Measures Of Posttraumatic Stress Disorder Research Articles

Outdoor recreational activity experiences improve psychological wellbeing of military veterans with post-traumatic stress disorder: Positive findings from a pilot study and a randomised controlled trial.

The authors confirm that all ongoing and related trials for this intervention are registered. The studies reported in this manuscript are registered as clinical trials at ISRCTN: Pilot ID- ISRCTN15325073 RCT ID- ISRCTN59395217.

Psychometric properties of the PCL-5 in a sample of first responders

Given that first responders experience elevated rates of posttraumatic stress disorder and suicide, there is a need for evidence-based assessments and treatments to accurately assess, diagnose, and evaluate treatment outcome. This study examined the psychometric properties of the Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) in a sample of 133 firefighters/emergency medical technicians and police officers seeking treatment for PTSD. The results indicated that PCL-5 scores showed strong internal consistency and convergent and discriminant validity. Signal detection analyses indicated a good diagnostic accuracy and an optimal cutoff score of 41 for detecting PTSD. Consistent with recent studies, confirmatory factor analyses indicated that the anhedonia model of PTSD best fit the data. Overall, findings support use of the PCL-5 as a psychometrically sound measure of PTSD in individuals at high risk for exposure to trauma.

Complex trauma and Trauma-Focused Cognitive-Behavioral Therapy: How do trauma chronicity and PTSD presentation affect treatment outcome?

BackgroundTraumatic experiences are common in youth and can be classified as acute (one incident or short-term) or complex (chronic exposure to multiple traumas) experiences. Posttraumatic stress disorder (PTSD) is a common response to trauma, often co-occurring with other mental health symptoms. According to the International Classification of Diseases, 11th Edition (World Health Organization, 2018), complex PTSD includes difficulties with affect regulation, interpersonal relationships, and self-blame. ObjectiveThe aims of this study were to evaluate trauma chronicity and PTSD presentation as moderators of outcomes of trauma-focused cognitive behavior therapy (TF-CBT).Participants and Setting: Participants included 176 youth and caregiver dyads who were participants in an ongoing effectiveness study of TF-CBT at a community-based clinic in NYC. MethodsMultilevel modeling was used to examine longitudinal, within-subject variability. Moderation analyses were used to assess the role of trauma chronicity and levels of PTSD on change in the outcomes. ResultsThere were no baseline differences between youth with acute versus chronic trauma. At baseline, participants who had PTSD plus 2 or 3 of the ICD-11 Complex PTSD symptom domains had significantly worse functioning than those with simple PTSD. We found significant improvement on most measures of PTSD and complex PTSD domains. Level of improvement was found to vary based on PTSD presentation at baseline. ConclusionsThis is the first study to evaluate both trauma chronicity and PTSD presentation in the context of evidence-based treatment, and findings support the effectiveness of TF-CBT for simple and complex PTSD for youth who have experienced acute and chronic trauma.

320P Psychometric interplay of the perception of the real-life impact of COVID-19 pandemic: A cross-sectional survey of patients with newly diagnosed malignancies

Patients newly diagnosed with malignancies amidst the COVID19 pandemic outbreak face the psychological double whammy of a gruesome diagnosis and a public health crisis. We conducted a cross-sectional survey to examine the association between common psychological disorders and cancer patients’ perception of COVID19’s real-life impact. Newly diagnosed cancer patients were surveyed with a two-part questionnaire constructed by oncologists and clinical psychologists. It first explored patients’ perceptions of pandemic’s impact on cancer care resources, treatment quality, health-seeking behaviour and other concerns. The second part involved the measurement of post-traumatic stress disorder (PTSD) (abbreviated PCL-5), anxiety and depression (emotion thermometer) and intolerance to uncertainty (IUS12), where patients were assigned into high and low-risk groups accordingly. Their associations were observed and analysed using chi-square test. 103 new cancer patients in Hong Kong were surveyed in May 2020. Results revealed there were more worries about the impact of COVID19 on cancer care manpower, and secondly about risk of infection during OPD waiting time, in patients of high risk group for PTSD (p= 0.011; p=0.015 respectively), anxiety (p=0.013; p=0.034), depression (p=0.017; p=0.043) and uncertainty tolerance (p=0.004; p=0.044). High IUS12 score was associated with more worry on pandemic’s impact on progress of cancer research and drug development (p=0.03). Patients of the high anxiety risk group were less likely to accept hospital’s “no visitor” policy during admission (p=0.013). High-risk group for anxiety (p=0.024) and depression (p=0.044) tend to consider the availability of media information on COVID19’s impact on cancer as inadequate. Patients of high PTSD risk group showed greater fear of being infected by family/carers (p=0.005). This original survey revealed the potential value of psychometrics in understanding cancer patient’s perception of COVID19’s impact and predicting particular concerns in patients with different psychological phenotypes, allowing better-tailored pandemic time cancer care.

