Complex PTSD Research Articles

Unraveling the Complexity: Exploring the Intersection of Panic Disorder, Dissociation, and Complex Post-Traumatic Stress Disorder.

Patients with panic disorder (PD) may experience increased vulnerability to dissociative and anxious phenomena in the presence of repeated traumatic events, and these may be risk factors for the development of complex post-traumatic stress disorder (cPTSD). The present study aims to find out whether the presence of cPTSD exacerbates anxiety symptoms in patients suffering from panic disorder and whether this is specifically associated with the occurrence of dissociative symptoms. One-hundred-and-seventy-three patients diagnosed with PD were recruited and divided into two groups based on the presence (or absence) of cPTSD using the International Trauma Questionnaire (ITQ) scale. Dissociative and anxious symptoms were assessed using the Cambridge Depersonalization Scale (CDS) and Hamilton Anxiety Scale (HAM-A), respectively. Significant differences in re-experienced PTSD (p < 0.001), PTSD avoidance (p < 0.001), PTSD hyperarousal (p < 0.001), and DSO dysregulation (p < 0.001) were found between the cPTSD-positive and cPTSD-negative groups. A statistically significant association between the presence of cPTSD and total scores on the HAM-A (p < 0.001) and CDS (p < 0.001) scales was found using regression analysis. This study highlights the potential link between dissociative symptoms and a more severe clinical course of anxiety-related conditions in patients with PD. Early intervention programs and prevention strategies are needed.

Prevalence and concordance of International Classification of Diseases-11th Revision and Diagnostic and Statistical Manual-Fifth Edition posttraumatic stress diagnostics among Northern Irish military veterans.

There are two primary competing diagnostic criteria for posttraumatic stress disorder (PTSD); the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual (DSM). These systems differ in terms of the number and nature of PTSD symptoms, the implied latent structure of the disorder, and associated posttraumatic diagnostic classifications. To investigate the prevalence and concordance of ICD-11th Revision (ICD-11) and DSM-Fifth Edition (DSM-5) PTSD, complex-PTSD (C-PTSD), and dissociative subtype of PTSD (D-PTSD) criteria in a sample of Northern Irish military veterans. Data were collected from a community sample of military veterans living in Northern Ireland (NI). Prevalence rates of ICD-11 PTSD and C-PTSD and DSM-5 PTSD and D-PTSD were estimated using validated self-report measures for each system. Concordance of caseness determined by diagnostic criteria was compared using Cohen's kappa. The DSM-5 algorithm criteria produced significantly higher prevalence estimates of PTSD (39.26%) relative to the ICD-11 algorithm criteria (32.09%). Both C-PTSD and D-PTSD were identified for subgroups within the sample (24.66% and 27.96%, respectively). There was moderate agreement between the diagnostic systems regarding PTSD caseness, and between C-PTSD and D-PTSD caseness. These findings have implications regarding the measurement of PTSD and associated diagnostic groupings for the wider literature, suggesting that the choice of diagnostic screening framework may influence classification. Both C-PTSD and D-PTSD may be relevant diagnostic considerations for the NI military veteran group. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Variations in services and intervention pathways for traumatic stress in Welsh prisons: A national survey.

Both Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder are prevalent in prison settings. Both often go undetected and untreated, while prisoners who already suffered previous trauma may be re-traumatised upon imprisonment. The current study aimed to conduct a national survey of all Welsh prisons to gather information about existing services and treatments for traumatic stress. The survey identified variation within Welsh prisons with regard to NICE-recommended evidence-based therapies. It is therefore recommended that there needs to be development of a pathway of Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder in the prison system which should be achieved through a consensus process of both frontline staff and experts in the field.

