apprehension when thinking about death, has long been associated with distress. Studies have suggested that DA may transdiagnostically contribute to mental disorders. We conducted a systematic review and meta-analysis, aiming to estimate the relationship between DA and distress or symptoms of mental disorders. The included studies reported the correlation between DA and distress or symptoms of mental disorders, across general population and clinical samples, using previously validated measures for all outcomes. PsychInfo and the Psychology and Behavioral Sciences Collection (via EBSCO), Embase, and Medline (via PubMed) were systematically searched up to 30 October 2023. Study quality was evaluated with the Study Quality Assessment Tools (National Heart, Lung, and Blood Institute). A total of 129 studies were included, reporting on 158 independent samples, for a total of 34,147 participants. Most studies were rated as poor quality. The findings indicated consistently positive associations between DA and distress outcomes (general anxiety: r = 0.42, P < 0.001; depression: r = 0.41, P < 0.001; distress: r = 0.36, P < 0.001). Heterogeneity was substantial, and prediction intervals crossed zero for all outcomes, except for anxiety and distress. We found no moderation by DA measure, sample type or the proportion of women in the sample. However, the association was stronger (t(35.37) = -2.055, P = 0.047) when medical conditions were present (r = 0.48, P < 0.001) than when they were absent (r = 0.37, P < 0.001). There was evidence of small-study effects, indicating possible publication bias. DA should be investigated in longitudinal studies across diverse samples of patients to clarify its contribution to psychopathology.

Vagus nerve stimulation therapy for treatment-resistant PTSD

BACKGROUND

Posttraumatic stress disorder (PTSD) is common and debilitating, and many individuals do not respond to existing therapies. We developed a fundamentally novel neuromodulation-based therapy for treatment-resistant PTSD. This approach is premised on coupling prolonged exposure therapy, a first-line evidence-based cognitive behavioral therapy that directs changes within fear networks, with concurrent delivery of short bursts of vagus nerve stimulation (VNS), which enhance synaptic plasticity.

METHODS

We performed a first-in-human prospective open-label early feasibility study (EFS) using a next-generation miniaturized system to deliver VNS therapy in nine individuals with moderate to severe treatment-resistant PTSD. All individuals received a standard 12-session course of prolonged exposure therapy combined with VNS. Assessments were performed before, 1 week after, and 1, 3, and 6 months after the completion of therapy.

CLINICALTRIALS

gov registration: NCT04064762.

RESULTS

VNS therapy resulted in significant, clinically-meaningful improvements in multiple metrics of PTSD symptoms and severity compared to baseline (CAPS-5, PCL-5, and HADS all p < 0.001 after therapy). These benefits persisted at 6 months after the cessation of therapy, suggesting lasting improvements. All participants showed loss of PTSD diagnosis after completing treatment. No serious or unexpected device-related adverse events were observed.

CONCLUSIONS

These findings provide a demonstration of the safety and feasibility of VNS therapy for PTSD and highlight the potential of this approach. Collectively, these support the validation of VNS therapy for PTSD in a rigorous randomized controlled trial.

The Psychological Outcomes of Direct and Indirect Exposure to Trauma: The Lebanese Experience

Studies have consistently highlighted a high prevalence of mental health difficulties following exposure to trauma. These symptoms can become even more prevalent if one experiences several traumatic events. This study is the first to explore the interaction effect of age and gender on the prevalence of psychological outcomes, including anxiety, depression, stress, and PTSD, investigating whether the impact of age on psychological health is different across genders. Our sample included 546 Lebanese adults who were exposed to both the 2020 Beirut Port explosion and the 2023 earthquakes. Participants completed the PCL-5, the DASS-21, and a series of demographic questions. Results showed that, in the context of direct exposure, the findings for male and female participants indicate that older age is associated with lower mental health symptomatology. Analyzing indirect exposure, age was not significantly correlated with psychological outcomes for males; however, significant negative relationships were observed for all outcomes for females. Findings are discussed from a cultural perspective, emphasizing recommendations for interventions targeting people affected by traumatic events, namely the importance of focusing on the young generation, namely females, who scored the highest on psychological difficulties following indirect exposure to trauma.