A Randomized, Placebo-Controlled Trial of Mirtazapine for the Treatment of Posttraumatic Stress Disorder in Veterans.

The aim of this study was to determine the efficacy of mirtazapine, a tetracyclic antidepressant, as monotherapy for the treatment of posttraumatic stress disorder (PTSD). This multisite, randomized, double-blind, placebo-controlled trial was conducted between April 2006 and November 2010 at the Tuscaloosa and Birmingham Veterans Affairs Medical Centers in Alabama. US military veterans who met DSM-IV criteria for PTSD were randomly assigned to placebo (n = 39) or mirtazapine (n = 39) titrated up to 45 mg/d for an 8-week double-blind period followed by an 8-week open-label phase of mirtazapine treatment. The primary outcome efficacy measure was the Structured Interview for Posttraumatic Stress Disorder (SIP). Secondary measures included other measures of PTSD, depression, and sleep. Analyses of treatment groups involved mixed-model procedures using a random intercept to test the hypotheses that mirtazapine would be more effective than placebo in reducing symptoms of PTSD and depression and improving quality of sleep. Seventy-eight participants were randomized with 61 completing the 8-week controlled phase and 48 completing the open-label phase. No significant differences were observed between groups on the primary outcome of SIP scores during the controlled phase (P = .418). In secondary outcomes, significant improvements per the Clinical Global Impressions-Improvement scale were found for the mirtazapine group compared to the placebo group (P = .041). The 8-week open-label phase demonstrated significant symptom improvement in SIP total score (P = .0003) and in scores on the SIP re-experiencing (P = .0007), avoidance (P = .0309), and hyperarousal (P = .0014) subscales. There were no significant differences in the occurrence of adverse events between groups. This study did not show efficacy of mirtazapine monotherapy in the treatment of PTSD. Identification of more effective treatments, either as monotherapy or adjunctive, for PTSD is imperative. ClinicalTrials.gov identifier: NCT00302107.

Screening for psychotrauma related symptoms: Japanese translation and pilot testing of the Global Psychotrauma Screen

ABSTRACT Background: The impact of traumatic experiences or adverse life experiences has been shown to potentially affect a wide range of mental health outcomes. However, there was no brief instrument to screen for a range of psychological problems in different domains after a potentially traumatic event, and for risk factors and protective factors. Objective: The aim of this study is to examine the internal consistency and concurrent validity of the Japanese version of the Global Psychotrauma Screen (GPS) in a traumatized sample in Japan. Method: A total sample (n = 58) with varying levels of potential posttrauma symptoms due to domestic violence or other events were recruited into this study. Self-rating measures of posttraumatic stress disorder (PTSD), depression, anxiety, and alcohol problems were conducted to investigate the concurrent validity. Results: The results show that a range of posttrauma symptoms assessed by the GPS were highly endorsed by this traumatized sample in all domains except for self-harm, derealization, and depersonalization. The GPS sum score was highly correlated (r > 0.79) with other measures of PTSD, depression, and anxiety symptoms. Also, the subdomain scores showed acceptable correlations with corresponding domain measures. Participants who had been sexually assaulted or had unwanted sexual experiences, and participants who had been physically assaulted during childhood, had higher scores on the total GPS and on subdomains of PTSD, as well as symptoms associated with Complex PTSD. Conclusions: This study provides an initial indication that the GPS may be a useful screening tool for trauma survivors and elucidates that the consequences of trauma are not limited to PTSD.

Screening for moral injury and comparatively evaluating moral injury measures in relation to mental illness symptomatology and diagnosis.

