A history of PTSD changes the way people express themselves during the COVID-19 pandemic.

Background: The words people use in everyday life tell us about their emotions, their mental state and allow us to understand how people process and interpret an event. Previous research has established a link between the content analysis of narrative texts and the psychopathology of people who have experienced trauma.Objectives: This study examines whether the development of PTSD following exposure to a previous traumatic event alters the way people express themselves in the context of an anxiety-provoking event, the COVID-19 pandemic.Methods: This study is based on semi-structured interviews conducted during the first lockdown period in France (23 April-16 May 2020) with people exposed to the 13 November 2015 attacks (N = 31) and nonexposed people (N = 57).Results: People with PTSD had longer narratives and used more first-person singular pronouns, lower first-person plural pronouns, more words related to negative emotions and anxiety compared to the nonexposed group. Within the PTSD group, there was no significant difference between the use of words related to the attacks and the pandemic. Conversely, the nonexposed group used more words related to the COVID-19 pandemic compared to words related to the attacks.Conclusion: These results confirm, as have other studies, that a history of PTSD can specifically modify the style and narrative of past experiences. They underline the importance of including linguistic analyses in psychological assessments of PTSD.

The PTSD group has a longer narrative compared to the nonexposed group.The PTSD group narrative was more individualistic and emotionally focused than the nonexposed group.The lexical field of the attacks relatively to the field of pandemic seems to occupy the same place in the accounts of people suffering from PTSD.

Traumatic loss: a systematic review of potential risk factors differentiating between posttraumatic stress disorder and prolonged grief disorder.

Background: When traumatic events and losses intersect in the form of traumatic loss, these events can trigger both posttraumatic stress disorder and pathological grief.Objective: This systematic review investigates which characteristics differentiate between the development of the respective disorders or are associated with comorbidity.Method: A systematic literature search using Medline, PubMed, APA PsycInfo and Web of Science yielded 46 studies which met the inclusion criteria. In these studies, PTSD was assessed using 17 and pathological grief using 16 different validated instruments. In the quality assessment, 12 studies were classified as average, 30 as above average, and 4 as excellent. The investigated risk factors were categorized into 19 superordinate clusters and processed using narrative synthesis.Results: The relationship to the deceased, mental health issues, and religious beliefs seem to be associated specifically with pathological grief symptoms compared to PTSD symptoms. Social support and social emotions emerged as significant correlates and potential risk factors for both PTSD and pathological grief. Included studies had mainly cross-sectional designs.Conclusions: Differentiating factors between pathological grief and PTSD appear to exist. The results should be considered within the limitations of the heterogeneity of the included studies and the research field. There is a lack of studies (1) using a longitudinal study design, (2) starting data collection early following the traumatic loss, (3) using standardized, up-to-date measurement instruments and (4) including comorbidity in their analyses. Further research is urgently needed for more accurate (acute) screenings, prognoses, and interventions following traumatic loss.

When traumatic events and losses intersect in the form of traumatic loss, these events can trigger both posttraumatic stress disorder and pathological grief. This systematic review investigates which characteristics can differentiate between the development of the respective disorders or are associated with comorbidity.The relationship to the deceased, mental health issues, and religious beliefs seem to be specific characteristics for predicting pathological grief. Social support and social emotions were frequently reported as significant correlates of both PTSD and pathological grief.The studies to date have been very heterogeneous and mainly cross-sectional. Further research considering both disorders after traumatic loss in longitudinal study designs is urgently indicated for better (acute) screenings, prognoses, and interventions.

Self-stigma mediates the relationships between childhood maltreatment and symptom levels of PTSD, depression, and anxiety.

Background: Childhood maltreatment is a risk factor for developing multiple forms of psychopathology, including depression, posttraumatic stress disorder (PTSD), and anxiety. Yet, the mechanisms linking childhood maltreatment and these psychopathologies remain less clear.Objective: Here we examined whether self-stigma, the internalization of negative stereotypes about one's experiences, mediates the relationship between childhood maltreatment and symptom severity of depression, PTSD, and anxiety.Methods: Childhood trauma survivors (N = 685, Mage = 36.8) were assessed for childhood maltreatment, self-stigma, and symptoms of depression, PTSD, and anxiety. We used mediation analyses with childhood maltreatment as the independent variable. We then repeated these mediation models separately for childhood abuse and neglect, as well as the different subtypes of childhood maltreatment.Results: Self-stigma significantly mediated the relationship between childhood maltreatment and depression, PTSD, and anxiety symptoms. For sexual abuse - but not physical or emotional abuse - a significant mediation effect of self-stigma emerged on all symptom types. For childhood neglect, self-stigma significantly mediated the relationship between both emotional and physical neglect and all symptom types.Conclusion: Our cross-sectional study suggests that different types of childhood maltreatment experiences may relate to distinct mental health problems, potentially linked to increased self-stigma. Self-stigma may serve as an important treatment target for survivors of childhood abuse and neglect.