Sex differences in PTSD speech biomarkers assessed by virtual agent-induced conversations

Introduction

Women face a substantially elevated risk of developing PTSD compared to men. With the emergence of automated digital biomarkers for assessing complex psychiatric disorders, it becomes imperative to take into account possible sex differences.

Objectives

Our objective was to explore sex-related speech differences in individuals with PTSD.

Methods

We utilized data from the DAIC-WOZ dataset, consisting of dialogs between participants with PTSD (n = 31) and a virtual avatar. Throughout these dialogs, the avatar utilized diverse prompts to maintain a conversation. Features were extracted from the transcripts, and acoustic features were obtained from the recorded audio files. Group comparisons, correlations, and linear models were calculated to assess sex-related differences in these features between male and female individuals with PTSD.

Results

Group comparisons yielded significant differences between male and female patients in acoustic features such as the F2 frequency Standard Deviation (higher in males) and Harmonics to Noise Ratio (lower in males). Correlations revealed that Loudness Standard Deviation was significantly associated with PCL-C scores in males, but not in females. Additionally, we found interaction effects for linguistic and temporal features such as verb phrase usage, adposition rate, mean utterance duration, and speech ratio, with males showing positive associations and females showing inverse associations.

Conclusion

Sex-related variations in the expression of PTSD severity through speech suggest contrasting effects in acoustic and linguistic features. These results underscore the importance of considering sex-specific expressions of behavioral symptoms in developing digital speech biomarkers for diagnostic and monitoring purposes in PTSD.

Evidence of physical deconditioning during psychiatric hospitalization in a Veteran sample

Prior observations of low physical activity in psychiatric inpatient care suggest a risk of physical deconditioning, but to date no studies have explicitly investigated this possibility by measuring change in cardiovascular fitness over the course of hospitalization. The present study used mattress actigraphy to obtain a passive measure of sleep heart rate (sHR) among a sample of 111 male Veterans receiving treatment for PTSD at the VA Palo Alto Health Care System Trauma Recovery Program (TRP). A linear mixed-effect regression model indicated that sHR significantly increased over nights hospitalized, though this effect was attenuated among those who participated at least once in a voluntary cycling program. Conversely, higher BMI at intake was associated with greater increases in sHR over nights. These findings provide evidence of physical deconditioning in the context of residential psychiatric treatment, while suggesting that at least some patients are protected from its impacts. Whole health interventions that promote exercise in tandem with mental health treatment may help to counteract physical deconditioning in psychiatric inpatient settings and should be designed to support patients of diverse fitness levels.

Red flags for depression and PTSD following acute myocardial infarction: the role of early psychological symptoms