Moral injury merits further study to clarify its identification, prevalence, assessment and intersection with psychosocial and psychiatric problems. The present study investigated the screening potential of the Brief Moral Injury Screen (BMIS) in a sample of post-9/11 veterans (N = 315) and comparatively evaluated how this tool, the Moral Injury Events Scale (MIES), and the Moral Injury Questionnaire-Military Version (MIQ-M) relate to psychiatric diagnoses and mental illness symptom severity. Those who endorsed failing to prevent or doing something morally wrong had the highest symptomatology scores on measures of posttraumatic stress disorder, depression, suicidality, alcohol abuse and drug abuse, followed by those who reported solely witnessing a moral injury event. Posttraumatic stress disorder and depressive symptoms correlated most strongly with scores on the MIQ-M; suicidality, alcohol abuse and drug abuse scores correlated most strongly with scores on the BMIS and MIQ-M. Moral injury, as measured by three scales, was robustly correlated with worse outcomes on various symptom measures. The three scales appear to differentially predict mental illness symptomatology and diagnoses, with the BMIS predicting suicidality and alcohol and drug abuse as well as better than other measures.

A-130 An Exploratory Analysis of the Impact PTSD Related Sleep Disturbance has on Language Generativity in Veterans with mTBI

Abstract Objective Reviewed literature suggests that individuals with Posttraumatic Stress Disorder (PTSD) demonstrate cognitive deficits in attention, learning/memory, and executive functions. Less is known regarding the relationship between sleep disturbance and language abilities among individuals with PTSD. We hypothesized that subjective perceptions of PTSD-related sleep disturbance would impact language generativity in Veterans with PTSD. Methods 38 individuals (mean age = 46.58, SD = 13.55; 10% female) were administered a brief neurocognitive battery including measures of verbal generativity [i.e., Delis-Kaplan Executive Function System: Verbal fluency subtest], PTSD symptoms (i.e., clinically significant PTSD = > 35 on the PTSD Checklist for DSM-IV), self-report measures of sleep quality (Pittsburgh Sleep Quality Inventory; PSQI), and PTSD-related sleep disturbances (PSQI – Addendum for PTSD). All participants had a history of mild traumatic brain injury (mTBI). An analysis of covariance was used to assess the contribution of PTSD-related sleep disturbance on verbal fluency in Veterans with PTSD. Post-hoc analyses were conducted. Results Those without PTSD performed better on letter fluency than those with PTSD (p=.019). There was no significant effect of PTSD (presence or absence) on letter fluency performance after controlling for subjective sleep quality, F(1, 35) = 1.43, p = .239. Follow up analyses failed to show any associations between PTSD and other cognitive measures. Conclusions PTSD related sleep disturbance accounts for a significant portion of the variance in the relationship between PTSD and verbal generativity. Individuals with a history of mTBI and current PTSD symptoms, may have worse verbal generativity but is partially accounted for by PTSD related sleep disturbance.

Psychometric properties of the International Trauma Questionnaire (ITQ) examined in a Norwegian trauma-exposed clinical sample

ABSTRACT Background The International Trauma Questionnaire (ITQ) is a self-report measure for post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD), corresponding to the diagnostic criteria in the International Classification of Diseases, 11th Revision (ICD-11). A 12-item version of the ITQ based on samples from English-speaking countries has been presented, and the wider generalizability to other languages needs to be examined. Objective The current study examines the psychometric properties of scores from a longer, preliminary 22-item version of the ITQ and the current reduced 12-item version by means of generalizability theory (G-theory) and confirmatory factor analysis (CFA). Method The 22-item version of the ITQ was translated into Norwegian and administered to patients in two trauma treatment trials (total N = 202). A generalizability study was used to investigate the psychometric properties of scores reflecting CPTSD. G-theory was also used to investigate alternative measurement designs to optimize the sufficient number of items that provide acceptable generalizability and dependability of scores. Model fit to the theoretical factor structure was then examined by CFA, both for the 22-item version and for the 12-item version of the ITQ. Results The two subscales negative self-concept and relational disturbances had acceptable generalizability coefficients. We found substantial measurement error related to affective dysregulation, mainly attributable to affective hyperactivation. A latent factor structure model with two separate affective dysregulation factors: hyperactivation and deactivation, represented the data well in the 22-item version. The proposed confirmatory structure model for the 12-item short form did not converge in the CFA. Conclusion This study supports the applicability of the ITQ in a non-English-speaking country and provides support for the validity of the Norwegian translation. Further research is needed to improve the psychometric properties of the affective dysregulation subscale.

