Maintenance Of Posttraumatic Stress Disorder Research Articles

Psychometric Evaluation of a Measure of Posttraumatic Safety Behaviors

Despite evidence that safety behaviors function as transdiagnostic causal maintenance factors for anxiety pathology, there has been relatively less empirical investigation of trauma-related safety behaviors in the development and maintenance of posttraumatic stress disorder. This paper introduces the development and preliminary psychometric evaluation of the Posttraumatic Safety Behaviors Inventory (PSBI), a 10-item self-report assessment of trauma-relevant safety behaviors. Two samples totaling 597 trauma survivors (61.8% female; Mage = 40.0; 76.2% White/Caucasian) recruited through Amazon Mechanical Turk completed the PSBI. Exploratory and confirmatory factor analyses identified a three-factor structure consisting of Avoidance, Coping with Negative Thoughts and Emotions, and Coping with Threats to Physical Safety. The PSBI also demonstrated favorable measurement invariance, construct validity, internal consistency, and test-retest reliability. Taken together, our preliminary findings suggest that the PSBI is an efficient, psychometrically sound assessment tool for posttraumatic safety behaviors. With further psychometric validation, the PSBI promises to aid researchers and clinicians in the identification and monitoring of trauma-relevant safety behaviors.

Compassion buffers the association between trauma exposure and PTSD symptom severity: Findings of a cross-sectional study

To advance intervention science dedicated to improve refugees’ mental health, a better understanding of factors of risk and resilience involved in the etiology and maintenance of post-traumatic stress disorder (PTSD) is needed. In the present study, we tested whether empathy and compassion, two trainable aspects of social cognition related to health, would modulate risk for PTSD after war-related trauma. Fifty-six refugees and 42 migrants from Arabic-speaking countries reported on their trauma experiences, PTSD symptoms, and perceived trait empathy and compassion. They further completed the EmpaToM, a naturalistic computer task measuring behavioral empathy and compassion. Moderation analyses revealed that behavioral, but not self-reported compassion was a significant moderator of the trauma-PTSD link. Trauma was more strongly related to PTSD symptoms when individuals had low (β =.59, t = 4.27, p <.001) as compared to high levels of behavioral compassion. Neither self-reported nor behavioral empathy moderated the trauma-PTSD link (β =.24, t = 1.57, p =.120). Findings indicate that the ability to go beyond the sharing of others’ suffering and generate the positive feeling of compassion may support resilience in the context of trauma and subsequent development of PTSD. Hence, compassion may be a suitable target for prevention and intervention approaches reducing PTSD symptoms after trauma.

Changes in trauma appraisal during brief internet-based exposure and cognitive restructuring treatment for Arabic-speaking people with PTSD

ABSTRACT Background: Maladaptive trauma appraisal plays an important role in the development and maintenance of posttraumatic stress disorder (PTSD). While studies have demonstrated the effectiveness of exposure and cognitive treatments for PTSD symptomatology, the effect of such treatments on specific trauma appraisals is still not well understood. Objective: The study investigated the effect of an exposure and a cognitive restructuring internet-based treatment on specific trauma appraisals in Arabic-speaking participants with PTSD. Method: 334 participants received either an exposure (n = 167) or a cognitive restructuring (n = 167) internet-based treatment. PTSD symptom severity (PCL-5) and specific trauma appraisals (TAQ) were assessed at pre- and post-treatment. Changes in specific trauma appraisals within and between the two treatments were analyzed using multi-group change modelling. Associations between changes in PTSD symptom severity and changes in trauma appraisals were evaluated using Pearson product-moment correlation. For both treatments, participants with versus without reliable improvement were compared regarding changes in specific trauma appraisals using Welch tests. Analyses were performed on 100 multiple imputed datasets. Results: Both treatments yielded significant changes in shame, self-blame, fear, anger, and alienation (all ps < .001). Changes in betrayal were only significant in the cognitive restructuring treatment (p < .001). There was no evidence of differences between treatments for any specific trauma appraisal. Changes in PTSD symptom severity were significantly associated with changes in trauma appraisals (all ps < .001). In both treatments, participants who experienced reliable improvement in PTSD symptom severity showed significantly larger pre- to post-treatment changes in specific trauma appraisals compared to those without reliable improvement. Again, differences in betrayal were only significant in the cognitive restructuring treatment. Conclusions: The findings indicate that both treatments are effective in reducing trauma appraisals in Arabic-speaking people with PTSD. Changes in trauma appraisal seem to be associated with changes in PTSD symptomatology. Trial registration: German Clinical Trials Register identifier: DRKS00010245.