Traumatic events and posttraumatic stress symptoms in a treatment-seeking sample of Ukrainian children during the war

BackgroundThe Russian invasion of Ukraine resulted in a dramatic increase of children and adolescents being confronted with war and other traumatic experiences, which could result in an increase of trauma-related mental health disorders such as posttraumatic stress disorder (PTSD) in an entire generation. This study aims at reporting the prevalence of traumatic events, PTSD, and Complex PTSD (CPTSD) in children and adolescents seeking for mental health treatment since the Russian invasion. Additionally, the consistency of child and caregiver reported trauma, PTSD and CPTSD will be examined.MethodsThis study is part of the “TF-CBT Ukraine” project in which Ukrainian therapists were trained in assessing their patients via the “Child and Adolescent Trauma Screen” (CATS-2) before initiating trauma-focused treatment, if indicated. Altogether N = 200 Ukrainian children and adolescents (Mage = 12.01, range 4–21; 62.0% female) were included in the study between October 2022 and August 2023. Data were analysed descriptively, via t-tests and bivariate correlations.ResultsThe children and adolescents reported on average four different traumatic events, most frequently war (n = 123; 68.7%), bullying threats (n = 71; 39.7%) and domestic violence (n = 68; 38.0%). Almost 70% (n = 123) of the participants fulfilled the DSM-5 PTSD criteria, 31% (n = 56) fulfilled the ICD-11 PTSD criteria and 21% (n = 38) the ICD-11 CPTSD criteria. Rates of PTSD were even higher in preschool children (95%). The comparisons of self-and caregiver reports on traumatic events and PTSD/CPTSD severity scores indicated moderate to high correlations between the patients and their caregivers (r = 0.710–0.767).ConclusionsThis study shows that Ukrainian children and adolescents starting treatment report a high number of traumatic events and trauma-related symptoms, which could have a long-lasting negative impact on their social-emotional development and quality of life. The implementation of evidence-based trauma-focused interventions for these children is therefore crucial.

ICD-11 post-traumatic stress disorder and complex post-traumatic stress disorder in mental health support-seeking former-serving Australian defence force veterans.

ICD-11 complex post-traumatic stress disorder is a more severe condition than post-traumatic stress disorder, and recent studies indicate it is more prevalent among military samples. In this study, we tested the psychometric properties of the International Trauma Questionnaire, assessed the relative prevalence rates of post-traumatic stress disorder and complex post-traumatic stress disorder in the sample population and explored relationships between complex post-traumatic stress disorder and post-traumatic stress disorder and a range of risk factors. Survey participants (N = 189) were mental health support-seeking former-serving veterans of the Australian Defence Force (ADF) recruited from primary care. Confirmatory factor analysis was used to test the factorial validity of the International Trauma Questionnaire. The latent structure of the International Trauma Questionnaire was best represented by a two-factor second-order model consistent with the ICD-11 model of complex post-traumatic stress disorder. The International Trauma Questionnaire scale scores demonstrated excellent internal reliability. Overall, 9.1% (95% confidence interval = [4.8%, 13.5%]) met diagnostic requirements for post-traumatic stress disorder and an additional 51.4% (95% confidence interval = [44.0%, 58.9%]) met requirements for complex post-traumatic stress disorder. Those meeting diagnostic requirements for complex post-traumatic stress disorder were more likely to have served in the military for 15 years or longer, had a history of more traumatic life events and had the highest levels of depression, anxiety and stress symptoms. The International Trauma Questionnaire can effectively distinguish between post-traumatic stress disorder and complex post-traumatic stress disorder within primary care samples of Australian Defence Force veterans. A significantly greater proportion of Australian Defence Force veterans met criteria for complex post-traumatic stress disorder than post-traumatic stress disorder. Australian military mental health services should adopt the International Trauma Questionnaire to routinely screen for complex post-traumatic stress disorder and develop complex post-traumatic stress disorder specific interventions to promote recovery in Australian Defence Force veterans with complex post-traumatic stress disorder.

Proposition of a transdiagnostic processual approach of emotion dysregulation based on core triggers and interpersonal styles.

