Changes In Posttraumatic Stress Disorder Research Articles

Prominent genetic variants and epigenetic changes in post-traumatic stress disorder among combat veterans.

Post-traumatic stress disorder (PTSD) is one of the most widespread and disabling psychiatric disorders among combat veterans. Substantial interindividual variability in susceptibility to PTSD suggests the presence of different risk factors for this disorder. Twin and family studies confirm genetic factors as important risk factors for PTSD. In addition to genetic factors, epigenetic factors, especially DNA methylation, can be considered as a potential mechanism in changing the risk of PTSD. So far, many genetic and epigenetic association studies have been conducted in relation to PTSD. In genetic studies, many single nucleotide polymorphisms have been identified as PTSD risk factors. Meanwhile, the variations in catecholamines-related genes, serotonin transporter and receptors, brain-derived neurotrophic factor, inflammatory factors, and apolipoprotein E are the most prominent candidates. CpG methylation in the upstream regions of many genes is also considered a PTSD risk factor. Accurate identification of genetic and epigenetic changes associated with PTSD can lead to the presentation of suitable biomarkers for susceptible individuals to this disorder. This study aimed to delineate prominent genetic variations and epigenetic changes associated with post-traumatic stress disorder in military veterans who have experienced combat, focusing on genetic and epigenetic association studies.

Health Behavior Change in Post-Traumatic Stress Disorder: Patient Perspectives

Health Behavior Change in Post-Traumatic Stress Disorder: Patient Perspectives

Change despite obstacles: A mixed-methods pilot study of a trauma-sensitive mindfulness and compassion intervention

This mixed-methods pilot study aimed to assess the symptomatic changes of post-traumatic stress disorder, complex post-traumatic stress disorder, dissociative symptoms, self-critique, and self-compassion following participation in a 16-week trauma-sensitive mindfulness and compassion intervention. The adverse experiences of participation were also explored explicitly. Seventeen predominantly female clients with severe post-traumatic stress disorder symptomatology participated in the trauma-sensitive mindfulness and compassion intervention. All clients completed questionnaires before (pre) and after (post) the intervention to gain information on symptom change, self-critique, and self-compassion. Second, a qualitative interview addressing clients’ experiences of participation, including an explicit focus on adverse experiences, was conducted. There was a significant decrease in PTSD, CPTSD, dissociative symptoms, self-hatred, and inadequate self before and after the intervention. All the clients reported having adverse experiences during participation but no lasting negative effects. The results point to the potential of the TMC intervention in helping reduce trauma symptoms and self-critique while also elucidating the tremendous stress that clients with trauma experience undergoing trauma treatment. However, no injurious adverse effects were reported. These preliminary results warrant further investigation via a randomized control trial to examine the efficacy of TMC. The study is registered in ClinicalTrials.gov ID: NCT05993468.

Changes in posttraumatic stress disorder symptom severity during the COVID-19 pandemic: Ten-wave findings from a longitudinal observational cohort study of community adults

Few studies have examined changes in posttraumatic-stress disorder (PTSD) symptomatology across an extended time period during the COVID-19 pandemic. This study used a longitudinal cohort design to examine: (1) changes in overall PTSD symptoms and symptom clusters; (2) moderators of change; (3) the clinical significance of observed changes; and (4) correlates of clinically meaningful changes. Community adults (N = 1412) were assessed using the PTSD Checklist for DSM-5 (PCL-5) at 10 timepoints (October 2018 - April 2022). Changes in overall PCL-5 score and symptom clusters were substantially moderated by pre-pandemic clinical severity (i.e., above/below PCL-5 cut-off). Pre-pandemic non-clinical participants exhibited increases in overall scores, Cluster D (negative cognitions), and Cluster E (arousal), while clinically elevated participants exhibited decreases overall and in all clusters. Regarding clinical significance, 12% of pre-pandemic non-clinical participants exhibited clinically meaningful increases, and 4% exhibited decreases. Conversely, 42% of the pre-pandemic elevated group exhibited clinically meaningful decreases, while 6% exhibited increases. Pandemic impacts in numerous psychosocial domains were associated with clinically meaningful change. Collectively, these findings reveal substantively divergent trajectories by pre-pandemic severity and PTSD symptom cluster. The large proportion of pre-pandemic high-severity participants exhibiting sizable decreases was an unexpected notable observation.