The effects of a combination of cognitive interventions and loving-kindness meditations (C-METTA) on guilt, shame and PTSD symptoms: results from a pilot randomized controlled trial

ABSTRACT Background: Trauma-related guilt and shame are crucial for the development and maintenance of PTSD (posttraumatic stress disorder). We developed an intervention combining cognitive techniques with loving-kindness meditations (C-METTA) that specifically target these emotions. C-METTA is an intervention of six weekly individual treatment sessions followed by a four-week practice phase. Objective: This study examined C-METTA in a proof-of-concept study within a randomized wait-list controlled trial. Method: We randomly assigned 32 trauma-exposed patients with a DSM-5 diagnosis to C-METTA or a wait-list condition (WL). Primary outcomes were clinician-rated PTSD symptoms (CAPS-5) and trauma-related guilt and shame. Secondary outcomes included psychopathology, self-criticism, well-being, and self-compassion. Outcomes were assessed before the intervention phase and after the practice phase. Results: Mixed-design analyses showed greater reductions in C-METTA versus WL in clinician-rated PTSD symptoms (d = −1.09), guilt (d = −2.85), shame (d = −2.14), psychopathology and self-criticism. Conclusion: Our findings support positive outcomes of C-METTA and might contribute to improved care for patients with stress-related disorders. The study was registered in the German Clinical Trials Register (DRKS00023470).

An investigation of laboratory-based positive and negative emotional suppression in relation to posttraumatic stress disorder symptom clusters.

Emotional suppression is a clinically significant aspect of emotion regulation with robust associations to psychopathology, including posttraumatic stress disorder (PTSD). Despite the fast-growing body of literature highlighting the role of positive emotion regulation difficulties in the development and maintenance of PTSD, extant work on emotional suppression and PTSD has almost exclusively focused on the role of negative emotions. The present study aimed to advance this literature by examining the associations between PTSD symptom clusters and participants' use of state emotional suppression during a laboratory task designed to elicit negative or positive emotions. Participants were 108 community women (Mage = 39.55; 33% Black/African American) currently experiencing intimate partner violence (IPV) by a male partner and using substances. Participants were interviewed using a structured diagnostic assessment for PTSD and reported on state emotional intensity and emotional suppression following idiographic negative or positive emotion inductions. Results of the moderation analyses showed that, when controlling for state emotional intensity, women experiencing clinical levels of PTSD symptom Clusters B (intrusive recollections), D (negative alterations in cognitions and mood), and E (alterations in arousal and reactivity) were significantly more likely to utilize emotional suppression, but only in the context of positive-not negative-emotions. Findings provide evidence for a link between PTSD and positive emotional suppression among women currently experiencing IPV by a male partner and using substances, highlighting positive emotional suppression as a potential target in PTSD treatment for IPV populations with comorbid substance use concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Anxiety sensitivity, finding the body, and posttraumatic stress disorder in suicide-bereaved treatment-seeking adults.