Emotion dysregulation (ED) has primarily been described in patients suffering from borderline personality disorder (BPD) and is an integral part of this diagnosis, but it is also a transdiagnostic construct that can be found in several other psychiatric disorders. The strong relationships between ED and BPD may lead clinicians to underestimate ED associated to other clinical contexts. This can lead to difficulties in diagnostic and treatment orientation, especially in the context of comorbidities. In this article, after reviewing the literature on the development and functioning of emotion dysregulation, and on the evidence for emotion dysregulation in eight disorders (borderline personality disorder, pathological narcissism with/without narcissistic personality disorder, obsessive-compulsive personality disorder, antisocial personality disorder, bipolar disorder, autism spectrum disorder, complex post-traumatic stress disorder, and adult attention deficit hyperactivity disorder), we present a transdiagnostic processual model of emotion dysregulation based on core triggers and interpersonal styles to try to address this issue and to provide a simple but technical tool to help clinicians in their diagnostic assessment and treatment orientation. By focusing more on typical patterns and interpersonal dynamics than only on categories, we believe that this model may contribute to the actual need for improvement of our current psychiatric classifications, alongside other well-studied and under-used dimensional models of psychopathology (e.g., HiTOP, AMPD), and may be useful to build more specific treatment frameworks for patients suffering from ED.

Can the PCL-5 be used as a potential indicator of probable Complex PTSD?

PurposeAlongside the recognition of the ICD-11 Complex Posttraumatic Stress Disorder (CPTSD), research has been underway to develop effective assessment measures to identify CPTSD. Given the novelty of the CPTSD diagnosis and associated assessment methods, many services have exhibited caution in incorporating such methods. Yet, there remains a clinical need to identify individuals experiencing CPTSD-like difficulties as it may hold important treatment considerations. This study aims to identify a score on the commonly administered Posttraumatic Stress Disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) (PCL-5) that may be suggestive of CPTSD-like difficulties. MethodsUsing cross-sectional data from a clinical veteran sample (N = 227), a Receiver Operating Characteristics (ROC) analysis using CPTSD criteria as a benchmark was conducted to identify an PCL-5 cut-off score. ResultsThis study suggests a PCL-5 cut-off score of 51, which had a sensitivity of 78.8 % and a specificity of 77.8 %. ConclusionThe potential utility of this score is discussed in terms of suitability as an indicator of potential CPTSD-like difficulties as well as potential service implications. Further research is required to further investigate the feasibility of a PCL-5 score to screen for CPTSD.

Sex Differences in the Relationship Between School Bullying Victimization and Complex Posttraumatic Stress Disorder: The Roles of Insecure Attachment.

School bullying victimization is a highly concerning issue that can lead to a range of negative outcomes. Despite the research showing a significant association between bullying victimization and complex posttraumatic stress disorder (CPTSD), the internal mechanisms with its two components (i.e., posttraumatic stress disorder symptoms [PTSD] and disorders of self-organization symptoms [DSO]) remain unclear. Previous studies have indicated that attachment style may influence the development of CPTSD symptoms and that there may be sex differences in attachment styles. Thus, the present study aims to examine the mediating role of insecure attachment between school bullying victimization and CPTSD symptoms in males and females. The study assessed bullying victimization, attachment orientation, and CPTSD (i.e., PTSD symptoms and DSO symptoms) symptoms in 675 college students (65.2% females; Mage = 19.6, SD = 1.34) from China who had reported bullying experiences at two different time points, 6 months apart. For females, school bullying victimization predicted PTSD and DSO symptoms through attachment anxiety and only predicted DSO symptoms through attachment avoidance. For males, we found that school bullying victimization predicted PTSD symptoms through attachment avoidance. These findings suggest that attachment is critical in understanding how school bullying victimization may lead to CPTSD symptoms among individuals of different sexes.