Childhood maltreatment is linked to depression, PTSD, and anxiety symptoms.Self-stigma, or internalizing negative stereotypes, plays a significant role in mediating this relationship.Different types of maltreatment are linked to varying levels of self-stigma and symptom severity.

A network perspective on posttraumatic stress disorder and comorbid borderline personality disorder symptoms.

Background: Comorbidity between posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) is surrounded by diagnostic controversy and although various effective treatments exist, dropout and nonresponse are high.Objective: By estimating the network structure of comorbid PTSD and BPD symptoms, the current study illustrates how the network perspective offers tools to tackle these challenges.Method: The sample comprised of 154 patients with a PTSD diagnosis and BPD symptoms, assessed by clinician-administered interviews. A regularised partial correlation network was estimated using the GLASSO algorithm in R. Central symptoms and bridge symptoms were identified. The reliability and accuracy of network parameters were determined through bootstrapping analyses.Results: PTSD and BPD symptoms largely clustered into separate communities. Intrusive memories, physiological cue reactivity and loss of interest were the most central symptoms, whereas amnesia and suicidal behaviour were least central.Conclusions: Present findings suggest that PTSD and BPD are two distinct, albeit weakly connected disorders. Treatment of the most central symptoms could lead to an overall deactivation of the network, while isolated symptoms would need more specific attention during therapy. Further experimental, longitudinal research is needed to confirm these hypotheses.Trial registration: ClinicalTrials.gov identifier: NCT03833453.

A network analysis of PTSD and BPD symptoms.PTSD and BPD symptoms largely clustered into separate communities.Intrusive memories, loss of interest and physiological cue reactivity seem valuable treatment targets.

Exogenous glucocorticoids to improve extinction learning for post-traumatic stress disorder patients with hypothalamic-pituitary-adrenal-axis dysregulation: a study protocol description.

Background: Trauma-focused treatments for post-traumatic stress disorder (PTSD) are effective for many patients. However, relapse may occur when acquired extinction memories fail to generalize beyond treatment contexts. A subgroup of PTSD patients - potentially with substantial exposure to early-life adversity (ELA) - show dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which results in lower cortisol levels. Glucocorticoids, including cortisol, appear to facilitate strength and generalization of emotional memories.Objective: We describe the protocol of an integrated PTSD study. We investigate (A) associations between HPA-axis dysregulation, ELA, epigenetic markers, and PTSD treatment outcome (observational study); and (B) effects of exogenous glucocorticoids on strength and generalization of extinction memories and associated neural mechanisms [pharmacological intervention study with functional magnetic resonance imaging (fMRI)]. The objective is to provide proof of concept that PTSD patients with HPA-axis dysregulation often experienced ELA and may show improved strength and generalization of extinction learning after glucocorticoid administration.Method: The observational study (n = 160 PTSD group, n = 30 control group) assesses ELA, follow-up PTSD symptoms, epigenetic markers, and HPA-axis characteristics (salivary cortisol levels during low-dose dexamethasone suppression test and socially evaluated cold-pressor test). The pharmacological intervention study (n = 80 PTSD group, with and without HPA-axis dysregulation) is a placebo-controlled fMRI study with a crossover design. To investigate strength and generalization of extinction memories, we use a differential fear acquisition, extinction, and extinction recall task with spatial contexts within a virtual environment. Prior to extinction learning, 20 mg hydrocortisone or placebo is administered. During next-day recall, strength of the extinction memory is determined by recovery of skin conductance and pupil dilation differential responding, whereas generalization is assessed by comparing responses between different spatial contexts.Conclusion: The integrated study described in the current protocol paper could inform a personalized treatment approach in which these PTSD patients may receive glucocorticoids as a treatment enhancer in trauma-focused therapies.Trial registration: The research project is registered in the European Union Drug Regulating Authorities Clinical Trials (EudraCT) database, https://eudract.ema.europa.eu/, EudraCT number 2020-000712-30.

This protocol reports a proof-of-concept study for glucocorticoids as an enhancer for PTSD treatment.The study examines whether glucocorticoids enhance the strength and generalization of extinction memory.A further aim is to identify HPA-axis-related PTSD subgroups that may particularly benefit.