Pre-treatment amygdala activation and habituation predict symptom change in post-traumatic stress disorder.

Trauma-focused psychotherapy approaches are the first-line treatment option for post-traumatic stress disorder (PTSD); however, up to a third of patients remain symptomatic even after completion of the treatment. Predicting which patients will respond to a given treatment option would support personalized treatments and improve the efficiency of healthcare systems. Although previous neuroimaging studies have examined possible pre-treatment predictors of response to treatment, the findings have been somewhat inconsistent, and no other study has examined habituation to stimuli as a predictor. In this study, 16 treatment-seeking adults (MAge = 43.63, n = 10 women) with a primary diagnosis of PTSD passively viewed pictures of emotional facial expressions during functional magnetic resonance imaging (fMRI). After scanning, participants rated facial expressions on both valence and arousal. Participants then completed eight weekly sessions of prolonged exposure (PE) therapy. PTSD symptom severity was measured before and after treatment. Overall, participants showed symptomatic improvement with PE. Consistent with hypotheses, lesser activation in the amygdala and greater activation in the ventromedial prefrontal cortex during the presentation of fearful vs. happy facial expressions, as well as a greater decline in amygdala activation across blocks of fearful facial expressions at baseline, were associated with greater reduction of PTSD symptoms. Given that the repeated presentation of emotional material underlies PE, changes in brain responses with repeated stimulus presentations warrant further studies as potential predictors of response to exposure therapies.

A Non-Inferiority Evaluation of Standard and Abbreviated Developmental Trauma and Adjustment Programming for Adopted and Foster Youth in Residential Care

ABSTRACT Youth who are involved with the adoption and foster care systems report notable rates of complex trauma responses associated with their developmental experiences, which can have deleterious implications for well-being across the lifespan. We implemented a retrospective quasi-experimental non-inferiority evaluation design using a frequency matching approach to estimate the degree of differential treatment effects reported by youth who completed a Developmental Trauma and Attachment Program protocol in its standard (DTAP) or abbreviated (DTAP-A) format at a long-term residential care facility located in the Midwestern United States. Program completers were 28 youth (M age = 12.39) who predominately identified as female (n = 23, 82%) with Caucasian/White (n = 12, 43%) or Multiracial (n = 10, 35%) racial identities. Analyses of scores on the UCLA Post-traumatic Stress Disorder Reaction Index and Behavior Assessment System for Children (3rd ed.) did not identify any statistical or practical significance between DTAP and DTAP-A program completers self-reported treatment gains. However, DTAP program completers tended to report clinically significant changes in posttraumatic stress disorder and personal adjustment to greater degrees when compared to those completing the DTAP-A protocol. Implications for increasing access, resource management, and supporting a continuum of care approach are provided.

The predictive role of personality traits and demographic features on post-traumatic stress disorder in a sample of COVID-19 hospitalized patients

BackgroundHospitalized COVID-19 patients suffer from psychological and psychiatric disorders such as post-traumatic stress disorder, depression, and anxiety. Because there was no comprehensive study on psychological factors in hospitalized COVID-19 patients in Iran, we investigated the predictive role of personality traits and demographic features on post-traumatic stress disorder in COVID-19 hospitalized patients.ResultsIn this research method first, 160 patients selected randomly and completed relevant questionnaires, which are prepared online. We examined the multivariate linear regression between the mentioned variables. The results showed that the independent variables are able to predict changes in post-traumatic stress disorder (P < 0.001). The percentage of explanation of changes in dependent variables was equal to 0.77, 0.65, 0.71, and 0.68, respectively.ConclusionPeople’s personality traits play a key role in facing and responding to stressful environmental events for instance COVID-19 pandemic, and as a result, some personality traits such as conscientiousness protect people from stress even though, neuroticism personality trait cause instability and make people more stresses, identifying these traits and treating them is.