The Impact of Complex PTSD on Suicide Risk in Patients with Bipolar Disorder: A Cross-Sectional Study

Background: Patients with bipolar disorder (BD) are more likely than the general population to experience traumatic events, particularly during childhood, and these may predict and be a risk factor for the development of complex PTSD (cPTSD). The presence of multiple traumas plays a relevant role from a psychopathological point of view, but little is known about the effect this may have on suicide attempts in patients with BD. Methods: A cross-sectional study was conducted comparing socio-demographic and clinical characteristics, recruiting 344 patients diagnosed with BD I and II, screened for the presence (or absence) of cPTSD using the International Trauma Questionnaire (ITQ). Suicide attempts were assessed directly during the clinical interview and from the patient’s medical record. Results: The results emerging from the study indicate that cPTSD can be considered a risk factor for suicide attempts in patients with BD. Furthermore, evidence is provided to support the idea that cPTSD is highly prevalent in patients with BD and is related to a higher psychopathological burden. Conclusions: The results recommend an urgent and comprehensive assessment of suicidal risk in patients with comorbidity of both bipolar disorder and cPTSD. There is a crucial demand for early intervention initiatives and proactive prevention strategies to address the intricate intersection of these mental health challenges.

Predictors and (in-)stability of ICD-11 complex posttraumatic stress disorder in older adults: findings from a longitudinal study in Switzerland.

Objective: There is a lack of research on complex post-traumatic stress disorder (CPTSD) in older individuals, with little known about the temporal course of CPTSD. Therefore, this study assessed and compared the demographic characteristics, adverse childhood experiences (ACE), and well-being of Swiss older adults with and without probable CPTSD. The (in-)stability of probable CPTSD was also examined in relation to the predictive value of various emotion-related factors.Methods: A longitudinal study was conducted in Switzerland with N = 213 participants (Mage = 69.98 years, SD = 10.61; 45.5% female). Data was collected via face-to-face assessments at baseline and follow-up, 21 months apart. The German version of the International Trauma Questionnaire was used to screen for (C)PTSD. Standardized instruments were used to assess ACE as well as the predictors anger, embitterment, emotion regulation, and meaning in life.Results: From the total sample, n = 16 participants (7.5%) were identified as having probable CPTSD, with only five of these (31.25%) having probable CPTSD at both baseline and follow-up. Individuals with and without probable CPTSD differed significantly regarding age and employment status. Significant predictors of probable CPTSD were anger (β = 0.16), embitterment (β = 0.06), cognitive reappraisal (β = -0.41), and the presence of meaning in life (β = -0.10).Conclusions: Probable CPTSD appears to be relatively unstable over the course of a 21-month period in older individuals. The links between CPTSD and emotion-related predictors highlight potential targets for intervention.

Predictors and moderators of treatment outcomes in phase-based treatment and trauma-focused treatments in patients with childhood abuse-related post-traumatic stress disorder

ABSTRACT Background: Knowledge of treatment predictors and moderators is important for improving the effectiveness of treatment for PTSD due to childhood abuse. Objective: The first aim of this study was to test the potential predictive value of variables commonly associated with PTSD resulting from a history of repeated childhood abuse, in relation to treatment outcomes. The second aim was to examine if complex PTSD symptoms act as potential moderators between treatment conditions and outcomes. Method: Data were obtained from a randomized controlled trial comparing a phase-based treatment (Skills Training in Affect and Interpersonal Regulation [STAIR] followed by Eye Movement Desensitization and Reprocessing [EMDR] therapy; n = 57) with a direct trauma-focused treatment (EMDR therapy only; n = 64) in people with PTSD due to childhood abuse. The possible predictive effects of the presence of borderline personality disorder, dissociative symptoms, and suicidal and self-injurious behaviours were examined. In addition, it was determined whether symptoms of emotion regulation difficulties, self-esteem, and interpersonal problems moderated the relation between the treatment condition and PTSD post-treatment, corrected for pre-treatment PTSD severity. Results: Pre-treatment PTSD severity proved to be a significant predictor of less profitable PTSD treatment outcomes. The same was true for the severity of dissociative symptoms, but only post-treatment, and not when corrected for false positives. Complex PTSD symptoms did not moderate the relationship between the treatment conditions and PTSD treatment outcomes. Conclusions: The current findings suggest that regardless of the common comorbid symptoms studied, immediate trauma-focused treatment is a safe and effective option for individuals with childhood-related PTSD. However, individuals experiencing severe symptoms of PTSD may benefit from additional treatment sessions or the addition of other evidence-based PTSD treatment approaches. The predictive influence of dissociative sequelae needs further research. The study design was registered in The Dutch trial register (https://www.trialregister.nl/trialreg/admin/rctview.asp?TC = 5991) NTR5991 and was approved by the medical ethics committee of Twente NL 56641.044.16 CCMO.