Impact of cognitive behavioural therapy on neural, inflammatory, & autonomic markers in a sample with PTSD and cardiovascular risk: protocol for a pilot randomised controlled trial.

Background: Individuals with posttraumatic stress disorder (PTSD) are at heightened risk for cardiovascular disease (CVD) compared to the general population. Inflammation and autonomic dysfunction are candidate mechanisms of CVD risk in PTSD; however, these mechanisms have not been well-characterised in the PTSD-CVD link. Further, these mechanisms may operate through altered stress-related neural activity (SNA). Yet, it remains unknown if changes in PTSD are associated with changes in CVD risk mechanisms.Objective: This manuscript describes the design and procedures of a pilot randomised controlled trial to assess the impact of a first-line treatment for PTSD (Cognitive Processing Therapy; CPT) versus waitlist control on mechanisms of CVD risk. Further, this study will test the hypothesis that CPT reduces CVD risk through its effects on inflammation and autonomic function and that these changes are driven by changes in SNA.Methods: Adults with PTSD and CVD risk (N = 30) will be randomised to CPT or waitlist control. Participants complete two laboratory visits (baseline and post-treatment) that include surveys, brain and peripheral imaging via 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), and resting measures of autonomic function. Primary outcomes include arterial inflammation and heart rate variability. Secondary outcomes include leukopoiesis (bone marrow uptake), heart rate, and blood pressure. The indirect effects of PTSD treatment on changes in inflammation and autonomic function through SNA will also be examined.Conclusions: This study seeks to characterise candidate neuroimmune mechanisms of the PTSD-CVD link to identify treatment targets and develop personalised interventions to reduce CVD events in PTSD populations.Trial registration: ClinicalTrials.gov identifier: NCT06429293..

Individuals with posttraumatic stress disorder (PTSD) have greater risk for cardiovascular disease (CVD) than the general population.Autonomic dysfunction and inflammation are candidate mechanisms of the PTSD-CVD link, which may be driven by changes in neural activity.This pilot randomised controlled trial will test the impact of a first-line PTSD treatment on autonomic dysfunction and inflammation, and whether neural alterations are associated with changes in these mechanisms.

Development of a stepped care intervention model of evidence-based interventions for the management of posttraumatic stress in the Belgian Police.

Background: Police officers are frequently exposed to a wide variety of potentially traumatic events (PTE) and are therefore at a considerable risk of developing posttraumatic stress disorder (PTSD). Previous research estimated the point prevalence of PTSD in Belgian police officers at 7.4%, significantly higher than in the general population. An effective organisational strategy to manage posttraumatic stress is essential.Objective: We aimed to develop a novel organisational approach regarding traumatic stress for Belgian police, combining evidence-based strategies for the prevention and treatment of posttraumatic stress in a stepped care intervention model.Method: In a broad development process, we combined scientific literature, case studies of best practices from other police organisations with insights gathered from a number of expert panels, thematic working groups and feedback groups.Results: A comprehensive stepped care intervention model was developed, consisting of evidence-based interventions for the prevention and treatment of posttraumatic stress.Conclusions: The intervention model is a promising organisational strategy for the management of posttraumatic stress in police organisations based on evidence-based interventions. Its effectiveness will be studied in the coming years.

Police officers are at considerable risk of developing PTSD as they are consistently exposed to a wide array of PTE.An adequate organisational response to manage the consequences of this exposure as much as possible is essential.We developed a comprehensive stepped care intervention model consisting of evidence-based interventions, based on scientific literature, best practices in other police organisations, and thorough expert review.

The significant others' responses to trauma scale (SORTS): applying factor analysis and item response theory to a measure of PTSD symptom accommodation.

Background: Symptom accommodation by family members (FMs) of individuals with posttraumatic stress disorder (PTSD) includes FMs' participation in patients' avoidance/safety behaviours and constraining self-expression to minimise conflict, potentially maintaining patients' symptoms. The Significant Others' Responses to Trauma Scale (SORTS) is the only existing measure of accommodation in PTSD but has not been rigorously psychometrically tested.Objective: We aimed to conduct further psychometric analyses to determine the factor structure and overall performance of the SORTS. Method: We conducted exploratory and confirmatory factor analyses using a sample of N = 715 FMs (85.7% female, 62.1% White, 86.7% romantic partners of individuals with elevated PTSD symptoms).Results: After dropping cross-loading items, results indicated good fit for a higher-order model of accommodation with two factors: an anger-related accommodation factor encompassed items related largely to minimising conflict, and an anxiety-related accommodation factor encompassed items related primarily to changes to the FM's activities. Accommodation was positively related to PTSD severity and negatively related to relationship satisfaction, although the factors showed somewhat distinct associations. Item Response Theory analyses indicated that the scale provided good information and robust coverage of different accommodation levels.Conclusions: SORTS data should be analysed as both a single score as well as two factors to explore the factors' potential differential performance across treatment and relationship outcomes.