Associations of alcohol and cannabis use with change in posttraumatic stress disorder and depression symptoms over time in recently trauma-exposed individuals.

Several hypotheses may explain the association between substance use, posttraumatic stress disorder (PTSD), and depression. However, few studies have utilized a large multisite dataset to understand this complex relationship. Our study assessed the relationship between alcohol and cannabis use trajectories and PTSD and depression symptoms across 3 months in recently trauma-exposed civilians. In total, 1618 (1037 female) participants provided self-report data on past 30-day alcohol and cannabis use and PTSD and depression symptoms during their emergency department (baseline) visit. We reassessed participant's substance use and clinical symptoms 2, 8, and 12 weeks posttrauma. Latent class mixture modeling determined alcohol and cannabis use trajectories in the sample. Changes in PTSD and depression symptoms were assessed across alcohol and cannabis use trajectories via a mixed-model repeated-measures analysis of variance. Three trajectory classes (low, high, increasing use) provided the best model fit for alcohol and cannabis use. The low alcohol use class exhibited lower PTSD symptoms at baseline than the high use class; the low cannabis use class exhibited lower PTSD and depression symptoms at baseline than the high and increasing use classes; these symptoms greatly increased at week 8 and declined at week 12. Participants who already use alcohol and cannabis exhibited greater PTSD and depression symptoms at baseline that increased at week 8 with a decrease in symptoms at week 12. Our findings suggest that alcohol and cannabis use trajectories are associated with the intensity of posttrauma psychopathology. These findings could potentially inform the timing of therapeutic strategies.

Evaluation of the Strength at Home Group Intervention for Intimate Partner Violence in the Veterans Affairs Health System

Intimate partner violence (IPV) is a serious and prevalent public health issue that is interconnected with experiences of trauma, mental and physical health difficulties, and health disparities. Strength at Home (SAH) is a group intervention for persons using IPV in their relationships. Although previous studies have provided evidence of SAH's effectiveness in reducing IPV, its patient outcomes as implemented within organized health care have not been examined. To evaluate patient outcomes from implementation of SAH in the Department of Veterans Affairs (VA) health system. This quality improvement study evaluated patient outcomes from a national implementation and training program conducted between December 11, 2015, and September 24, 2021. Data were collected as part of treatment and submitted by clinicians at 73 VA health care facilities. Patients were 1754 veterans seeking care aimed at addressing and/or preventing their use of aggression in intimate relationships. They completed 1 pretreatment assessment and 1 follow-up assessment in the immediate weeks after group completion. Strength at Home is a 12-week trauma-informed and cognitive behavioral group intervention to address and prevent the use of IPV in relationships. Changes in IPV were measured with the Centers for Disease Control and Prevention 2010 National Intimate Partner and Sexual Violence Survey. Changes in posttraumatic stress disorder (PTSD) symptoms were measured with the PTSD Checklist for DSM-5, and alcohol misuse was measured with the Alcohol Use Disorders Identification Test. The study included 1754 participants (mean [SD] age, 44.3 [13.0] years; 1421 men [81%]), of whom 1088 (62%) were involved with the criminal legal system for IPV charges. Analyses indicate that SAH was associated with reductions in use of physical IPV (odds ratio, 3.28; percentage difference from before to after treatment, -0.17 [95% CI, -0.21 to -0.13]) and psychological IPV (odds ratio, 2.73; percentage difference from before to after treatment, -0.23 [95% CI, -0.27 to -0.19]), coercive control behaviors (odds ratio, 3.19; percentage difference from before to after treatment, -0.18 [95% CI, -0.22 to -0.14), PTSD symptoms (mean change, -4.00; 95% CI, 0.90-7.09; Hedges g = 0.10), and alcohol misuse (mean change, 2.70; 95% CI, 1.54-3.86; Hedges g = 0.24). In this quality improvement study of the patient outcomes after implementation of SAH, results suggested that the program was associated with reductions in IPV behaviors, PTSD symptoms, and alcohol misuse. Results also suggest that IPV intervention in routine health care at VA health care facilities was successful; extension to other organized health care systems could be warranted.