Resilience, Trauma, and Cultural Norms Regarding Disclosure of Mental Health Problems among Foreign-Born and US-Born Filipino American Women

Resilience refers to a set of personal qualities and abilities that allow an individual to confront challenges, risks, or traumatic experiences in an integrated manner and to thrive in the face of significant adversities. This cross-sectional study explores resilience, posttraumatic stress disorder (PTSD), and family norms with disclosure of mental health problems (FNAD) in a sample of 182 Filipino American women (FAW). Participants completed survey measures of resilience, PTSD, and FNAD and open-ended questions about beliefs and reasons for (not) disclosing mental health problems outside the family. Previous research found that the rates of psychological trauma and depression among FAW are higher than those in other Asian ethnic groups, which makes it necessary to investigate the protective characteristic of resilience among FAW. According to our results, foreign-born FAW had a significantly lower PTSD and greater resilience as compared to their US-born counterparts. A significant negative relationship between PTSD and resilience was observed only among foreign-born FAW. We also found a conditional moderating effect of FNAD on the negative relationship between resilience and PTSD. The results of our qualitative analysis of the participants’ responses to the open-ended questions of the survey showed that FAW’s family norms of nondisclosure are related to the cultural value of “saving face,” a salient cultural construct among Asian family members. Results suggest that protective properties of resilience against PTSD are influenced by cultural factors, such as FNAD. Taken together, our findings underscore the importance of considering the impact of collectivistic cultural values (e.g., FNAD) in future research on resilience among Asian Americans.

The Reliability and Validity of the Post-Traumatic Stress Disorder Checklist (PCL) in the Earthquake-Stricken Population of Kermanshah, Iran

Background: The post-traumatic stress disruption checklist (PCL) is a reliable self-assessment measure for post-traumatic stress disorder (PTSD). Recently, the PCL has been updated based on the DSM-5 criteria for PTSD Objectives: The present study aimed to determine the psychometric properties and diagnostic capability of the PCL as a screening tool in an earthquake-stricken population in Kermanshah, Iran. Methods: This cross-sectional study was conducted on 200 injured earthquake victims in Sales and Javanrud counties. The subjects were selected via purposive sampling. The PCL was translated into Kurdish (Surani), and trained interviewers run the translated version for 200 individuals manifesting the symptoms of post-earthquake stress in the earthquake-stricken cities of Javanrud and Sales located in Kermanshah province. After two weeks, 100 participants were randomly selected, and the questionnaire was completed again. Results: The internal consistency of the PCL (α = 85%) was indicative of the validity of the checklist. The Youden’s index with the cutoff point of 23 was considered optimal for the PCL tool. The diagnostic values of sensitivity and specificity were estimated at 0.82 and 0.81, respectively (P < 0.001). In addition, the test-retest results were equal after two weeks (α = 87%), indicating the high reliability of the checklist. Conclusions: According to the results, the PCL is a sensitive and accurate tool for assessing the status of PTSD in disaster victims and accidents and could be used in the screening of PTSD in the health monitoring programs for these victims.

Legal regulation of organization and provision of rehabilitation assistance to anti-terrorist operation/joint forces operation participants

Purpose of the study. Investigate the current legal mechanisms for organizing and providing rehabilitation assistance to participants and victims of the armed conflict in the eastern regions of Ukraine.
 Materials and methods. To achieve these goals, a standard methodological apparatus for scientific research was used: bibliosemantic, for the analysis of periodical literature, and content analysis, for the analysis of legal documents.
 Results. As stated in the regulations, one of the main responsibilities of the state is to ensure the social protection of participants in the armed conflict in the east of the country. To fulfill this function, a number of laws and regulations have been enacted at the legislative levels, which are constantly being revised to improve social, medical and psychological care for participants in the joint force operation (anti-terrorist operation) and its victims. Comprehensive assistance to disabled military personnel and combatants includes statutory guarantees and procedures for their rehabilitation and adaptation. This list includes medical rehabilitation (provision of medical care, including prosthetics and orthoses, provision of technical means of rehabilitation); psychological rehabilitation; social rehabilitation; vocational rehabilitation.
 Conclusions. In Ukraine, there is a welldeveloped legal regulation of the process of providing rehabilitation assistance to participants in the armed conflict in the eastern regions of Ukraine. Organizational mechanisms for rehabilitation are constantly being improved: the International Classification of Functioning, Restriction of Life has been introduced; qualification characteristics of rehabilitologists and rehabilitation specialists, occupational therapists, physical therapy assistants and occupational therapists have been developed. It has been established that there are no unified protocols for medical rehabilitation in Ukraine: only a protocol of measures for post-traumatic stress disorder has been developed. A «road map» for medical care, reparative treatment and rehabilitation measures in health care facilities is available and applicable.