We examined the Significant Others' Responses to Trauma Scale (SORTS), a measure of symptom accommodation in PTSD, among a large sample of family members.As measured by the SORTS, accommodation in PTSD could be broken down into two aspects: anger-related accommodation and anxiety-related accommodation.Accommodation was positively related to PTSD severity and negatively related to relationship satisfaction.

Cultural differences in appraisals of control and posttraumatic stress disorder symptoms.

Background: Appraisals are central to posttraumatic stress disorder (PTSD). Yet, few studies have examined how culture influences the associations between different types of trauma-related appraisals and PTSD symptoms.Objective: This study investigated cultural influences on appraisals of control and their associations with PTSD symptoms.Method: European Australian (n = 140, Mage = 35.80, SD = 12.44; 21 men, 97 women, 20 gender diverse/prefer not to report) and Chinese Australian (n = 129, Mage = 30.16, SD = 8.93, 21 men, 97 women, 20 gender diverse/prefer not to report) trauma survivors completed measures of appraisals, cultural values, and PTSD symptoms.Results: Findings showed that the Chinese Australian group was associated with greater Chinese cultural beliefs about adversity (i.e. emphasizing the value of adversity and people's ability to overcome adversity) and fewer fatalism appraisals (i.e. appraising one's destiny as externally determined), which in turn were atemporally associated with fewer PTSD symptoms; these atemporal indirect associations were moderated by self-construal and holistic thinking. The Chinese Australian group also reported fewer secondary control appraisals (i.e. attempts to change aspects of the self and accept current circumstances), which were atemporally associated with greater PTSD symptoms. In contrast, the European Australian group was associated with fewer primary control appraisals (i.e. perceived ability to personally change or control a situation), which were atemporally associated with greater PTSD symptoms.Conclusion: These findings highlight the importance of considering the influence of culture on appraisals in PTSD. However, it must be noted that causal relationships cannot be inferred from cross-sectional mediation analyses and thus, future longitudinal research is needed.

Chinese Australian trauma survivors were associated with greater reporting of Chinese cultural beliefs about adversity and fewer fatalism appraisals, which were associated with fewer PTSD symptoms. These associations were moderated by a trauma survivor's self-construal and level of holistic thinking.Chinese Australian trauma survivors reported fewer secondary control appraisals, which were associated with greater PTSD symptoms.European Australian trauma survivors were associated with fewer primary control appraisals, which were associated with greater PTSD symptoms.

Stronger together: the longitudinal relations between partner responsiveness, dyadic coping and PTSD recovery.

Background: Past research has primarily focused on negative associations between PTSD and relationships. Therefore, this investigation delves into the potential positive role of these relational aspects in aiding PTSD recovery during treatment.Objective: This study aimed to examine the impact of dyadic coping and perceived partner responsiveness on treatment trajectories of PTSD patients.Method: The study included 90 participants, who were requested to complete online questionnaires twice, with a six-month gap between the measures.Results: The results from linear regression analyses indicated that perceived partner responsiveness had a positive effect on PTSD recovery, whereas dyadic coping had the opposite effect: higher levels of dyadic coping were associated with an increase in posttraumatic stress symptoms over time. Additional examination of the subscales indicated that heightened communication between clients and partners regarding stress was related with increased posttraumatic stress symptoms.Conclusions: These findings underscore the importance and complexity of effective and supportive communication between patients with PTSD and their partners. While existing literature supports both perceived partner responsiveness and dyadic coping as beneficial, this study indicates that only perceived partner responsiveness positively impacted PTSD recovery.

Perceived Partner Responsiveness and PTSD Recovery: the study reveals a significant positive impact of perceived partner responsiveness on PTSD recovery. Patients perceiving higher levels of understanding from their romantic partners experience enhanced recovery, possibly through increased social support and the development of new self-narratives.Dyadic Coping and PTSD Recovery: contrary to expectations, aspects of dyadic coping, particularly stress communication, were found to hinder PTSD recovery. Unhelpful disclosure and problematic interpersonal dynamics in discussing trauma within the relationship seemed to limit recovery, indicating the nuanced nature of communication's role in PTSD recovery.