A randomised pilot feasibility study of eye movement desensitisation and reprocessing recent traumatic episode protocol, to improve psychological recovery following intensive care admission for COVID-19.

Approximately 50% of intensive care survivors experience persistent psychological symptoms. Eye-movement desensitisation and reprocessing (EMDR) is a widely recommended trauma-focussed psychological therapy, which has not been investigated systematically in a cohort of intensive care survivors: We therefore conducted a randomised pilot feasibility study of EMDR, using the Recent Traumatic Episode Protocol (R-TEP), to prevent psychological distress in intensive care survivors. Findings will determine whether it would be possible to conduct a fully-powered clinical effectiveness trial and inform trial design. We aimed to recruit 26 patients who had been admitted to intensive care for over 24 h with COVID-19 infection. Consenting participants were randomised (1:1) to receive either usual care plus remotely delivered EMDR R-TEP or usual care alone (controls). The primary outcome was feasibility. We also report factors related to safety and symptom changes in post-traumatic stress disorder, (PTSD) anxiety and depression. We approached 51 eligible patients, with 26 (51%) providing consent. Intervention adherence (sessions offered/sessions completed) was 83%, and 23/26 participants completed all study procedures. There were no attributable adverse events. Between baseline and 6-month follow-up, mean change in PTSD score was -8 (SD = 10.5) in the intervention group versus +0.75 (SD = 15.2) in controls (p = 0.126). There were no significant changes to anxiety or depression. Remotely delivered EMDR R-TEP met pre-determined feasibility and safety objectives. Whilst we achieved group separation in PTSD symptom change, we have identified a number of protocol refinements that would improve the design of a fully powered, multi-centre randomised controlled trial, consistent with currently recommended rehabilitation clinical pathways. ClinicalTrials.gov: NCT04455360.

The Italian Version of the International Trauma Questionnaire: Symptom and Network Structure of Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder in a Sample of Late Adolescents Exposed to a Natural Disaster.

The 11th revision of the International Classification of Diseases has endorsed substantial changes in Post-Traumatic Stress Disorder (PTSD) and has introduced Complex PTSD (cPTSD). The objective of this study was to assess the symptom and network structure of PTSD and cPTSD using the International Trauma Questionnaire- Italian version (ITQ) and the prevalence of PTSD and cPTSD in a community sample of late adolescents enriched with exposure to a destructive earthquake. A 1,010 high school students participated to the study. Confirmatory Factor Analysis supports that a six first-order correlated factors was the best fitting model of ICD-11 PTSD/cPTSD. The network analysis supports a clear separation between core PTSD symptoms and disturbances in self-organization (DSO) symptoms, avoidance, and negative self-concept were the most central items. The prevalence of PTSD and cPTSD was 9.11 and 4.06%, respectively. Female participants reported higher rates of both PTSD and cPTSD. This is the first study to report on ICD-11 PTSD and cPTSD rates on an Italian adolescence community sample. Consistent with other community samples, we found higher rates of PTSD compared to cPTSD. The results confirmed the factorial validity of the ITQ. The network structure highlights the importance of negative self-concept in cPTSD and avoidance in PTSD.

Neurobiological Changes in Posttraumatic Stress Disorder and Their Reversibility by Psychotherapy

Abstract. Background: Posttraumatic stress disorder (PTSD) is a debilitating illness associated with distressing symptoms and a high societal burden. Objective: To investigate the neurobiological underpinnings of PTSD to improve our understanding of this disorder and its treatment. Methods: This article reviews currently researched mechanisms that can explain the development of PTSD symptoms. It presents key findings on neural (i. e., brain functioning and brain structure), neuroendocrine (i. e., noradrenergic and hypothalamic-pituitary-adrenal axis activity), and related (epi)‌genetic changes in individuals with PTSD. Furthermore, it presents preliminary research examining the reversibility of these alterations during psychotherapeutic treatment. Results: PTSD is characterized by specific neurobiological alterations, with preliminary findings indicating that at least some of these may normalize during psychotherapy. Discussion: A multidimensional perspective on the development, maintenance, and treatment of PTSD has the potential to improve our understanding of the causal processes underlying the disorder and may ultimately inform the conception of novel treatments.