Those bereaved by suicide are at greater risk of prolonged distress compared to those bereaved by other modes of death. Trauma- and emotion-related factors may increase this vulnerability. Finding the body of the deceased may intensify postsuicide distress. Anxiety sensitivity, fear of one's anxiety-related symptoms, has been positively associated with posttraumatic stress disorder (PTSD) in other trauma populations but has not been studied in the suicide bereaved. This study examined the relationships among finding the body, anxiety sensitivity, and PTSD in a treatment-seeking, suicide-bereaved sample (N = 50). Pretreatment baseline data on demographics, the Anxiety Sensitivity Index, and the PTSD Checklist were analyzed. Younger age (r = -.31, p = .03), being a person of color (r = -.32, p = .02), and fewer days since the loss (r = -.30, p = .03) were associated with greater PTSD. Controlling for age, race, and days since the loss, PTSD was unrelated to finding the body, F(1, 45) = 0.01, p = .92, but was positively associated with anxiety sensitivity (pr = .32, p = .03). In simultaneous regression analyses, age, race, days since the loss, finding the body, and anxiety sensitivity accounted for 33% of the variance in PTSD, F(2, 44) = 4.29, p = .003; anxiety sensitivity was the only significant predictor of PTSD symptoms (β = .36, t = 2.35, p = .02). Anxiety sensitivity has important implications for the development and maintenance of PTSD in the suicide bereaved and should be assessed and targeted in suicide postvention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Attentional bias modification and attention control training in PTSD: a systematic review and meta-analysis.

Cognitive models of post-traumatic stress disorder (PTSD) highlighted the effect of maladaptive cognitive processing in the development and maintenance of PTSD. PTSD is related to attentional bias (AB) toward threatening stimuli and greater attentional bias variability (ABV). Attentional bias modification (ABM) and attention control training (ACT) have demonstrated the effect of improving PTSD, but the results of randomized controlled trials (RCTs) are controversial. The current study aimed to evaluate the extent of evidence supporting the efficacy of ABM in the treatment of PTSD. Systematic review and meta-analysis. We searched PUBMED, PsycINFO, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials for articles published between 1980 and 2022. RCTs of ABM for adult participants with PTSD symptoms were identified. The primary outcome was changes in PTSD severity, and the second outcome was changes in AB and ABV. Trial quality was assessed using the Cochrane Risk of Bias Tool. Publication bias was assessed using the Doi plot and Luis Furuya-Kanamori (LFK) index. Eight RCTs comparing the effect of ABM to ACT were included in the review, and six studies were meta-analyzed. Meta-analysis favored ACT in improving PTSD symptoms and ABV, and the effect size was large. ABM and ACT demonstrated similar effects in improving AB. ACT should not only be seen as a control training condition but also has therapeutic values. However, since the current meta-analysis only included a limited number of studies, further research was still needed to examine the clinical value of ACT in PTSD treatment.

The dual role of time perception in trauma-exposed individuals: A conceptual review.

This comprehensive review seeks to integrate knowledge on the dual role of time as a reactive and a constructive measure with literature on the distinctive encoding of traumatic memories. First, we discuss the dual role of time. Later, we show how encoding traumatic events may lead to chronic alteration in time perception. Finally, we review the potential of temporal metacognitive awareness as a therapeutic avenue to rectify chronic time dilation following trauma, ultimately mitigating posttraumatic symptoms. A systematic search of electronic databases was conducted using four main terms: time perception, temporal encoding of traumatic memories, temporal metacognitive awareness, and temporal learning tasks as clinical interventions. The review proposes that the interplay between the dual roles of time-reactive and constructive-alongside the elemental encoding of traumatic events can give rise to a self-perpetuating cycle. Within this cycle, overgeneralized fear could lead to neutral stimuli triggering and fortifying time dilation, thus contributing to the maintenance of posttraumatic stress disorder (PTSD) symptoms. Furthermore, we propose that cultivating temporal metacognitive awareness could potentially yield a positive impact on time dilation by embracing a more adaptable learning approach-one that places less emphasis on external signals and does not necessitate direct engagement with traumatic content. Strengthened temporal awareness might serve to mitigate chronic time dilation, potentially leading to a reduction in PTSD symptoms. The review emphasizes the need for further research to examine whether enhancing temporal metacognitive awareness for time duration may offer an innovative and effective avenue for alleviating PTSD symptoms in trauma-exposed individuals. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Using experience sampling methodology (ESM) to improve our understanding of day-to-day intrusion frequency and related distress in survivors of trauma