Types of childhood maltreatment as predictors of posttraumatic stress disorder severity and complex posttraumatic stress disorder in patients with substance use disorders.

Background: Childhood maltreatment (CM) can be divided into: emotional abuse (EA), physical abuse (PA), sexual abuse (SA), emotional neglect (EN), and physical neglect (PN). CM is associated with (Complex)Posttraumatic stress disorder (PTSD/CPTSD) and substance use disorder (SUD).Objective: This cross-sectional study examined the relationships between CM-subtypes with PTSD-severity and CPTSD in patients with SUD-PTSD.Method: Participants (N = 209) were treatment-seeking SUD-PTSD patients who completed the Childhood Trauma Questionnaire-short form, the Clinician-Administered PTSD Scale for DSM-5 and the International Trauma Questionnaire. Regression analyses and a model selection procedure to select an optimal model were used to examine CM-subtypes as predictors of (C)PTSD, adjusted for sex and age.Results: Total CM and all CM-types significantly predicted PTSD-severity in the univariate regression analysis, with EA begin the strongest predictor. In the multiple regression only SA predicted PTSD-severity. Subsequently, model selection indicated that the optimal model to predict PTSD-severity included EA and SA. In the univariate analyses total CM, EA, and PN significantly predicted CPTSD-classification, and total CM and all CM-types significantly predicted CPTSD-severity. In the multiple regression for CPTSD-classification only EA and PA were significant predictors and for CPTSD-severity EA, PA and SA were significant predictors. In post-hoc multiple regression analyses, only EA was a significant predictor of CPTSD-classification and CPTSD-severity. Finally, in the model selection the most parsimonious model only included EA for both CPTSD-classification and CPTSD-severity. Sex was not a moderator in the relationship between CM and PTSD, nor in CM and CPTSD.Conclusions: These findings indicate that for SUD-PTSD patients, several CM-types have predictive value for (C)PTSD-severity, however SA and especially EA appear to contribute to these complaints. Since EA does not constitute an A-criterion, it is generally more overlooked in PTSD treatment. Its impact should therefore be underlined, and clinicians should be attentive to EA in their treatment.

All types of Childhood Maltreatment are associated with PTSD severity.Emotional Abuse and Sexual Abuse are most predictive for PTSD severity.Emotional Abuse is most predictive for CPTSD classification and symptom severity.

Advancing the understanding and treatment of post-traumatic stress disorder with computational modelling.

The existing theories of post-traumatic stress disorder (PTSD) have inspired large volumes of research and have contributed substantially to our current knowledge base. However, most of the theories are of a qualitative and verbal nature, and may be difficult to evaluate and compare with each other. In this paper, we propose that one way forward is to use computational modelling to formulate more precise theories of PTSD that can be evaluated by (1) assessing whether the model can explain fundamental phenomena related to PTSD, and (2) comparing simulated outcomes with real data. Computational modelling can force us to describe processes more precisely and achieve stronger theories that are viable for testing. Establishing the theoretical groundwork before undertaking empirical studies can help us to avoid doing research with low probability of valid results, and counteract the replicability crisis in psychology. In conclusion, computational modelling is a promising avenue for advancing the understanding and treatment of PTSD.

Computational modelling can help us to specify the psychological processes involved in PTSD, which may increase our understanding of how best to help people to recover after traumatic events.With computational models of PTSD, we can simulate the consequences of the theoretical principles and make sure to design research studies that are theoretically well grounded.To validate the computational models, high-quality empirical data are still needed.

PTSD risk factors in earthquake survivors and their families: a systematic review.

Background: Exposure to earthquakes can cause adverse effects on the mental health of survivors, including an increased risk of PTSD.Objective: This systematic review aims to analyse the previous secondary studies to identify the risk factors for PTSD from children to elderly earthquake survivors. In addition, it aims to consider the complexity of the joint effects of the individual, relational, and contextual risk factors, to also detect the most at-risk families.Method: After reviewing and screening studies from the literature search through PubMed, Web of Science, Scopus, and EBSCO under the guidance of PRISMA guidelines, ten eligible secondary studies were identified that examine the risk factors for PTSD in individuals (from children to elderly) affected by worldwide earthquakes.Results: The analysis of the included studies allowed the identification of a series of socio-demographic, pre-traumatic, peri-traumatic, and post-traumatic PTSD risk factors in children, adolescents, youth, adults, and elderly survivors. The results represent the complexity of the joint effects of these risk factors at individual, relational, and contextual levels.Conclusions: The consideration of the PTSD risk factors highlights the importance of individual characteristics and the type of experiences and exposure in the period before, during, and after the earthquake. This knowledge could allow the early identification of at-risk individuals of different ages and families and the implementation of intervention programmes.