Bidirectional relationship of posttraumatic stress disorder (PTSD) symptom severity and alcohol use over the course of integrated treatment.

Posttraumatic stress disorder (PTSD) and alcohol use disorder commonly co-occur. Little is known about how symptoms of one affect subsequent week symptoms of the other during the course of integrated treatment for both disorders. The sample included 107 veterans who were randomized to receive either Concurrent Treatment of PTSD and Substance Use Disorder Using Prolonged Exposure (COPE; an exposure-based trauma focused treatment) or Seeking Safety (SS; a present-focused coping skills-based treatment) and completed measures of PTSD and alcohol use at every other session. Multilevel models estimated the prospective associations between PTSD and alcohol use during treatment. Results indicated that greater PTSD symptom severity was associated with greater future alcohol use (b = 0.20, p = .024), and greater alcohol use was associated with greater future PTSD symptom severity (b = 0.13, p = .003). The effect size for PTSD symptoms to future alcohol use was larger than the reciprocal relationship. When using lagged PTSD severity to predict future drinking, results revealed that clinically significant differences in PTSD severity levels were associated with comparably large differences in drinking. Treatment condition did not moderate the effect of PTSD symptom severity on alcohol use (or the reciprocal relationship). Findings lend support to the mutual maintenance model of addiction. Integrated treatments that treat both PTSD and alcohol use may be preferential to sequential model of care where individuals are expected to achieve abstinence or reduced use prior to receiving trauma-focused treatment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

High Rates of Mental Health Disorders in Civilian Employees Working in Police Organizations.

Working in a police organization often involves being exposed to potentially traumatic events and stressful circumstances regardless of occupation or rank. Police mental health is a public health concern, but the mental health of civilian employees working in police organizations has been much less studied. The current study aims to compare the frequency of mental health conditions in both police officers and civilians. This was evaluated by measuring mean scores on several mental health screening tools including scales to determine symptom severity for posttraumatic stress disorder (PTSD) with the PTSD Checklist – PCL-5, depression with the Patient Health Questionnaire-9 (PHQ), general anxiety with the Generalized Anxiety Disorder 7-item scale (GAD-7), and alcohol use with the Alcohol Use Disorders Identification Test (AUDIT). The total potential population was 1,225 civilian employees and 3,714 police officers, of which 513 (10%) participated. Of these, 201 (16%) were civilians, and 312 (8%) were police officers (p<0.001). In the study population, 26% screened positive for any mental health disorder. Somewhat surprisingly, we found significantly more civilians (32.8%) than police officers (22.7%) met diagnostic criteria. We also found that civilian participants had higher mean scores in measures of PTSD, anxiety, and depression, although only for depression did this reach statistical significance. Civilians were 1.7 times more likely to screen positive for depression compared to police officers, a statistically significant difference. In contrast, police officers demonstrated statistically higher scores for alcohol use than civilians. One limitation of this study is that the data reflects responses from only a minority of the overall population and, therefore, may not accurately reflect the frequency of mental health issues in the total police organization including civilian employees. Nonetheless, the results strongly suggest that the mental health of all employees can be negatively impacted by working in a police environment, and this is important given the growing number of civilians employed within police organizations. These findings support initiatives aimed at destigmatizing mental health disorders, improving stress management, and increasing access to mental health care on an organization-wide basis, and not just limited to front-line police officers.