Background and objectivesCognitive models of posttraumatic stress disorder (PTSD) suggest that appraisals of traumatic sequelae and subsequent distress drive the development and maintenance of PTSD. Posttraumatic research has relied heavily on macro-longitudinal designs, with weeks or months between assessments of trauma-related cognitions and symptoms. The present study uses experience sampling methodology (ESM) better understand the day-to-day experiences of trauma exposed individuals. MethodsOne-hundred trauma exposed adults reported their posttraumatic symptoms, interpretations, and behaviours four times a day over a 10-day ESM period. ResultsAs anticipated, within-person fluctuations in negative appraisals of intrusions and maladaptive coping strategies (e.g., thought suppression) were significantly positively associated with intrusion frequency and related distress. In all cases, the associations for negative appraisals and maladaptive coping were stronger with intrusion related distress than intrusion frequency. LimitationsThe observed contemporaneous associations only demonstrate that variables reliably fluctuated together and cannot indicate causality. ConclusionsThe findings demonstrate that day-to-day fluctuations in trauma related perceptions and sequelae are significant and should be explored alongside broader individual differences to advance our understanding of the development, maintenance, and treatment of PTSD.

Differential Associations Between Posttraumatic Cognitions, Posttraumatic Stress Disorder Symptoms, and Race Among Black and White Veterans Seeking Treatment for Assaultive Military Sexual Trauma.

Past research supports the role of negative posttraumatic cognitions (NPCs) in the development and maintenance of posttraumatic stress disorder (PTSD). The relationship between NPCs and PTSD may be uniquely impacted by racial status and experiences of military sexual trauma (MST), both of which may have a unique impact on one's understanding of self, others, and the world. We explored racial differences in the association between NPCs and PTSD symptom clusters in a sample of veterans endorsing MST (N = 139; 74.8% White, 25.2% Black). A path model was created and analyzed both with the full sample and separately by racial group. In the full sample, NPCs about the self and world were significantly associated with intrusion, negative alterations in cognitions and mood (NACM), and arousal, but not avoidance. Self-blame was not a significant predictor of negative alterations in cognition in mood. This model was consistent in the White veteran model, whereas only negative cognitions about the self were associated with NACM in the Black veteran path model. NPCs about the self and world appear important to non-avoidance PTSD symptomatology related to MST and thus should be targeted in treatment. For Black veterans endorsing distress related to NACM symptoms, negative beliefs about the self should be specifically considered for intervention.

Was it me? The Role of Attributions and Shame in Posttraumatic Stress Disorder (PTSD): A Systematic Review

AbstractShame has been identified as a key emotional response to trauma exposure and is implicated in the development and maintenance of PTSD. Despite this, there is a lack of empirical research explaining how and why shame emerges following trauma exposure. Current theoretical models of shame converge on the idea that shame is elicited through internal, stable, and global attributions about the precipitating event. A systematic review was conducted to assess the relationship between causal attributions, shame, and PTSD symptomology. A database search of PsycINFO, PubMED, Medline, EMBASE and PTSDPubs identified articles published between 1980 to 2022 that enabled examination of the relationship between attributions, shame, and PTSD. A total of eight articles met inclusion criteria for this review. There were cross-sectional relationships between internal attributions, shame, and PTSD symptoms, with shame demonstrating the strongest relationship with PTSD symptoms. Significant indirect effects were found between internal attributions, shame, and PTSD. Concerns surrounding reliability of measurements and sampling bias made it difficult to draw definitive conclusions. The current evidence is too preliminary to offer strong support for the mediation hypothesis. However, it does offer important avenues for future research that will have important clinical applications.

