Treatment Of Posttraumatic Stress Disorder Research Articles

Early-stage randomised controlled trial of therapist-supported online cognitive therapy for post-traumatic stress disorder in young people.

Effective face-to-face treatments for Post-Traumatic Stress Disorder (PTSD) are available, but most young people with PTSD do not receive effective treatment. Therapist-supported online Cognitive Therapy has the potential to improve accessibility of effective treatment. This early-stage trial gathered data on the feasibility, acceptability, and initial signal of clinical efficacy of a novel online Cognitive Therapy program for young people with PTSD. A two-arm, parallel-groups, single-blind, early-stage feasibility RCT compared online Cognitive Therapy to a waitlList condition. Participants were N = 31 adolescents (12-17 years-old) with a diagnosis of PTSD, randomised in a 1:1 ratio using minimisation. Thresholds for progression to a larger trial were set a priori for recruitment rate, data completeness, and the initial signal of clinical efficacy. The primary clinical outcome was PTSD diagnosis at 16 weeks post-randomisation. Secondary clinical outcomes were continuous measures of PTSD, depression, and anxiety at 16 weeks; and at 38 weeks in the online Cognitive Therapy arm. All pre-determined feasibility thresholds for progression to a larger trial were met. We recruited to target at a rate of 1-2 participants/month. No patient dropped out of therapy; 94% of all participants were retained at 16 weeks. At 16-weeks, the intention-to-treat (ITT) effect adjusted odds ratio was 0.20 (95% CI, 0.02, 1.42), indicating that the odds of meeting PTSD caseness after online therapy were 80% lower than after the waitlist (10/16 participants met PTSD caseness after therapy compared to 11/13 after WL). Effect-size estimates for all secondary clinical outcomes were large-moderate; improvements were sustained 38 weeks after online Cognitive Therapy. Therapist-supported online Cognitive Therapy for PTSD is acceptable to young people and has potential for meaningful and sustained clinical effects. A larger trial appears feasible to deliver. Further work is needed to refine the intervention and its delivery and to evaluate it in a larger confirmatory trial.

Hypnosis applications to the treatment of posttraumatic stress disorder

ABSTRACT Current evidence-based therapies considered efficacious for posttraumatic stress disorder (PTSD) include Prolonged Exposure Therapy (PE), Cognitive Processing Therapy (CPT), Eye Movement Desensitization Reprocessing (EMDR), and medication treatments. Hypnosis, one of the first mind-body therapies known to Western medicine, has been used for mind-body problems such as conversion reactions, medication-less anesthesia, and wound healing. Because PTSD is a mind-body problem, hypnosis seems especially suited for its treatment. Hypnosis is a state-based treatment that can move PTSD patients into a state of calm, downregulate their emotional reactivity, and facilitate altering maladaptive beliefs. Combined with cognitive behavioral therapy (CBT) approaches, hypnosis may magnify their effects. In this article, we present hypnotic techniques applicable to PTSD based on the PTSD symptom clusters they treat. We describe the goals, similarities, and differences between hypnosis and mindfulness, Dialectical Behavioral Therapy, and Acceptance and Commitment Therapy. We describe how adding hypnosis to PTSD treatment protocols such as PE and CPT boosts their impact. We encourage the use of hypnotic techniques which can enhance the therapeutic palette of the CBT practitioner treating PTSD.