The influence of betrayal trauma on complex posttraumatic stress disorder symptoms.

Complex posttraumatic stress disorder (complex PTSD) is characterized by symptoms of PTSD combined with disturbance in self-organization and is distressing for many people who have experienced chronic and repetitive interpersonal trauma. Studies on the precursors to complex PTSD have thus far focused on the forms of trauma perpetrated rather than who perpetrated the trauma. Traumas that are associated with complex PTSD (i.e., chronic and repetitive interpersonal traumas) are often perpetrated by someone that is close to the victim and thus involve an element of betrayal. However, there is little research on whether traumas high in betrayal are more associated with complex PTSD symptoms than traumas lower in betrayal. The aim of this study is to examine the association between traumas with varying degrees of betrayal and complex PTSD symptoms. We examined this association in a sample of adults (N = 364) recruited using Amazon's Mechanical Turk using a Bayesian approach to multiple regression. Results suggest that interpersonal traumas both with and without a component of betrayal were associated with complex PTSD symptoms for both women and men. We further found that for men, noninterpersonal trauma was also associated with complex PTSD symptoms. Study findings highlight the role of interpersonal trauma on complex PTSD symptoms, especially for women. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Living with a friend mediates PTSD and CPTSD symptoms among trauma-exposed Ukrainians during the second year of 2022 Russian invasion

Purpose This study aims to develop and test multivariable psychosocial prediction models of perceived post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD) symptoms development among trauma-exposed Ukrainian adults (n = 761) after 1.5 years of the 2022 Russian invasion of Ukraine. Design/methodology/approach This research was designed as a survey in line with the methodology of “Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis” checklist. The survey included a questionnaire on sociodemographic characteristics and specifics of trauma exposure, as well as validated self-reported inventories: The International Trauma Questionnaire, Acceptance and Action Questionnaire – version 2, Connor–Davidson Resilience Scale-10 and the Modified BBC Subjective Well-being Scale. Findings Regression analysis revealed different prediction models for PTSD and CPTSD symptoms, explaining 18.4% and 41.4% of their variance with five and eight predictors, respectively. Four variables were similar in predicting PTSD and CPTSD: war-relatedness of trauma, living with a friend, perceived physical health and regret for the past. War-relatedness of trauma the respondents were exposed to was among the strongest predictors for PTSD and CPTSD severity. However, living with a friend was almost equally strong in mitigating these mental consequences. Regret for past and lowly rated physical health were assessed as relatively weaker but statistically significant predictors in this study. Originality/value Upon the original theoretical framework, two psychosocial prediction models were developed for PTSD and CPTSD symptoms in a non-clinical sample of trauma-exposed Ukrainian adults.

Exploring trauma exposure and post-traumatic stress in university students of different identity statuses in Lithuania and Japan.