Beta spectral power during sleep is associated with impaired recall of extinguished fear.

The failure to retain memory for extinguished fear plays a major role in the maintenance of posttraumatic stress disorder (PTSD), with successful extinction recall necessary for symptom reduction. Disturbed sleep, a hallmark symptom of PTSD, impairs fear extinction recall. However, our understanding of the electrophysiological mechanisms underpinning sleep's role in extinction retention remains underdetermined. We examined the relationship between the microarchitecture of sleep and extinction recall in healthy humans (n = 71, both male and females included) and a pilot study in individuals with PTSD (n = 12). Participants underwent a fear conditioning and extinction protocol over 2 days, with sleep recording occurring between conditioning and extinction. Twenty-four hours after extinction learning, participants underwent extinction recall. Power spectral density (PSD) was computed for pre- and post-extinction learning sleep. Increased beta-band PSD (~17-26 Hz) during pre-extinction learning sleep was associated with worse extinction recall in healthy participants (r = 0.41, p = .004). Beta PSD was highly stable across three nights of sleep (intraclass correlation coefficients > 0.92). Results suggest beta-band PSD is specifically implicated in difficulties recalling extinguished fear.

The Role of Negative Posttraumatic Cognitions in the Treatment of Patients with Post-traumatic Stress Disorder

BackgroundNegative post-traumatic cognitions (PTC) are a risk factor for the development and maintenance of post-traumatic stress disorder (PTSD). PTC have further been linked to symptoms of depression, anxiety, and emotion regulation (ER). We investigated the role of PTC in the treatment of PTSD patients.MethodWe analyzed data from 339 inpatients (279 female) who received inpatient trauma-focused treatment for eight to twelve weeks. PTC, symptoms of PTSD, depression, anxiety, and ER were assessed at admission and discharge. PTC assessment included negative cognitions about the self, the world, and self-blame.ResultsThe results show that all symptoms and ER, and all PTC except for self-blame, decreased during treatment. Only baseline level of PTC about the self was related to changes in depression severity. The other baseline levels of PTC were not related to any changes in symptom severity. Changes in PTC about the self were related to changes in all symptoms and ER. Changes in PTC about the world were only linked to symptoms of PTSD. Changes in self-blame were only associated with symptoms of re-experiencing.ConclusionsOur findings suggest that PTC about the self play a more general and PTC about the world a more specific role in the treatment of PTSD. Further research is needed to clarify the role of self-blame in the treatment.

Cognitive distortions, anxiety, and depression in individuals suffering from PTSD

Cognitive distortions are an essential factor in the development and maintenance of post-traumatic stress disorder (PTSD). The aim of the study is to investigate the link between the production of cognitive distortions and PTSD by measuring levels of anxiety and depression. Our sample comprised 183 participants divided into three groups: 59 trauma-exposed with PTSD, 61 trauma-exposed without PTSD, and 63 non-trauma-exposed non-PTSD (controls). All participants were assessed on the following dimensions: PTSD (PCL-5), cognitive distortions (EDC-A), anxiety and depression (HADS). The main results highlight a production of cognitive distortions in people with PTSD, who had significantly more positive than negative cognitive distortions compared to the group exposed to trauma without PTSD. In addition, the PTSD group had higher anxiety and depression scores than the other two groups. Findings indicate that people with PTSD show more positive cognitive distortions than those without PTSD, and that this is not related to levels of anxiety and depression.