Change in posttraumatic stress disorder-related thoughts during treatment: Do thoughts drive change when pills are involved?

Posttraumatic negative thoughts about one's self and the world are related to posttraumatic stress disorder (PTSD) symptom severity and change in cognitive behavioral treatment (CBT), but little is known about this association when CBT is delivered with medication. The current study presents a planned comparison of changes in negative posttraumatic thoughts during (a) prolonged exposure (PE) plus pill placebo (PE+PLB), (b) sertraline plus enhanced medication management (SERT+EMM), and (c) PE plus sertraline (PE+SERT) as part of a randomized clinical trial in a sample of 176 veterans. Lagged regression modeling revealed that change in posttraumatic negative thoughts was associated with PTSD symptom change in the conditions in which participants received sertraline, ds=0.14-0.25, ps=0.04-.001). However, contrary to previous research, the models that started with symptom change were also statistically significant, d=0.23, p<.001, for the lagged effect of symptoms on negative thoughts about self in the SERT+EMM condition, indicating a bidirectional association between such thoughts and PTSD symptoms. In the PE+PLB condition, no significant association between posttraumatic thoughts and PTSD symptoms emerged in either direction. These results suggest that the previously demonstrated role of change in posttraumatic thoughts leading to PTSD symptom reduction in PE may be altered when combined with pill administration, either active or placebo.

Rushed Decisions: Ethical Considerations for Digital Storytelling Practitioners.

The American Dreaming project, a community-based participatory research study conducted in collaboration with the nonprofit organization Define American, focuses on bolstering the mental health of immigrant rights advocates between the ages of 25 and 40 years. All participants identify as undocumented or formerly undocumented and have been public with their status since 2012. Seven people were recruited for the pilot program to participate in a digital storytelling (DST) workshop. They created digital stories (videos approximately 3 minutes in duration) from a series of general story prompts about their lives. Participants also completed pre- and posttests with measures assessing change in posttraumatic stress disorder, stress, self-esteem, depression, belonging, social support, and resilience. Follow-up, semistructured workshop evaluations were gathered, and life history interviews were conducted. The project also included a strategic communications component. In this article, I outline ethical challenges faced as the goals and parameters of the project shifted while conducting a multifaceted critical narrative intervention. The key lesson learned was to make space, prior to the DST workshop, for establishing and agreeing on project priorities with all stakeholders. I recommend creating a one-page memorandum of understanding that includes (1) a brief project description outlining the objectives, (2) goals listed in priority order, and (3) a decision tree to help stakeholders navigate competing interests. While DST is a powerful tool for supporting storyteller agency, working within structures of funding, support, and research can create challenges that critically complicate the narrative intervention.

Longitudinal Changes in Posttraumatic Stress Disorder After Resettlement Among Yazidi Female Refugees Exposed to Violence