Prevalence and comorbidity of the ICD-11 and DSM-5 for PTSD caseness with previous diagnostic manuals among the Japanese population

ABSTRACT Background: The diagnostic criteria for posttraumatic stress disorder (PTSD) differ between DSM-5 and ICD-11, which may affect the estimation of prevalence. Objective: To investigate the concordance of ICD-11 and DSM-5, as compared to ICD-10 and DSM-IV, regarding PTSD caseness among Japanese people who had experienced different potentially traumatic events. In addition, we estimated the comorbidity with major depressive disorder and generalized anxiety disorder according to these four diagnostic manuals. Method: A web-based survey (n = 6,180) was conducted from November 2016 to March 2017. Participants completed the PTSD Checklist for DSM-5, and other standardized measures of PTSD, depression, and anxiety. Results: The prevalence of PTSD caseness according to ICD-11 was significantly lower as compared to DSM-IV, DSM-5, and ICD-10. Cohen’s kappa between DSM-5 and ICD-11 was 0.79, indicating substantial agreement. Comorbidity with depression was significantly higher in unique DSM-5 cases than in unique ICD-11 cases. Unique DSM-5 PTSD cases were significantly stronger functionally impaired than unique ICD-11 PTSD cases. Conclusions: Although requiring fewer items, the ICD-11 showed substantial agreement with DSM-5 regarding PTSD caseness. The lower comorbidity rates in unique cases may support the concept of the ICD-11 which intends to reduce comorbidity by identifying the core elements of PTSD.

Factor structure of posttraumatic stress disorder (PTSD) in Australian Vietnam Veterans: Confirmatory factor analysis of the Clinician-Administered PTSD Scale for DSM–5

Introduction: The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5) brought a change to the symptom clusters of posttraumatic stress disorder (PTSD). In line with the DSM–5 changes, an updated version of the Clinician-Administered PTSD Scale (CAPS–5) was released. The CAPS–5 is considered to be the gold-standard measure of PTSD; however, examinations of the psychometric properties and optimal factor structure of this scale are underrepresented in PTSD studies. Methods: This study used confirmatory factor analysis (CFA) to assess the factor structure of the CAPS–5 using a sample of 267 male Australian Vietnam Veterans. Models drawn from the PTSD CFA literature were used to test the underlying dimensions of PTSD: the four-factor DSM–5 model, six-factor externalizing behaviour and anhedonia models, and seven-factor hybrid model. Results: The results found that the DSM–5 model showed slightly less than adequate fit (comparative fit index [CFI] = 0.90, Tucker–Lewis index [TLI] = 0.88, root mean square error of approximation [RMSEA] = 0.064), however, other models showed acceptable fit. The anhedonia model provided a significantly better fit than the other models (CFI = 0.92, TLI = 0.90, RMSEA = 0.059). Discussion: Overall, the results supported the anhedonia model. This result may indicate that the underlying dimensions of PTSD in Australian Vietnam Veterans may best be represented by six distinct factors.

Predictors of positive and negative post-traumatic psychological outcomes in a sample of Iranian cancer survivors.

Objectives This study aimed to identify predictors of positive and negative post-traumatic psychological outcomes within a sample of Iranian cancer survivors. Methods In this cross-sectional research, 300 (167 females; age M=53.00, SD=27.57) cancer survivors (breast cancer, leukaemia, colorectal cancer) were recruited from oncology outpatient clinics in Iran. Participants completed measures of post-traumatic stress disorder (PTSD), post-traumatic growth (PTG), cognitive processing, attentional biases, and autobiographical memory specificity. Results Using partial least square structural equation modelling, it was found that the proposed model was capable of predicting PTSD and PTG. Negative attentional biases were significantly associated with PTSD symptoms, but were not significantly associated with PTG. In contrast, memory specificity and positive attentional biases tended to be associated with PTG, but were not significantly associated with PTSD symptoms. Second, negative cognitive processing was significantly associated with PTSD symptoms, while positive cognitive processing was significantly associated with PTG. Finally, there was support for indirect pathways between positive cognitive tendencies and PTG through positive cognitive processing, while there were indirect pathways between negative habitual cognitive tendencies and PTSD symptoms through negative cognitive processing. Conclusions Our findings support growing evidence for differential trajectories to PTG and PTSD symptoms in cancer. Such cognitive factors may be important therapeutic targets in psycho-oncology interventions. Statement of contribution What is already known on this subject? The diagnosis of cancer and its subsequent treatment can result in symptoms of post-traumatic stress disorder (PTSD). Positive changes and psychosocial growth (post-traumatic growth; PTG) are also common as a result of patients' experience of cancer. What does this study add? This study identified predictors of positive (PTG) and negative trauma (PTSD) outcomes within a sample of Iranian cancer survivors (N=300). General habitual cognitive tendencies (memory specificity, attentional biases) were associated with cognitive processing, which in turn contributed to psycho-traumatic adaption. There was support for indirect pathways between positive cognitive tendencies and PTG through positive cognitive processing, while there were indirect pathways between negative habitual cognitive tendencies and PTSD symptoms through negative cognitive processing.