Neuroscientific account of Guilt- and Shame-Driven PTSD phenotypes

ABSTRACT Background: Guilt and Shame, two core self-related emotions, often emerge following trauma and play an important role in the development and maintenance of post-traumatic stress disorder (PTSD). Importantly, Guilt and Shame exhibit specific focal and non-specific global impacts of trauma on self-perception, respectively. Objective and Methods: Integrating psychological theories with neuroscientific knowledge, we suggest a scheme of two diverging clinical phenotypes of PTSD, associated with distinct self-related processes and differential functionality of relevant neural networks. Proposal: The Guilt-driven phenotype is characterized by preoccupation with negative self-attributes of one's actions in the traumatic event. It involves altered functionality of both the salience network (SN) and the default-mode network (DMN), associated with heightened interoceptive signalling and ruminative introspection which may lead to hyperarousal and intrusive symptoms, respectively. On the contrary, the Shame-driven phenotype is characterized by global, identity-related negative self-attributions. It involves altered functionality of both the SN and the DMN, associated with blunted interoceptive signalling and diminished introspection which may result in withdrawal and anhedonia symptoms together with dissociative experiences, respectively. Conclusion: The proposed PTSD phenotypes may inform neuropsychological therapeutic interventions (e.g. self-focused psychotherapy and neuromodulation) aiming to restore the function of large-scale self-related neural processing.

Emotion regulation repertoires in trauma-exposed college students: Associations with PTSD symptoms, emotional awareness, and emotional clarity.

Emotion regulation (ER) plays a prominent role in the development and maintenance of posttraumatic stress disorder (PTSD). Although links between ER strategies and PTSD symptoms are well documented, recent advancements in ER research emphasize the need to move beyond examining ER strategies as isolated processes. Instead, there is a growing movement to understand ER repertoires, or the patterns in which individuals report habitually using the multiple ER strategies available to them. Additionally, awareness and clarity of one's emotional experiences might play a key role in the effective use of ER strategies. The current study examined person-centered repertoires of the habitual use of eleven ER strategies among 372 undergraduates exposed to Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) Criterion A trauma-and their relations to PTSD symptoms, emotional awareness, and emotional clarity. Latent profile analysis yielded a three-profile solution (Adaptive, Average, and Maladaptive Regulators) and profiles differed on mean levels PTSD symptoms. Emotional clarity, but not emotional awareness, emerged as a significant predictor of profile classification, even after adjusting for negative affect. Findings suggest that emotional clarity might help foster healthy repertoires of ER strategy use and buffer against the development of PTSD among trauma-exposed individuals. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Subjective Sleep Disturbances in Sexual Assault Survivors: Associations With Trauma and Posttraumatic Stress Disorder Symptom Severity

Prior work implicates sleep disturbance in the development and maintenance of posttraumatic stress disorder (PTSD). However, the majority of this literature has focused on combat veteran men, and limited work has examined links between sleep disturbance and PTSD symptoms in sexual assault survivors. This is a notable gap in the literature, as sexual trauma is disproportionately likely to result in PTSD and is more common in women. We sought to examine the relations between subjective sleep disturbance, sexual assault severity, and PTSD symptoms in a sample of sexual assault survivors with PTSD (PTSD+), without PTSD (PTSD-), and healthy controls. The sample (N = 60) completed the Insomnia Severity Index and prospectively monitored their sleep for 1 week using the Consensus Sleep Diary. The sexual assault survivors also completed the Sexual Experiences Survey and PTSD Checklist-5. Results of group comparisons found that the PTSD+ group reported significantly higher insomnia symptoms, longer sleep onset latency, more nocturnal awakenings, and lower sleep quality compared to the healthy control group and higher insomnia symptoms compared to the PTSD- group. Results of regression analyses in the sexual assault survivors found that insomnia symptoms and number of nocturnal awakenings were significantly associated with higher PTSD symptoms, and sexual assault severity was significantly associated with higher insomnia symptoms, longer sleep onset latency, and lower sleep quality. These findings highlight specific features of sleep disturbance that are linked to trauma and PTSD symptom severity among sexual assault survivors.