Emerging adulthood is the time when identity questions are addressed. It is also a time of excessive stress and risk for mental health problems. Different identity statuses relate to different mental health outcomes. Yet, little research has addressed how identity status is interlinked with trauma exposure and post-traumatic stress reactions, especially in multicultural contexts. The current study aimed to explore whether different traumatic experiences are related to the current identity status of university students aged between 18 and 29 years and investigate to what extent trauma-exposed emerging adults of different identity statuses report symptoms of post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). In total, 2237 university students from Lithuania (n = 791) and Japan (n = 1345) participated in the current study. Identity profiles were revealed by using the Latent Class Analysis approach. Lithuania and Japan were comparable in terms of identity profiles and structure of PTSD/CPTSD. Trauma-exposed emerging adults reported a higher probability of being in troubled diffusion identity status; students in achievement identity status had a lower probability of CPTSD and lower rates of symptoms of disturbances in self-organization. The diffused identity of emerging adults from Lithuania and Japan is associated with trauma exposure, and positive identity is linked with fewer CPTSD reactions.

Complex posttraumatic stress disorder in intergenerational trauma transmission among Eritrean asylum-seeking mother-child dyads

ABSTRACT Background: Traumatic stress among forcibly displaced people has a variety of adverse consequences beyond individual mental health, including implications for poor socioemotional developmental outcomes for their children post-displacement. Objective: This study explored the intergenerational transmission of maternal ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) and depression among asylum-seeking mothers for their children’s internalizing and externalizing difficulties. Method: Participants were 127 trauma-affected Eritrean mothers of preschool-aged children in Israel. The severity of child difficulties was compared between mothers with probable ICD-11 CPTSD (94.5% comorbid depression), ICD-11 PTSD (48.5% comorbid depression), unimorbid depression, and healthy mothers, using multivariate analyses of variance, while controlling for children’s direct exposure to adverse life experiences. Results: Probable ICD-11 CPTSD and PTSD were present in 23.6% and 26.0% of mothers, respectively. Relative to maternal PTSD, CPTSD was significantly and strongly associated with elevated child internalizing symptoms (d = 2.44) and marginally significantly, although strongly, associated with child externalizing symptoms (d = 1.30). Post-hoc exploratory analyses documented that, relative to maternal PTSD and depression, CPTSD and depression comorbidity was marginally significantly but strongly associated with child internalizing (SMD = .67), but not externalizing symptoms (SMD = .35). Conclusions: Findings implicate maternal CPTSD and comorbid depression in child socio-emotional development and inform clinical assessment, prevention, and intervention to attenuate poor development among children in unstable post-displacement settings.

Creative arts as self-care: vicarious trauma, resilience and the trainee art therapist

ABSTRACT Background Research shows that indirect trauma can negatively affect professionals in helping professions, with students and young professionals at greater risk, particularly if they have a personal history of trauma. Research suggests that engaging in the creative arts may help professionals process vicarious trauma and promote resilience. Context This paper explores the use of creative arts practice for self-care by an art therapy trainee with lived experience of somatic disorder symptoms and complex post-traumatic stress disorder (C-PTSD), working in a secure setting. Approach Using a trauma lens, the paper discusses how the creative arts can ameliorate the effects of indirect trauma when working as a trainee art therapist in a challenging context. The trainee’s early life experiences elucidate the challenges of countertransference and trauma. The creative arts process supports the reflexive skills an art therapist uses for effective practice. Outcomes The creative arts as a self-care practice supported the trainee art therapist to negotiate her dissociative defence style. It was an effective tool for managing the ill-effects of exposure to trauma, including somatic symptoms, and benefited the trainee’s development. Conclusions The creative arts helped the trainee to reconnect with her body and emotions, and subsequently benefited her clinical thinking. Implications for research Art therapy training programmes could include explicitly teaching about the risks and benefits of working in the profession, as this may promote longevity and improve therapeutic outcomes for service users. Further research on dissociative responses to trauma and creative arts as self-care for therapists would be valuable. Plain-language summary Research in the past 30 years has found that people working in helping professions are at risk of experiencing trauma symptoms through their work with service users. This can have a negative effect on their health and wellbeing, as well as their relationships with others. If unaddressed it can also negatively affect their ability to provide effective therapy. Students and people with a history of trauma are at greater risk. This paper explores the personal experience of a trainee art therapist working in a secure hospital setting. It describes how creative arts practice helped the trainee to cope with the challenging content of therapy sessions and promote their own wellbeing. It uses the trainee’s experience as a young carer to elucidate the emotional and physical toll of caring and the long-lasting impact it can have. The trainee’s experiences suggest that the creative arts can help with high levels of stress and hypervigilance, negative physical symptoms and personal trauma triggers, and promote greater wellbeing. The article calls for research into the value of including teaching around trauma, including physical symptoms, in training programmes for art therapists, and how the creative arts can be used as a self-care tool.