Patients who have experienced an acute myocardial infarction (AMI) are at increased risk of developing depression or post-traumatic stress disorder (PTSD) in the long term. However, whether these psychiatric comorbidities are preceded by early psychological symptoms appearing within the first days after AMI remains unclear. This study provides the identification of early psychological symptoms after AMI and evaluates their predictive value for the subsequent development of AMI-related depression and PTSD. A cohort of 129 AMI patients underwent assessments for early psychological symptoms (depressive symptoms, anxiety, intrusions, avoidance, and hyperarousal) within the first days after AMI using the psychometric questionnaires HAMD-17, HADS, and IES-R. Patients with clinically significant depression or PTSD within the year prior to AMI were excluded based on a clinical assessment and a review of medical records conducted by an experienced consultation-liaison psychiatrist. At a six-month follow-up, long-term depression and PTSD were diagnosed based on the HAMD-17 and CAPS-5, with PTSD assessments explicitly keyed to AMI. Stepwise multiple regression analyses identified early psychological predictors of depression and PTSD following AMI. Five days after AMI, 55 (43%) out of 129 participants exhibited early depressive symptoms, which were strongly associated with hyperarousal, intrusions, avoidance, and anxiety symptoms. Women, individuals living alone, and those with a history of psychiatric illness or treatment were at increased risk of developing these early psychological symptoms. In 80% of these patients, early depressive symptoms progressed in the long term to clinically significant depression, with 49% also developing comorbid PTSD. PTSD without clinically significant depression occurred only in subclinical form. Predictors for AMI-induced depression in the long term included early depressive symptoms, hyperarousal, and living in a solitary arrangement. Predictors for comorbid PTSD included early avoidance symptoms and solitary living arrangements. In this study, women, individuals living alone, and those with a history of psychiatric illness were particularly affected by early psychological symptoms such as depressive symptoms, hyperarousal and avoidance behaviour within the first days after an AMI. These early psychological symptoms emerging within the first days after AMI and solitary living arrangements predict the development of AMI-related depression and PTSD in the long term. These findings suggest that a comprehensive biopsychosocial post-AMI treatment should incorporate an early psychological screening within the first days after AMI to identify high-risk patients at an early stage and to prevent AMI-related depression and PTSD in the long term. The observed impact of gender, living in a solitary arrangement and a history of psychiatric morbidity highlights the need for personalized care plans that also address preexisting mental health conditions and incorporate gender-specific psychosocial interventions. High-risk patients identified in this context may benefit from early admission to community-based psychosocial services.

Amygdala EFP Neurofeedback Effects on PTSD Symptom Clusters and Emotional Regulation Processes

Background: Post-traumatic stress disorder (PTSD) manifests through distinct symptom clusters that can respond differently to treatments. Neurofeedback guided by the Amygdala-derived-EEG-fMRI-Pattern (Amyg-EFP-NF) has been utilized to train PTSD patients to regulate amygdala-related activity and decrease symptoms. Methods: We conducted a combined analysis of 128 PTSD patients from three clinical trials of Amyg-EFP-NF to evaluate effects across symptom clusters (as assessed by CAPS-5 subscales) and on emotion regulation processing (evaluated by the ERQ). Results: Amyg-EFP-NF significantly reduced severity across all PTSD symptom clusters immediately post-treatment, with improvements maintained at three-month follow-up. The arousal and reactivity cluster showed continued significant improvement during follow-up. Combined effect sizes were large (η2p = 0.23-0.35) across all symptom clusters. Regression analysis revealed that emotion regulation processes significantly explained 17% of the variance in symptom improvement during the follow-up period. Conclusions: Reduction of PTSD symptoms following Amyg-EFP-NF occurs across all symptom clusters, with emotional regulation processes potentially serving as an underlying mechanism of action. These results support Amyg-EFP-NF as a comprehensive treatment approach for PTSD that continues to show benefits after treatment completion.

The diagnostic utility of the PCL-5 in a traumatically injured black population

BACKGROUND

Posttraumatic stress disorder (PTSD) is common after traumatic injury, negatively impacting recovery. Black Americans face elevated PTSD risk following traumatic injury, yet diagnostic accuracy of assessments in trauma center settings serving this population is unknown. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) exhibits strong psychometric properties but optimal cut-scores by race require examination.

METHODS

Data were combined from three ongoing projects of injured Black American adults (N = 270). Participants completed the PCL-5 and Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) six months post-injury. Receiver operating characteristic analysis determined the PCL-5's diagnostic utility against the CAPS-5. Sensitivity, specificity, predictive values, and diagnostic efficiency were calculated across cut scores.

RESULTS

Prevalence of CAPS-5 PTSD at 6-months post-injury was 34.4 %. The PCL-5 demonstrated good accuracy in detecting PTSD (AUC=.931). A PCL-5 cut-score of > 33 maximized diagnostic efficiency (89.1 %), with sensitivity of 89.1 % and specificity of 87.6 %.