Neural valuation of rewards and punishments in posttraumatic stress disorder: a computational approach

Posttraumatic stress disorder (PTSD) is associated with changes in fear learning and decision-making, suggesting involvement of the brain’s valuation system. Here we investigate the neural mechanisms of subjective valuation of rewards and punishments in combat veterans. In a functional MRI study, male combat veterans with a wide range of posttrauma symptoms (N = 48, Clinician Administered PTSD Scale, CAPS-IV) made a series of choices between sure and uncertain monetary gains and losses. Activity in the ventromedial prefrontal cortex (vmPFC) during valuation of uncertain options was associated with PTSD symptoms, an effect which was consistent for gains and losses, and specifically driven by numbing symptoms. In an exploratory analysis, computational modeling of choice behavior was used to estimate the subjective value of each option. The neural encoding of subjective value varied as a function of symptoms. Most notably, veterans with PTSD exhibited enhanced representations of the saliency of gains and losses in the neural valuation system, especially in ventral striatum. These results suggest a link between the valuation system and the development and maintenance of PTSD, and demonstrate the significance of studying reward and punishment processing within subject.

Altered bed nucleus of the stria terminalis and amygdala responses to threat in combat veterans with posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) significantly impacts many veterans. Although PTSD has been linked to alterations in the fear brain network, the disorder likely involves alterations in both the fear and anxiety networks. Fear involves responses to imminent, predictable threat and is driven by the amygdala, whereas anxiety involves responses to potential, unpredictable threat and engages the bed nucleus of the stria terminalis (BNST). The BNST has been implicated in PTSD, but the role of the BNST in combat veterans with PTSD has yet to be examined. Identifying alterations in BNST responses to unpredictable threat could provide important new targets for treatment. The current study examined whether veterans with PTSD have altered BNST or amygdala responses (function and connectivity) to unpredictable and predictable threat. The fMRI task involved viewing predictable threat cues followed by threat images, predictable neutral cues followed by neutral images, and unpredictable threat cues followed by either a threat or neutral image. Participants included 32 combat-exposed veterans with PTSD and 13 combat-exposed controls without PTSD. Across all conditions, veterans with PTSD had heightened BNST activation and displayed stronger BNST and amygdala connectivity with multiple fear and anxiety regions (hypothalamus, hippocampus, insula, ventromedial prefrontal cortex) relative to controls. In contrast, combat controls showed a pattern of stronger connectivity during neutral conditions (e.g., BNST-vmPFC), which may suggest a neural signature of resilience to developing PTSD, ηp 2 = .087-.527, ps < .001. These findings have implications for understanding fear and anxiety networks that may contribute to the development and maintenance of PTSD.

The Posttraumatic Cognitions Inventory (PTCI): Psychometric evaluation in veteran men and women with trauma exposure.

The Posttraumatic Cognitions Inventory (PTCI) is a self-report measure of negative posttraumatic cognitions, which is an important construct in the development and maintenance of posttraumatic stress disorder (PTSD). Evidence for the most appropriate PTCI item and factor structure is mixed, and this measure has not been extensively studied in veterans. The present study examined the psychometric properties of the PTCI in two national samples of veteran men and women. Participants in Sample 1 (veterans from all service eras) and Sample 2 (recently separated veterans) completed the PTCI and additional measures of mental health symptoms. Confirmatory factor analyses indicated that a brief version of the PTCI (PTCI-9; 3-factor, nine-item) was a superior fit relative to other examined factor structures. Consistent with the original conceptualization of the measure, these factors were labeled: Negative cognitions about self, negative cognitions about the world, and self-blame. Scores on the PTCI-9 were differentially associated with the PTSD symptom clusters and with scores on self-report measures of external comorbidities. PTCI-9 scores were higher among individuals with trauma exposure and with a probable PTSD diagnosis. There was evidence of full (Sample 1) and partial (Sample 2) scalar invariance across men and women. Overall, the present study supports the use of the PTCI-9 as a measure of negative cognitions; however, scores may not be specific to PTSD and may represent a global negative thinking style. Even so, the PTCI-9 appears to be a suitable and abbreviated measure that could be used with veterans in research and clinical practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).