Integration of limbic self-neuromodulation with psychotherapy for complex post-traumatic stress disorder: treatment rationale and case study

ABSTRACT Treatment Rationale: Exposure to repeated sexual trauma, particularly during childhood, often leads to protracted mental health problems. Childhood adversity is specifically associated with complex posttraumatic stress disorder (PTSD) presentation, which is particularly tenacious and treatment refractory, and features severe emotion dysregulation. Augmentation approaches have been suggested to enhance treatment efficacy in PTSD thus integrating first-line psychotherapy with mechanistically informed self-neuromodulation procedures (i.e. neurofeedback) may pave the way to enhanced clinical outcomes. A central neural mechanism of PTSD and emotion dysregulation involves amygdala hyperactivity that can be volitionally regulated by neurofeedback. We outline a treatment rationale that includes a detailed justification for the potential of combining psychotherapy and NF and delineate mechanisms of change. We illustrate key processes of reciprocal interactions between neurofeedback engagement and therapeutic goals. Case Study: We describe a clinical case of a woman with complex PTSD due to early and repetitive childhood sexual abuse using adjunctive neurofeedback as an augmentation to an ongoing, stable, traditional treatment plan. The woman participated in (a) ten sessions of neurofeedback by the use of an fMRI-inspired EEG model of limbic related activity (Amygdala Electrical-Finger-Print; AmygEFP-NF), (b) traditional weekly individual psychotherapy, (c) skills group. Before and after NF training period patient was blindly assessed for PTSD symptoms, followed by a 1, 3- and 6-months self-report follow-up. We demonstrate mechanisms of change as well as the clinical effectiveness of adjunctive treatment as indicated by reduced PTSD symptoms and improved daily functioning within this single case. Conclusions: We outline an integrative neuropsychological framework for understanding the unique mechanisms of change conferring value to conjoining NF applications with trauma-focused psychotherapy in complex PTSD.

Repetitive transcranial magnetic stimulation in complex posttraumatic stress disorder: A case report

Abstract Complex posttraumatic stress disorder (cPTSD) represents a unique clinical phenomenon. It is marked by traditional PTSD symptoms coupled with emotional instability, unfavorable self-perception, and challenges in interpersonal relationships. While the diagnostic recognition of cPTSD remains debated, emerging evidence supports its unique profile and clinical significance. This study presents an instance involving a 30-year-old woman who has been clinically determined to have severe cPTSD, comorbid borderline personality traits, major depressive disorder, and fibromyalgia. The patient underwent 25 bilateral sessions of repetitive transcranial magnetic stimulation (rTMS) targeting prefrontal cortices. Comprehensive assessments using standardized scales were conducted pre- and post-rTMS treatment. Results revealed significant reductions in cPTSD symptoms (PTSD Checklist-5 scores decreased from 55 to 21) and reduced borderline personality symptomatology (the Zanarini Rating Scale for borderline personality disorder scores decreased from 9 to 4), alongside improvements in other areas. These findings suggest the potential utility of rTMS as an adjunctive intervention for cPTSD. Aligned with previous PTSD research, the study highlights the capacity of rTMS to mitigate cPTSD symptoms, comorbidities, and subjective distress. Nevertheless, further exploration with larger samples and extended follow-up is needed to substantiate and generalize these findings. This preliminary evidence underscores rTMS’s promise as a prospective therapeutic avenue for complex PTSD, offering hope for improved treatment strategies.