This is the first systematic review to identify PTSD risk factors from children to elderly earthquake survivors using secondary studies.Considering the complexity of the joint effects at individual, relational, and contextual levels, several socio-demographic, pre-traumatic, peri-traumatic, and post-traumatic risk factors for PTSD were identified in the age groups considered. Moreover, the consideration of these factors could help the identification of at-risk families.The identification of risk factors for PTSD across the lifespan could provide helpful knowledge for prevention and intervention programmes.

Cultural psychological factors in posttraumatic symptom development and expression: a study protocol.

Introduction: Cultural factors were shown to be particularly relevant for the development and expression of posttraumatic stress. Recently, the concept of cultural scripts of trauma has been introduced, which proposes that trauma sequelae elements may be sequentially linked and specifically associated with cultural factors. Furthermore, a cascade model is proposed, including trauma exposure, demographic characteristics, cultural affiliation, and trauma-related value orientations as influencing factors of posttraumatic development. The purpose of this Network Project is to investigate cultural psychological factors that contribute to the expression of posttraumatic stress.Methods: The present Network Project implements a mixed methods approach and will be conducted in 5 different study sites, including Switzerland, Israel, Georgia, China, and East Africa. In sub-study I, the cultural scripts of traumatic stress inventories (CSTIs) will be developed. These scales provide a pool of trauma sequelae elements for each cultural group. For this purpose, focus groups with trauma survivors and trauma experts will be conducted and analysed using qualitative research methods. Sub-study II implements a validation analysis of the CSTIs and the empirical investigation of a cultural cascade model. This quantitative approach will include a larger sample of individuals who experienced traumatic life events.Discussion: This contribution is timely and enriches the knowledge of trauma and culture. Future publications of this Network Project will address trauma sequelae from a cultural perspective and provide diagnostic and psychotherapeutic implications.

This paper presents a Network Project that investigates cultural factors in posttraumatic sequelae.The Network Project encompasses an innovative research design with both qualitative and quantitative methods.New developments in the field of cultural clinical psychology are introduced, including cultural scripts of trauma and a cascade model of cultural factors in posttraumatic symptom expression.

A pilot randomised control study to investigate the effect of the South African Adolescence Group Sleep Intervention (SAASI) on adolescent sleep and PTSD.

Background: Trauma exposure prevalence and consequent post-traumatic stress disorder among South African adolescents are significant. Sleep disturbances are among the most frequently reported difficulties faced by those dealing with PTSD. The current study examined the feasibility and preliminary efficacy of the South African Adolescence Group Sleep Intervention on PTSD symptom severity and sleep disturbance.Method: Sixty-one adolescents with PTSD diagnoses and sleep disturbance were randomly assigned (1:1) to one individual and four group sessions of a sleep intervention (SAASI) or a control group. Participants completed the Child PTSD symptom scale for DSM5 (CPSS-5) and the Pittsburgh Sleep Quality Index (PSQI) among other sleep and psychiatric measures. The trial was registered on the Pan African Trial Registry (PACTR202208559723690).Results: There was a significant but similar decrease in PSQI scores in both groups over time indicating no overall intervention effect (Wald test = -2.18, p = .029), mean slope = -0.2 (95% CI: -0.37 to -0.02) (p = .583). On the CPSS-5, interaction between groups was also not significant (p = .291). Despite this overall finding, the mean difference in CPSS-SR-5 scores increased over time, with the difference between groups post-treatment -9.10 (95%CI: -18.00 to -0.21), p = .045 and the 1-month follow-up contrast - 11.22 (95%CI: -22.43 to -0.03), p = .049 suggesting that PTSD symptom severity decreased more in the intervention group than the control group. The dropout rate was higher than expected for both the intervention (n = 10; 32%) and control (n = 8; 26.7%) groups. Dropout were mostly school commitments or travel related.Conclusions: Early findings suggest a trend towards dual improvement in sleep quality and PTSD symptom severity in adolescents with a sleep disturbance and PTSD receiving a group sleep intervention (SAASI). Further investigation in a properly powered RCT with detailed retention planning is indicated.

A four-week group sleep intervention seems feasible in adolescents with PTSD and sleep disturbances in a low-resource South African setting.Utilising less specialised mental health resources such as nurses and counsellors in intervention delivery was feasible and effective.Preliminary results are promising and support further research to establish the efficacy of the intervention.