CONCLUSIONS

The PCL-5 is an accurate PTSD screening tool for injured Black Americans using an appropriate threshold. Findings have implications for improving mental health care access in trauma settings serving marginalized groups.

Implementation of a Dedicated Intake Team Reduces Time to Massed PTSD Treatment

The Institute of Medicine (2001) describes quality health care as safe, effective, patient-centered, efficient, equitable, and timely. Although this definition highlights the necessity of continuous program evaluation to ensure that these goals are being addressed, there is a notable lack of industry-wide standards and benchmarks, and many clinical programs lack the ability to continually and rigorously evaluate their own performance with data. This might be particularly true in the case of ensuring service members and veterans with posttraumatic stress disorder (PTSD) obtain treatment, as several systemic barriers exist, such as long wait times and lack of equitable treatment for individuals with minoritized identities. The current study examines the impact of a clinic-wide intake redesign for a massed PTSD treatment program to shift the intake process to a small, dedicated team rather than a responsibility shared across all clinicians. The redesign led to significantly shorter wait times for treatment and reduced some types of pre-treatment dropout. On average, patients received an acceptance/rejection decision 1 week sooner, attended the program almost 2 months sooner, and saw a roughly 60% reduction in the odds of dropout at the point of receiving an acceptance/rejection decision. Some disparities in wait times for those who were not partnered, women, and individuals who financially supported more family members remained after the redesign. Results are discussed in light of the importance of continuous program evaluation to address IOM's holistic definition of quality health care.

Written Exposure Therapy for Posttraumatic Stress Symptoms and Suicide Risk: A Randomized Controlled Trial With High-Risk Patients Admitted to a Military Inpatient Psychiatric Unit

INTRODUCTION

Active duty service members who are psychiatrically hospitalized for suicide are at the highest risk for suicide death following discharge. It is essential to test brief treatments that can be delivered during the short length of stay in inpatient psychiatry. Written Exposure Therapy, a brief treatment for posttraumatic stress disorder (PTSD), was augmented with Crisis Response Planning (WET + CRP) to address PTSD and suicidal ideation (SI).

METHODS

This randomized controlled trial evaluated the efficacy of the WET + CRP plus treatment as usual (n = 47; TAU) compared with TAU alone (n = 48) in reducing SI, PTSD symptoms, and rehospitalization among suicidal patients with at least moderate PTSD symptoms admitted to an inpatient psychiatric unit. PTSD symptoms and SI were assessed with clinician-administered interviews and self-report.

RESULTS

Participants were primarily male (61.1%) and active duty/reserve (93.7%). There were no significant group differences in clinician-assessed SI presence and PTSD symptom severity (the primary outcomes) or self-reported SI severity. WET + CRP demonstrated significant reductions in self-reported PTSD symptom severity compared with TAU; these reductions were the strongest during the month following discharge.

CONCLUSIONS

Although the findings were not fully consistent with hypotheses, WET + CRP is feasible to deliver to suicidal, psychiatrically hospitalized service members and warrants additional study.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04225130.

A network analysis of clinician-rated posttraumatic stress disorder and substance use disorder symptom clusters in a sample of veterans seeking outpatient treatment

The presentation of comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) differs by substance type. The current study applied network analysis to explore the relationships between diagnostic symptom clusters by examining the strength and direction of unique associations between PTSD and SUD. Network analyses were estimated using a sample of 422 veterans diagnosed with co-occurring PTSD/SUD initiating psychotherapy for PTSD while receiving concurrent outpatient SUD treatment as part of a randomized clinical trial. Separate network models were estimated for PTSD and the three most common SUD in the sample: alcohol use disorder (AUD), cannabis use disorder (CUD) and stimulant use disorder (StUD). Trauma-related intrusions and alcohol-related social impairment were the bridging symptom clusters that connected PTSD and AUD. Symptom clusters that connected PTSD and CUD were trauma-related intrusions and hyperarousal symptoms. Trauma-related alterations in cognition and mood and stimulant-related pharmacological symptoms were the bridging symptom clusters that connected PTSD and StUD. Each network of symptom clusters culminated in the trauma-related avoidance cluster, suggesting avoidance may represent a final outcome of the downstream effects of these symptoms. Across models, PTSD and SUD symptom clusters both served as sources of activation driving the comorbidity. There were also few and relatively weak bridging symptom clusters that connected PTSD/SUD, suggesting symptom change in one disorder may have minimal effect on the other disorder. Therefore, simultaneously treating PTSD and SUD as well as employing individualized treatment planning to target prominent symptoms may be most beneficial for veterans with PTSD/SUD.