Cognitive Processing Therapy for Posttraumatic Stress Disorder in Japan

Cognitive processing therapy (CPT) is an evidence-based treatment for posttraumatic stress disorder (PTSD). However, there is little evidence on the efficacy of CPT in East Asia. To evaluate whether CPT is effective in treating PTSD among outpatients in a Japanese medical setting. This randomized clinical trial used a 16-week, single-center, assessor-blinded, parallel-group superiority design to examine the efficacy of CPT in conjunction with treatment as usual (CPT-TAU) vs waiting list with TAU (WL-TAU) from April 2016 through December 2022. The trial included adult patients with PTSD at a national psychiatric referral hospital in Tokyo, Japan. Analysis was based on intention to treat and per protocol and was performed from February 1 to April 30, 2024. Participants were randomized 1:1 to CPT-TAU (n = 29), which consisted of 12 weekly individual CPT sessions, or WL-TAU (n = 31), which consisted of clinical monitoring and/or pharmacotherapy. The primary outcome was the Clinician-Administered PTSD Scale (CAPS-5) score for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) at 17 weeks. Secondary outcomes included self-reported PTSD symptoms assessed by the PTSD Checklist-5 and responder status at 17 weeks. Adverse events were evaluated using the Japanese version of the Common Terminology Criteria for Adverse Events, version 4.0. Among 60 eligible participants (all included in the intention-to-treat analysis), mean (SD) age was 36.9 (9.9) years; 54 (90.0%) were women. The CPT-TAU group showed a mean (SE) reduction in CAPS-5 scores of 14.00 (1.92) points, with a low dropout rate (2 of 29 [6.9%]). Patients in the CPT-TAU group showed superiority in all secondary and other outcomes. The mean change difference was observed in depression (8.83; 95% CI, 6.00-11.66), suicidal ideation (6.73; 95% CI, 1.25-12.22), disability (8.16; 95% CI, 3.90-12.43), clinical global impression (0.84; 95% CI, 0.41-1.26), and loss of principal PTSD diagnosis (59.09; 95% CI, 37.19-81.00). There were no serious adverse events in the CPT-TAU group and 3 serious adverse events in the WL-TAU group during the intervention period. In this randomized clinical trial of CPT-TAU vs WL-TAU, CPT was superior in reducing PTSD symptoms. These results strengthen the evidence for use of CPT in East Asian populations. Umin.Uc.Jp/Ctr Identifier: UMIN000021670.

Augmenting trauma-focused cognitive behavior therapy for post-traumatic stress disorder with memory specificity training: a randomized controlled trial.

Although trauma-focused cognitive behavior therapy (TF-CBT) is the recommended treatment for post-traumatic stress disorder (PTSD), up to one-half of patients do not respond to this intervention. There is an urgent need to develop new strategies to improve treatment response. Training people to recall specific positive memories may augment treatment gains in TF-CBT. We conducted a controlled trial in Australia with current or former first responders (including police, firefighters and paramedics) with PTSD, who were randomized on a 1:1 basis to 12 weekly 90-min individual sessions of either TF-CBT combined with memory specificity training (TF-CBT/MT) or TF-CBT alone. The primary outcome was change in PTSD severity independently assessed at baseline, post-treatment, and six months after treatment (primary outcome timepoint). Secondary outcomes included measures of depression, trauma-related cognitions, alcohol use, and quality of life. Between October 2021 and May 2023, fifty participants were randomized to TF-CBT/MT, and fifty to TF-CBT alone. Most participants were males (71.0%) and the mean age was 46.8±9.9 years. At the 6-month assessment, participants receiving TF-CBT/MT showed a greater reduction of PTSD severity than those randomized to TF-CBT alone (mean difference: 9.2, 95% CI: 3.2-15.1, p=0.003), indicating a large effect size (0.9, 95% CI: 0.1-1.6). Participants receiving TF-CBT/MT also had greater reductions in alcohol use (mean difference: 5.3, 95% CI: 1.5-9.2, p=0.007; effect size: 0.8, 95% CI: 0.2-1.4) and self-blame cognitions (mean difference: 0.8, 95% CI: 0.2-1.4, p=0.008; effect size: 0.5, 95% CI: 0.1-0.9). These data suggest that memory specificity training adds significantly to the effect of standard TF-CBT in reducing PTSD severity. This approach can offer a simple and easy to implement strategy to augment treatment for PTSD patients.

The Cost of Pharmacological Treatments for Post-Traumatic Stress Disorder in a French Patient Sample: A Health Economic Cohort Study

The Cost of Pharmacological Treatments for Post-Traumatic Stress Disorder in a French Patient Sample: A Health Economic Cohort Study

Compassion-focused group therapy as a transdiagnostic treatment for comorbid eating disorders and posttraumatic stress disorder: a pilot feasibility and acceptability study

ABSTRACT Objective Trauma and posttraumatic stress disorder (PTSD) commonly co-occur with eating disorders (EDs), however, evidence-based treatments for individuals who experience these conditions concomitantly are limited. This pilot study aimed to investigate the feasibility and acceptability of a 10-week outpatient compassion-focused group intervention to treat comorbid EDs among individuals with current PTSD symptoms. Method Five women with an ED and PTSD symptoms (M = 33.40years, SD = 15.61) participated. Primary outcomes of interest were ED symptoms, PTSD symptoms and self-compassion.Participants provided qualitative feedback via semi-structured interviews. Results Participation was high, and all participants completed the programme. The group modality was viewed positively, and participants described increased engagement with compassion, greater ability to recognise and regulate emotions and reduced self-criticism. From baseline to endpoint, four participants reported reliable change on PTSD symptoms, and three on self-compassion. Three participants reported clinically significant change on PTSD symptoms and self-compassion. No reliable or clinically significant change was reported on ED symptoms. Conclusions This study provides preliminary evidence that compassion-focused group interventions may be an acceptable and feasible treatment for people with EDs and comorbid PTSD symptoms. Research to assess long-term symptom change and refinement of content and delivery to optimise outcomes, is warranted.