Veterans' 12-month PTSD and depression outcomes following 2- and 3-week intensive cognitive processing therapy-based treatment.

Background: Growing evidence indicates that daily delivery of evidence-based PTSD treatments (e.g. Cognitive Processing Therapy (CPT)), as part of intensive PTSD treatment programmes (ITPs), is feasible and effective. Research has demonstrated that a 2-week CPT-based ITP can produce equivalent outcomes to a 3-week ITP, suggesting shorter treatment can also be highly effective. However, the extent to which ITP length and composition impact longer-term outcomes needs further study.Objective: We examined whether PTSD and depression symptoms 3-, 6-, and 12-months following completion of a 2-week ITP could be considered non-inferior, or equivalent, to those of a 3-week ITP.Method: Data from 638 veterans who participated in a 2-week CPT-based ITP were evaluated against 496 veterans who participated in a 3-week CPT-based ITP. A Bayes factor approach was used to examine whether PTSD and depression severity outcomes of the 2-week ITP could be considered equivalent to the 3-week ITP.Results: Participants across both ITPs reported large PTSD (d = 0.98) and moderate to large depression symptom reductions (d = 0.69) from baseline to 12-month follow-up. The PTSD and depression symptom reductions seen in the 2-week ITP were determined to be equivalent to those of the 3-week ITP.Conclusions: Low follow-up completion was a limitation. Future research might replicate the present findings using samples with greater follow-up rates and explore whether adjunctive services impact other relevant constructs, such as quality of life and functioning.

This study demonstrated that intensive PTSD treatment programmes for veterans can produce large and lasting PTSD and depression symptoms reductions.A 2-week intensive PTSD treatment programme that offered 37 fewer clinical hours was just as effective as a 3-week programme for veterans, with lasting symptom improvement up to 12 months after treatment.The 2-week programme focused primarily on individual Cognitive Processing Therapy delivered twice per day whereas the 3-week programme combined individual and group CPT and had a much larger number of adjunctive services.

Potentially morally injurious experiences and associated factors among Dutch UN peacekeepers: a latent class analysis.

Background: During peacekeeping missions, military personnel may be involved in or exposed to potentially morally injurious experiences (PMIEs), such as an inability to intervene due to a limited mandate. While exposure to such morally transgressive events has been shown to lead to moral injury in combat veterans, research on moral injury in peacekeepers is limited.Objective: We aimed to determine patterns of exposure to PMIEs and associated outcome- and exposure-related factors among Dutch peacekeepers stationed in the former Yugoslavia during the Srebrenica genocide.Method: Self-report data were collected among Dutchbat III veterans (N = 431). We used Latent Class Analysis to identify subgroups of PMIE exposure as assessed by the Moral Injury Scale-Military version. We investigated whether deployment location, posttraumatic stress disorder (PTSD), posttraumatic growth, resilience, and quality of life differentiated between latent classes.Results: The analysis identified a three-class solution: a high exposure class (n = 79), a moderate exposure class (n = 261), and a betrayal and powerlessness-only class (n = 135). More PMIE exposure was associated with deployment location and higher odds of having probable PTSD. PMIE exposure was not associated with posttraumatic growth. Resilience and quality of life were excluded from analyses due to high correlations with PTSD.Conclusions: Peacekeepers may experience varying levels of PMIE exposure, with more exposure being associated with worse outcomes 25 years later. Although no causal relationship may be assumed, the results emphasize the importance of better understanding PMIEs within peacekeeping.

Peacekeeping veterans reported different patterns of exposure to potentially morally injurious experiences: high exposure, moderate exposure, or experiences of betrayal and powerlessness only.Deployment location predicted the pattern of exposure.More exposure was associated with worse psychological outcomes 25 years later.

Does disconfirmatory evidence shape safety-and danger-related beliefs of trauma-exposed individuals?

Recent accounts of predictive processing in posttraumatic stress disorder (PTSD) suggest that trauma-exposed individuals struggle to update trauma-related hypotheses predicting danger, which may be involved in the etiology and maintenance of this disorder. Initial research supports this account, documenting an association between trauma-exposure, impaired expectation updating, and PTSD symptoms. Yet, no study to date has examined biased belief updating in PTSD using a scenario-based approach.Objective: Here, we examined the predictive processing account among trauma-exposed and non-trauma-exposed individuals using a modified Trauma-Related version of the Bias Against Disconfirmatory Evidence task.Method: The task presents both danger-and safety-related scenarios highly relevant for trauma-exposed individuals. For each scenario, participants viewed several explanations and rated their plausibility. Their ability to update their initial interpretation following new-contradictory information was assessed.Results: Preregistered analyses did not reveal any significant findings. Based on indications that our sample may not have been sufficiently powered, we conducted exploratory analyses in an extended sample of participants. These analyses yielded a significant association between reduced belief updating and PTSD symptoms which was evident for disconfirming both safety and danger scenarios. However, the effect sizes we found were in the small-to-medium range.Conclusion: Although preliminary, our current findings support initial evidence that individuals with higher PTSD symptoms show a higher resistance to update their beliefs upon new disconfirmatory evidence. Our results should be interpreted cautiously in light of the extended sample and the limitations of the current study.