Peer support during in vivo exposure homework to reverse attrition from prolonged exposure therapy for posttraumatic stress disorder (PTSD): description of a randomized controlled trial

BackgroundEffective treatments for posttraumatic stress disorder (PTSD) (e.g., prolonged exposure (PE); cognitive processing therapy (CPT)) exist and are widely adopted by the Departments of Veterans Affairs (VA) and Defense (DoD). Unfortunately, dropout from these treatments regularly exceeds 30%. However, in a recent survey of patients who dropped out of PE, approximately half indicated a greater likelihood of completion if a peer who had completed treatment were available to help with the in vivo exposure homework.MethodsWe will use a between-groups randomized controlled design with repeated assessment at baseline, post treatment, and 3- and 6-month follow-up across measures of PTSD, depression, and functioning with 150 veterans who have indicated that they intend to drop out of treatment. Participants will be randomly assigned to one of two PE + Peer Support conditions: (1) a peer will offer support directly during in vivo exposure homework for 3–4 weeks; vs (2) a peer will call weekly for 3–4 weeks to offer general support and to check in on treatment progress.DiscussionThe present study was designed to test the hypothesis that dropout from exposure-based PTSD treatment may be mitigated by using peers as support agents directly during PE in vivo homework experiences. Specifically, we intend to determine: whether patients who have dropped out of PE and are offered the “in vivo peer” adjunctive component to PE therapy will (1) return and complete treatment and (2) evince reduced PTSD symptomatology, compared to the same PE treatment, but with general peer support more reflective of current VA practices.Trial registrationThis study protocol is approved and information is available at ClinicalTrials.gov, ID: NCT03485391. Registered on 2 April 2018.

Multidirectional Pathways between Attachment, Mentalizing, and Posttraumatic Stress Symptomatology in the Context of Childhood Trauma

Introduction:Exposure to traumatic stressful events in childhood is an important risk factor for the development of posttraumatic symptomatology. From a mentalization-based developmental perspective, childhood adversity can affect attachment in children and may result in insecure attachment and impaired mentalizing abilities, which increase the lifetime risk for psychopathology. The present cross-sectional study examined the potential mediating role of attachment insecurity and impaired mentalizing on the relationship between childhood trauma and posttraumatic symptomatology. Method: Adults who had experienced childhood neglect and abuse (n = 295, 184 patients with personality disorder and 111 community controls) completed self-report measures of posttraumatic stress disorder (PTSD) symptoms, dissociative experiences, adult attachment insecurity, and mentalizing. Results: Structural equation modelling results revealed that attachment insecurity together with lower mentalizing mediated the link between childhood trauma and PTSD symptoms, and lower mentalizing mediated the link between childhood trauma and dissociative experiences. Conclusion: The findings show that attachment insecurity and lower mentalizing play significant mediating roles in the reporting of posttraumatic symptomatology among survivors of childhood abuse and neglect, with treatment implications for mentalization-based therapy as beneficial for individuals with a history of childhood trauma.

Inflammation and Trauma-Related Psychopathology in Syrian and Iraqi Refugees.

Refugees experience high rates of post-traumatic stress disorder (PTSD), anxiety, and depression due to exposure to civilian war trauma and forced migration. Inflammatory products may offer viable biological indicators of trauma-related psychopathology in this cohort, promoting rapid and objective assessment of psychopathology. Incoming Syrian and Iraqi refugees (n = 36) ages 18–65 completed self-report measures of PTSD, anxiety, and depression and provided saliva samples during an assessment at a primary care clinic within the first month of resettlement in the United States. Interleukin 1β (IL-1β) and C-reactive protein (CRP) differentially correlated with symptom severity by domain, and there was a non-significant trend for sex moderating the relation between inflammation and PTSD symptoms. Our findings show unique relations between trauma-related psychopathology and inflammation. There is a need for further research in diverse ethnic cohorts with differential trauma exposures for inflammation to be considered a biological indicator of psychopathology.