Posttraumatic stress disorder (PTSD) is highly prevalent among refugees surviving mass atrocities, especially among women. Longitudinal studies investigating factors associated with PTSD course are essential to enable adequate treatment yet widely lacking. To identify longitudinal changes in PTSD severity and posttraumatic coping among severely traumatized female refugees as well as risk and protective factors for PTSD course. This prospective cohort study took place in 14 German cities in the context of a humanitarian admission program that resettled 1000 especially vulnerable women and children from northern Iraq to Germany. Approximately 400 adult beneficiaries of the humanitarian admission program were eligible for the study. At baseline, a total of 116 of the 400 beneficiaries (29.0%) participated, with 96 (82.8%) of these women participating in the follow-up assessment. The study included a baseline assessment conducted 2 years after resettlement (September 1, 2017, to January 12, 2018) and a 1-year follow-up (August 29, 2018, to January 15, 2019). Violence and/or captivity during the 2014 genocide in northern Iraq by the so-called Islamic State. Posttraumatic stress disorder severity and coping strategies were assessed in interpreter-aided interviews using the Impact of Event Scale-Revised. A total of 116 women (mean [SD] age, 32.2 [8.2] years; 115 [99.1%] Yazidi; 1 [0.9%] Christian) participated at baseline. According to the Impact of Event Scale-Revised, a high PTSD severity was found (mean [SD] raw sum score, 60.88 [15.75] of 88, with higher scores indicating greater distress), with no significant change over time. Helpful coping strategies included prayer, belief in collective strength, and belief in personal strength. Earlier symptoms of intrusions (β = 0.389, P = .007) and longer captivity (β = 0.218, P = .02) were identified as being associated with PTSD severity 1 year later. Longer captivity was associated with PTSD aggravation over time (β = 0.227, P = .04). Posttraumatic strengthening in faith (β = -0.206, P = .05) and in social relationships (β = -0.221, P = .03) were associated with a reduction in PTSD symptoms. These findings suggest that female refugee survivors of genocide are at high risk for severe and chronic PTSD beyond the initial years of resettlement. The findings provide suggestions for mental health care specialized for particularly vulnerable populations.

Posttraumatic stress disorder and professional burnout among local government staff seven years after the Wenchuan earthquake in China: A longitudinal study.

Although local government staff are crucial in post-quake reconstruction, their long-term psychological and professional consequences remain unclear. This longitudinal study investigated changes of posttraumatic stress disorder (PTSD) and professional burnout over seven years, and their underlying relationship. The study assessed 250 staff at one year (T1y) after the earthquake, and 162 (64.8 %) were followed up at seven years (T7y). PTSD and professional burnout were assessed with the Short Screening Scale for DSM-IV PTSD and the burnout subscale of Professional Quality of Life Scale (ProQOL), respectively, at both time points. Longitudinal changes in PTSD and burnout were examined and cross-lagged panel analyses were conducted to test the relationship between PTSD and burnout. The rates of positive cases of PTSD screening were 23.2 % at T1y and 11.1 % at T7y. The percentages of moderate burnout were 61.7 % at T1y and 23.5 % at T7y. Scores of PTSD (z = -5.70, p < 0.001) and burnout (t = 10.07, p < 0.001) from T1y to T7y decreased. The cross-lagged analysis indicated that burnout at T1y predicted PTSD at T7y (β = 0.19, p = 0.025). In conclusion, the Wenchuan earthquake has long-lasting negative effects on local government staff, although they can recover over time. Interventions to reduce professional burnout after disaster may does be beneficial to decrease the risk of PTSD in the long run.

Epigenetic pathways in PTSD

Abstract BodyNonhuman primates (NHPs) are critical for translational research due to their close genetic, physiological, and behavioral similarity to humans. In particular, higher brain functions depend on brain regions and neural circuits that evolved differently between primates and rodents. Thus, NHPs are a strong translational model system to investigate the pathophysiology and relevant biological correlates of mental disorders. This talk will focus on translational approaches leveraging NHP models to advance our understanding of environmentally induced epigenetic changes in post-traumatic stress disorder (PTSD). Environmental factors including early life stress significantly contribute to risk and resilience for psychiatric disorders including PTSD. However, human studies are often confounded, and it remains challenging to identify robust epigenetic signals in clinical populations even in large studies. We investigate the natural spectrum of behavioral phenotypes in rhesus macaques to complement human studies with a focus on stress and fear. This talk will present data on epigenetic signatures of fear and the effects of early life stress in rhesus monkeys and their relationship to human studies.DisclosureNo significant relationships.