We developed a modified version of the Bias Against Disconfirmatory Evidence task.We found significant associations between PTSD symptoms and belief updating.The association was evident for disconfirming both safety and danger scenarios.

Sudden gains in routine clinical care: application of a permutation test for trauma-focused cognitive behavioural therapy.

Background: Sudden gains, defined as large and stable improvements of psychopathological symptoms, are a ubiquitous phenomenon in psychotherapy. They have been shown to occur across several clinical contexts and to be associated with better short-term and long-term treatment outcome. However, the approach of sudden gains has been criticized for its tautological character: sudden gains are included in the computation of treatment outcomes, ultimately resulting in a circular conclusion. Furthermore, some authors criticize sudden gains as merely being random fluctuations.Objective: Use of efficient methods to evaluate whether the amount of sudden gains in a given sample lies above chance level.Method: We used permutation tests in a sample of 85 patients with posttraumatic stress disorder (PTSD) treated with trauma-focused cognitive behaviour therapy in routine clinical care. Scores of self-reported PTSD symptom severity were permuted 10.000 times within sessions and between participants to receive a random distribution.Results: Altogether, 18 participants showed a total of 24 sudden gains within the first 20 sessions. The permutation test yielded that the frequency of sudden gains was not beyond chance level. No significant predictors of sudden gains were identified and sudden gains in general were not predictive of treatment outcome. However, subjects with early sudden gains had a significantly lower symptom severity after treatment.Conclusions: Our data suggest that a significant proportion of sudden gains are due to chance. Further research is needed on the differential effects of early and late sudden gains.

Treatment-related sudden gains exhibit clinical significance when their manifestation is above chance level.We used permutation tests to examine their occurrence in trauma-focused cognitive behaviour therapy as applied in a naturalistic treatment setting.The occurrence of sudden gains in general was not significantly higher than chance, yet early sudden gains were associated with improved treatment outcome.

Working mechanisms of imagery rescripting (ImRs) in adult patients with childhood-related PTSD: a pilot study.

Background: Imagery rescripting (ImRs) has shown to be an effective treatment for posttraumatic stress disorders (PTSD) resulting from childhood-related trauma. The current theory is that the change of meaning of the trauma memory is central to the treatment. Several authors have suggested that the expression of needs, feelings and actions may act as potential healing factors, but little specific research aimed at (in)validating this hypothesis has been done so far.Objective: In this study we investigated to what extent the expression of inhibited action tendencies and the fulfilling of needs lead to the reduction of PTSD symptoms in clients with early childhood trauma.Method: Recordings of 249 therapy sessions of 24 ImRs treatments were rated with an observation instrument developed for this purpose, after which the scores were related to pre and posttreatment symptoms, assessed with the Impact of Events Scale-Revised (IES-R).Results: Scores on the IES-R decreased from pretreatment to posttreatment. The two subscales of the NATS (At-scale and N-scale)significantly predicted the posttreatment scores on the IES-R after controlling for the influence of pretreatment IES-R scores: the better the expression of inhibited action tendencies and the better the fulfilling of needs, the lower the symptoms after treatment.Conclusions: This pilot study on the underlying mechanisms of ImRs in PTSD treatment has shown that the expression of action tendencies and fulfilling basic needs during ImRs are associated with a decrease in PTSD symptoms after treatment, and that actions and basic needs cannot be viewed separately. Follow-up research could focus on which of the six domains of the Needs and Action tendencies Scale (NATS) has the greatest effect on the reduction of PTSD symptoms. With this information we can further improve the ImRs protocol.

The pilot study of working mechanisms of imaginary rescripting shows that the NATS is a reliable research tool for observing expressed action tendencies and fulfilled needs.The better the action tendencies are expressed during treatment and the better the needs are fulfilled, the lower posttreatment symptoms.It seems useful if practitioners are specifically trained during the ImRs training in performing actions that lead to the fulfilment of basic needs.