North Korean defectors with PTSD and complex PTSD show alterations in default mode network resting-state functional connectivity.

North Korean defectors (NKDs) have often been exposed to traumatic events. However, there have been few studies of neural alterations in NKDs with post-traumatic stress disorder (PTSD) and complex PTSD (cPTSD). To investigate neural alterations in NKDs with PTSD and cPTSD, with a specific focus on alterations in resting-state functional connectivity networks, including the default mode network (DMN). Resting-state functional connectivity was assessed using brain functional magnetic resonance imaging in three groups of NKDs: without PTSD, with PTSD and with cPTSD. Statistical tests were performed, including region of interest (ROI)-to-ROI and ROI-to-voxel analysis, followed by post hoc correlation analysis. In the ROI-to-ROI analysis, differences in functional connectivity were found among the components of the DMN, as well as in the thalamus and the basal ganglia. Right hippocampus-left pallidum and right amygdala-left lingual gyrus connectivity differed between groups in the ROI-to-voxel analysis, as did connectivity involving the basal ganglia. The post hoc analysis revealed negative correlations between Coping and Adaptation Processing Scale (CAPS) score and left posterior cingulate cortex-right pallidum connectivity and between CAPS score and right putamen-left angular gyrus connectivity in the control group, which were not observed in other groups. The results suggest that there are alterations in the functional connectivity of the DMN and the limbic system in NKDs with PTSD and cPTSD, and that these alterations involve the basal ganglia. The lower correlations of CAPS score with right basal ganglia-DMN functional connectivity in patients compared with controls further implies that these connectivities are potential targets for treatment of PTSD and cPTSD.

Особливості надання психологічної допомоги військовослужбовцям з ознаками психологічного травмування

Background . The war waged by Russia against Ukraine makes extremely difficult demands on the personality of a military personnel. In stressful conditions, his psyche may experience a psycho-traumatic effect. These risks encourage the search for optimal approaches to providing psychological care without waiting for the end of hostilities. In global practice, there are a large number of effective tools for improving the psychophysiological state of military personnel after exposure to excessive stress. A comparison of foreign and domestic approaches to the problem of overcoming the psychotraumatic consequences of war will make it possible to single out the main tasks of providing psychological assistance in today's extremely difficult conditions. The purpose of the article is theoretical substantiation and definition of the main areas of providing psychological assistance to military personnel in the conditions of the Russian-Ukrainian war. Methods . The theoretical methods of analysis, synthesis and generalization of scientific sources were used to establish the theoretical basis of the research. Empirical research methods were used to determine the specifics of providing psychological assistance to military personnel (observation, experiment, questionnaire and testing). Results . The peculiarities of psychological trauma of military personnel, participants of the Russian-Ukrainian war, as well as modern evidence-based methods of providing psychological assistance to military personnel are analyzed. The expediency of providing comprehensive psychological assistance to military personnel with signs of psychological trauma using evidence-based psychotherapy methods was considered. Conclusions . In today's conditions of full-scale armed aggression of the Russian Federation against Ukraine, military personnel of the Armed Forces of Ukraine are exposed to various types of psychological trauma during their continuous participation in hostilities. The main psychotraumatic factors include a constant threat to life and health, captivity and violence, loss, mutilation, neglect by the enemy of the provisions of International Humanitarian Law, etc. These factors lead to an increase in the number of cases of complex post-traumatic stress disorder and increase the need for psychological help, which is confirmed by the results of a psychological study. The analysis of foreign experience shows the success of the early intervention protocols of psychological assistance in the world's leading armies. The use of evidence-based methods of psychological assistance gives a positive result, so this direction of research is promising.