Effects of a mobile mindfulness smartphone app on posttraumatic stress disorder symptoms and alcohol use problems for veterans: A pilot randomized controlled trial.

Veterans returning from deployment have high rates of posttraumatic stress disorder (PTSD) and co-occurring alcohol use disorder (AUD). Current treatments for PTSD and AUD report high dropout rates, and many veterans report alcohol misuse to cope with symptoms of PTSD. The present study is a pilot randomized controlled trial in which veterans (N = 201) were randomized to receive a mobile mindfulness-based intervention enhanced with brief alcohol intervention content (Mind Guide) or an active stress management program. To be eligible for the study, veterans had to have served after September 11, 2001 (post-9/11 veteran) and screen positive for PTSD and AUD. All participants were asked to complete a baseline and four monthly follow-up assessments (two during treatment phase and two posttreatment phase). Primary outcomes were PTSD symptoms, frequency of alcohol use, and alcohol use consequences. Engagement with Mind Guide was excellent (averages of over 31 logins and 5 hr of app usage). Those assigned to Mind Guide showed significant reductions in PTSD symptoms (d = -0.36; 16-week follow-up). No differences emerged for frequency of alcohol use (d = -0.12; 16-week follow-up) or consequences (d = -0.12; 16-week follow-up). Mind Guide may be a valuable adjunct to more intensive in-person PTSD treatment by facilitating interest in services, integration into care, and/or sustainment of posttreatment improvements. Further development of Mind Guide may enhance efficacy at reducing alcohol use and consequences. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Posttraumatic Stress Disorder Is Associated With Endothelial Dysfunction in Women With HIV.

HIV induced endothelial dysfunction (ED) contributes to cardiovascular disease (CVD) in women with HIV (WWH). Although psychosocial stress has been implicated in the development of CVD in HIV, its impact on ED in WWH remains unknown. The authors hypothesized that posttraumatic stress disorder (PTSD) and HIV interact to contribute to ED in WWH. We enrolled 87 women from the Women's Interagency HIV Study in Atlanta, Georgia, who reported previous trauma and completed the PTSD Checklist: Civilian Version (PCL-C), which assesses PTSD symptom severity (PCL-C score) and PTSD status (PCL-C >44). Brachial artery flow-mediated dilation (FMD) was measured to assess endothelial function. The impact of PTSD, HIV, and their interaction on endothelial function was evaluated using linear regression models adjusted for demographics, CVD risk factors, depressive symptoms, and statin use. Overall, 55 (63.2%) had HIV, 24 (27.5%) had PTSD, and 13 (14.9%) had both. Those with PTSD were more likely to smoke (18 [75%] vs 28 [44.4%], P=0.02) and have depressive symptoms (14 [58.3%] vs 18 [28.6%], P=0.02) than those without PTSD. In adjusted models, the HIV-PTSD (severity and status) interaction effect on FMD was significant (P=0.01). Both PTSD severity (β per 10-point increase:-0.72% [95% CI: -1.22 to-0.21], P=0.01) and PTSD status (β:-2.51% [95%CI: -4.21 to-0.77], P=0.01) were independently associated with lower FMD in WWH but not in those without HIV. PTSD is independently associated with ED in WWH. Whether treatment for PTSD improves ED and CVD in WWH needs further study.

Centering prayer in the treatment of Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event. A significant proportion of sexual assault survivors develop PTSD. Research indicates that 75% of sexual assault survivors meet the criteria for PTSD one month after the assault. PTSD treatment combines psychotherapy, medication, hypnosis, meditation, and emerging therapies to help individuals manage trauma-related symptoms and regain control over their lives. Nonetheless, despite advances in PTSD treatments, there remains a pressing need for new approaches to address gaps in current care. We recently demonstrated that centering praying (CP) is useful in treating Parkinson’s disease. Objective: To treat female patients complaining of PTSD due to sexual abuse or rape with CP. Methods: We will develop a randomized controlled trial studying five females from 18 to 35 years old who complain of PTSD due to sexual abuse or rape. Five women paired in an age without any neurological, psychiatric, or systemic disorder will be the control group. Patients will be randomly selected blindly according to the DSM-5 criteria by two neurologists. Comorbid major psychiatric disorders, substance abuse, or severe medical conditions will be excluded. Each patient and the control subjects will be studied by computer tomography to exclude any neurological condition. Outcome Measures will be the PTSD Checklist for DSM-5 (PCL-5) and the quantitative computer tomography (QEEGt). Secondary outcomes will be the PHQ-9 (Patient Health Questionnaire-9) to assess depression specifically, Results: Demographic data showed a significant improvement in patients’ clinical condition assessed by PLC-5 and PHQ-9 after CP treatment. QEEGt records demonstrated a stable pattern in all five patients: an increase of theta activity (4–8 Hz) in the left parietal-temporal-occipital areas of PTSD patients. Figure 3 shows a grand average of the five patients, demonstrating an important augmentation of theta activity in this region. Z-values in the QEEGt map show a progressive decrement of the statistically significant Theta increment above our normative data as long as the CP treatment progresses. Conclusion: We conclude that CP appears to offer a distinct and accessible pathway for managing PTSD, promoting emotional regulation, resilience, and a sense of inner peace rooted in spirituality.