The relationship between language features and PTSD symptoms: a systematic review and meta-analysis

Objective

The aim of this study is to investigate the relationship between language features and symptoms of Post-Traumatic Stress Disorder (PTSD) to determine if language features can serve as a reliable index for rapid screening and assessing PTSD.

Methods

A comprehensive literature search was performed using Pubmed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Ovid databases, augmented by backward reference tracking, to gather pertinent literature concerning language features and traumatic stress disorders published until August 2024.

Results

Twelve observational studies were included, comprising a cumulative sample size of 5,706 cases. Various language analysis tools, such as Linguistic Inquiry and Word Count (LIWC), manual coding, and machine learning techniques, were employed in the studies. Meta-analysis findings revealed a positive correlation between death-related words and PTSD symptoms (OR 1.32, 95%CI 1.10 to 1.59, I² 79.4%, p = 0.004), as well as significant positive correlations between negative emotion words and PTSD symptoms (OR 1.21, 95%CI 1.11 to 1.32, I² 30.5%, p < 0.001), anger-related words and PTSD symptoms (OR 1.14, 95%CI 1.11 to 1.17, I² 0.0%, p < 0.001), word count and PTSD symptoms (OR 1.20, 95%CI 1.09 to 1.31, I² 11.2%, p < 0.001). Additionally, a positive correlation was observed between body-related words and hyperarousal symptoms of PTSD (OR 1.26, 95%CI 1.15 to 1.37, I² 0.0%, p < 0.001), intrusive symptoms (OR 1.40, 95%CI 1.16 to 1.68, I² 0.0%, p < 0.001), and avoidance symptoms (OR1.29, 95%CI 1.21 to 1.37, I² 0.0%, p < 0.001). Death-related words (OR 1.16, 95% CI 1.08 to 1.25, I² 0.0%, p < 0.001) and word count (OR 1.18, 95% CI 1.10 to 1.27, I² 0.0%, p < 0.001) were observed positive correlations between intrusive symptoms of PTSD. Conversely, no correlation was found between the use of words related to sadness, anxiety, positive emotions, first-person pronouns, sensory, cognitive-related words and PTSD symptoms.

Conclusion

Death-related words, anger-related words, negative emotion words, body-related words and word count in Language features hold promise as a reliable indicator for rapid screening and assessing PTSD; however, further research is warranted to investigate their relationship with PTSD symptoms across various cultural contexts, genders, and types of trauma.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024528621.

Validation of the Childhood Trauma Questionnaire (CTQ) in the Context of Trauma-Focused Treatment