60558 Non-Suicidal Self Injury in Military Veterans with PTSD: An Ecological Momentary Assessment Study

ABSTRACT IMPACT: This study will help determine whether ecological momentary assessment is feasible in assessing changes in negative affect and the occurrence of non-suicidal self-injury (NSSI) in military Veterans with post-traumatic stress disorder; if so it will allow for further examination of correlates of NSSI which will inform treatment efforts. OBJECTIVES/GOALS: Given the advantages of ecological momentary assessment (EMA), and the lack of research on non-suicidal self-injury (NSSI) in military populations, the goal of the current pilot study is to determine the feasibility of using EMA to assess daily changes in post-traumatic stress disorder (PTSD) symptoms, negative affect and NSSI in veterans with PTSD. METHODS/STUDY POPULATION: Twenty military veterans with post-traumatic stress disorder (PTSD) who have engaged in non-suicidal self-injury (NSSI) in the previous 12 months will be recruited. Participants will complete assessments 4 times per day for 28 days at randomly scheduled times. Assessments will measure PTSD symptoms, negative emotions, and NSSI urges and behaviors. At the conclusion of the 28-day study period, participants will complete measures that ask about their experiences in the study, (e.g., the acceptability of the daily surveys and the accessibility of the web-based surveys). Feasibility will be determined with regard to the success of recruiting eligible participants and compliance with daily survey completion. Variability in PTSD symptoms, negative affect, and NSSI urges and behaviors also will be determined. RESULTS/ANTICIPATED RESULTS: It is anticipated that this study will successfully recruit 20 veterans with PTSD with a history of engaging in NSSI within the previous 12 months. It is also anticipated that daily survey completion rates will be approximately 90% based on previous research using EMA with veterans with PTSD and that participants will indicate satisfaction with the procedures of the study. It is anticipated that participants will demonstrate variability in PTSD symptoms, indicated by changes in the number of symptoms endorsed and the intensity of those symptoms experienced. Finally, it is anticipated that participants will demonstrate variability in negative emotions (fear, hostility, guilt, and sadness).DISCUSSION/SIGNIFICANCE OF FINDINGS: Findings from this study will support the use of EMA in a subsequent large-scale investigation examining time-varying symptoms of PTSD and negative affect as antecedents to NSSI. Information from this large-scale study will in turn be used to inform treatments that may to decrease NSSI in veterans by targeting specific symptoms and negative emotions.

Changes in posttraumatic stress disorder (PTSD) and depressive symptoms over the course of prolonged exposure.

Prior studies of prolonged exposure therapy (PE) suggested that reduction of posttraumatic stress disorder (PTSD) precedes reduction in depression, yet no research has collapsed data across multiple studies to examine whether the directionality of reduction remains consistent in larger and diagnostically diverse samples. Thus, the objective of this study is to conduct an evaluation of bidirectional associations between PTSD and depression in PE. Participants (n = 216) from three randomized controlled trials of PE alone, PE + alcohol use disorder treatment, and PE + nicotine use disorder treatment completed weekly PTSD and depression severity measures. First, we analyzed the directional relationship between PTSD and depression over time in 2 single models to separately examine the effects of PTSD on depression and vice versa. Second, we analyzed a combined model to examine the simultaneous effects of reduction in PTSD on reduction in depression over and above the effects of reduction in depression on reduction in PTSD, and vice versa. Two single models suggested that reductions in PTSD lead to reductions in depression and vice versa. The combined models suggested that both directions of change are important and reciprocal. The strength of predictive power from PTSD to depression, and vice versa, is approximately equal. Most significant prediction of PTSD from depression and vice versa occurred early in treatment. The relationship between reductions in PTSD and depression during PE is transactional. Regardless of whether PTSD or depression decreases first, reduction in the other symptom cluster is likely to follow. (PsycINFO Database Record

Symptom Changes in Posttraumatic Stress Disorder and Major Depressive Disorder After Transcranial Magnetic Stimulation: Mechanisms of Where and How in the Brain

Symptom Changes in Posttraumatic Stress Disorder and Major Depressive Disorder After Transcranial Magnetic Stimulation: Mechanisms of Where and How in the Brain