Systematic review and meta-analysis of propranolol in the prevention and treatment of post-traumatic stress disorder

ObjectiveThis systematic review and meta-analysis aim to comprehensively evaluate the efficacy of propranolol in the prevention and treatment of post-traumatic stress disorder (PTSD), with a focus on its improvement of core PTSD symptoms.MethodsA literature search was conducted across multiple databases (including PubMed, Cochrane, Web of Science, and Embase), with the search cutoff date in October 2024. The studies included randomized controlled trials (RCTs) investigating pharmacological treatments for PTSD. PTSD symptoms were assessed using standardized clinical scales, including the Clinician-Administered PTSD Scale (CAPS) and the PTSD Checklist (PCL). The primary outcome was the improvement in PTSD symptoms.ResultsSeven studies met the inclusion criteria for the meta-analysis. The studies showed low heterogeneity, with a chi-squared value of 2.56 (df = 6, p = 0.86) and I2 = 0%. The overall effect test indicated significant improvement in PTSD symptoms after propranolol intervention (Z = 2.32, p = 0.02). These findings suggest that propranolol has a statistically significant effect on reducing the severity of PTSD symptoms, with a moderate effect size according to Cohen’s criteria.ConclusionThis systematic review and meta-analysis provide preliminary evidence supporting the possible role of propranolol in alleviating PTSD symptoms. Future researches are needed to further clarify the therapeutic potential, mechanisms of action, and long-term safety of propranolol in PTSD treatment.

Physiology mechanisms of exercise for PTSD: a narrative review

In at-risk societies, the population of post-traumatic stress disorder (PTSD) incidence is gradually expanding from veterans to the general public. In the face of the high incidence of PTSD, exercise therapy, as an economical and maneuverable treatment, has not received the attention it deserves. In this paper, the literature on PTSD symptom improvement through comb-climbing exercise interventions found that performing long-term exercise can achieve significant improvement in PTSD symptoms by modulating the central nervous system, autonomic nervous system, and immune system at the physiological level. Aerobic exercise (running, walking) is beneficial to the central nervous system and immune system; anaerobic exercise positively affects the autonomic nervous system, including resistance or strength endurance training; yoga, which focuses on flexibility and balance training, has a positive effect on the immune system. Future research should explore the neutral and negative effects and mechanisms of exercise on PTSD interventions. Expand more empirical studies in special occupational populations. And implement longitudinal intervention studies with PTSD patients to gain an in-depth understanding of PTSD intervention effects.

Assessment of risks of post-traumatic stress disorder among Ukrainian military personnel as a component of public health preservation

The paper is focused on exploring the potential impact of Post-Traumatic Stress Disorder (PTSD) among combatants on the national public health system. It utilizes scientific statistical data on the prevalence of PTSD symptoms among military personnel who have participated in armed conflicts worldwide over the past 50 years. For a deeper analysis of PTSD's potential influence on Ukraine's public health system, the research examines scientific data on major somatic and mental health disorders triggered by PTSD among military personnel. The study highlights the association between PTSD in combatants and the development of comorbid conditions such as depression, substance dependency, diabetes, and cardiovascular diseases. PTSD is identified as a key risk factor that should be accounted for when planning medical and preventive measures for Ukraine's Defense Forces. The article also analyzes global trends in the declining quality of life among military personnel due to reduced material and functional capabilities. It provides data on the direct and indirect costs of treatment and rehabilitation for PTSD and its associated comorbidities. Furthermore, the article discusses PTSD's impact on self-actualization abilities, such as education, employment, job retention, and interpersonal communication. These effects, resulting from PTSD's disruption of various aspects of life, inevitably lead to negative consequences and a sharp decline in the quality of life for affected individuals.