Background: The Childhood Trauma Questionnaire (CTQ) is widely used, but retrospective self-report measures may be susceptible to bias especially in the context of pathology. Therefore, we aimed to validate the CTQ in the context of reduced psychopathology following trauma-focused treatment. Methods: We analyzed 149 outpatients with posttraumatic stress disorder (PTSD) related to childhood abuse. Participants received one of three variants of prolonged exposure. The CTQ was administered at baseline and six months later. The internal consistency of the CTQ was assessed using Cronbach's alpha, inter-item and item-total correlations. Convergent validity was assessed with the clinician administered PTSD Scale for DSM-5 (CAPS-5). The consistency of CTQ scores over time was analyzed using linear mixed models and intra-class correlation coefficients. Results: Most CTQ subscales demonstrated high internal consistency and satisfactory inter-item and item-total correlations except for physical neglect and minimization/denial subscales. CTQ subscales physical and sexual abuse exhibited adequate convergent validity with the CAPS-5. None of the CTQ subscales mean score changed significantly from baseline to follow-up. Agreement between the baseline and follow-up assessment within-persons was moderate at item-level but good at subscale-level except for subscale minimization/denial. Minimization/denial at baseline and change in symptomatology during treatment were not significantly related to change in CTQ subscale scores. Conclusions: These findings support the use of the CTQ subscales to retrospectively assess childhood maltreatment.

Reduction in reintegration stress among post-9/11 Veterans in a clinical trial for trauma-related guilt

Reintegration stress is commonly reported by returning Veterans with post-trauma distress and associated with mental health and functioning difficulties. Interventions are needed to reduce reintegration stress and provide a pathway to improve Veterans' connections with their families, friends, and communities. The present study compared the effectiveness of Trauma Informed Guilt Reduction Therapy (TrIGR) and Supportive Care Therapy (SCT) in reducing reintegration stress, assessed by the Military to Civilian Questionnaire (M2C-Q) at post-treatment and 3- and 6-month follow-up. Data were derived from a randomized controlled trial treating U.S. military Veterans endorsing trauma-related guilt stemming from an event that occurred during deployment to the recent conflicts in Iraq and Afghanistan (N = 145). Intent to treat analyses using mixed models indicated a significant treatment * time interaction (p = .004) whereby patients randomized to TrIGR reported significantly lower reintegration stress compared to those in SCT by the 6-month follow-up. Between-condition effect sizes were d = 0.11 at post-treatment and d = 0.37 and d = 0.57 at 3- and 6-month follow-up assessments, respectively. Targeting trauma-related guilt may be an effective pathway to help facilitate the process of reintegration to civilian life for some Veterans.

COVID-19 Pandemic Impacts on STRESS, PTSD, and Prefrontal Cortical Thickness in Pre-Pandemic Trauma Survivors

Background/Objectives: The COVID-19 pandemic increased psychiatric symptoms in patients with pre-pandemic mental health conditions. However, the effects of pandemic on the brain, stress, and mental illness remain largely conjectural. Our objective was to examine how the pandemic affected prefrontal cortical thicknesses (CTs), stress, and PTSD symptoms in people with pre-pandemic trauma histories. Methods: Fifty-one survivors from a pre-pandemic trauma study who had completed a pre-pandemic PTSD Checklist-5 (PCL) to assess PTSD symptoms and a sMRI scan to measure prefrontal CTs were re-recruited after the pandemic. They subsequently completed the COVID Stress Scale (CSS) to assess stress, the Clinician Administered PTSD Scale-5 (CAPS) to diagnose PTSD, and a second sMRI scan. COVID-19 infection was self-reported. Associations between stress and symptom assessments and post-pandemic CTs, differences in CTs in PTSD vs. non-PTSD groups, and changes in pre- to post-pandemic CTs were examined. Results: Pre-pandemic PCL scores were positively associated with CSS scores which, in turn, were higher in the PTSD group. Thicker IFG-opercularis CTs were associated with COVID-19 infection. Post-pandemic rMFG and IFG-orbitalis CTs were positively associated with CAPS scores. rACC CTs were negatively associated with CSS scores. Pre- to post-pandemic rMFG and frontal pole CTs thickened in the PTSD group but thinned in the non-PTSD group, whereas rACC CTs thinned in the PTSD group but thickened in the non-PTSD group. Conclusions: These findings provide novel evidence that the COVID-19 pandemic had diverse effects involving prefrontal cortex structure, stress, and PTSD symptoms in subjects with pre-pandemic trauma history and suggest that treatments are needed to counter these diverse effects.