Development of a guide for continuous positive airway pressure use - A good fit: Making continuous positive airway pressure work for you.

Obstructive sleep apnea (OSA) is highly prevalent in veterans with mental illnesses such as post-traumatic stress disorder (PTSD). Untreated OSA reduces the effectiveness of the treatment of PTSD. Treatment of OSA has been shown to reduce daytime sleepiness and symptoms of PTSD and depression. Continuous positive airway pressure (CPAP) therapy is the most effective treatment for OSA. A large number of veterans cannot tolerate CPAP therapy due to anxiety and PTSD symptoms. Positive airway pressure (PAP) NAP, a daytime sleep study for patients with anxiety about starting CPAP and exposure-based cognitive behavioural interventions are the mainstay for the management of CPAP intolerance. However, these options are not readily available to veterans in rural areas, who constitute about 40% of veterans registered in the South Texas Veterans Health Care System (STVHCS). After getting local IRB exemption, we surveyed thirty (30) veterans in the outpatient clinic setting who could not tolerate CPAP therapy to evaluate the need for a tool to improve CPAP adherence. We reviewed the literature and conducted focused group meetings with local and national experts. We also convened consumer groups and stakeholder meetings, including primary care, sleep medicine, and mental health providers. After a comprehensive evaluation process, we compiled a concise self-help guide combining principles of cognitive behavioural therapy using a behavioural hierarchy approach towards CPAP desensitization. This guide can be used by veterans independently at their homes to improve CPAP use. A printer-friendly version is available for download on the South Central Mental Illness, Research, Education and Clinical Center (SC MIRECC) and the South Texas Veterans Healthcare System (STVHCS) website. The guide will be provided to veterans during the initial CPAP setup and available in clinic waiting rooms throughout the system. Our guide will serve as an effective self-help tool to improve CPAP adherence. It may result in the improvement of various medical and psychiatric conditions.

On the Role of Epigenetic Modifications of HPA Axis in Post Traumatic Stress Disorder (PTSD) and Resilience.

Stress is a fundamental adaptive response mediated by the amygdala and Hypothalamus-Pituitary-Adrenal (HPA) axis. Extreme or chronic stress, however, can result in a multitude of neuropsychiatric disorders, including anxiety, paranoia, bipolar disorder (BP), major depressive disorder (MDD), and Post-Traumatic Stress Disorder (PTSD). Despite widespread exposure to trauma (70.4%), the incidence of PTSD is relatively low (6.8%), suggesting that either individual susceptibility or adaptability driven by epigenetic and genetic mechanisms are likely at play. PTSD takes hold from exposure to traumatic events, such as death threats or severe abuse, with its severity being impacted by the magnitude of trauma, it's frequency, and the nature. This comprehensive review examines how traumatic experiences and epigenetic modifications in hypothalamic pituitary axis (HPA), such as DNA methylation, histone modifications, non-coding RNAs, and chromatin remodeling, are transmitted across generations, and impact genes like FKBP5, NR3C1, BDNF, and SLC6A4. It also provides a comprehensive overview on trauma reversal, resilience mechanisms, and pro-resilience factors such as HATs/HDACs ratio, DHEA/Cortisol ratio, testosterone levels, and neuropeptide Y, thus highlighting potential therapeutic approaches for trauma-related disorders. The studies highlighted here underscore the narrative, for the first time, that the examination and treatment of PTSD and other depressive disorders must invoke a multitude of approaches to seek out the most effective and personalized strategies. We also hope that the discussion emanating from this review will also inform government policies directed towards intergenerational trauma and PTSD.

Transauricular vagus nerve stimulation in preventing post-traumatic stress disorder in emergency trauma surgery patients in China: a study protocol for a multicenter, double-blind, randomised, controlled trial

IntroductionThe incidence of post-traumatic stress disorder (PTSD) in emergency trauma surgery patients is 24%, emphasising the urgent need for effective early interventions and treatments. Transauricular vagus nerve stimulation (ta-VNS) modulates...

A meta-analytic review of cognitive processing therapy with and without the written account.

There are two versions of the Cognitive Processing Therapy (CPT) protocol: one that includes a trauma narrative and one that does not. Despite both versions being used in clinical practice, to date, there has not been a comprehensive comparison of posttraumatic stress disorder (PTSD) treatment outcomes associated with these two protocols. The current study is a meta-analytic review of 29 randomized controlled trials of CPT+A (k = 13) and CPT-C (k = 16) in which we investigated whether there are differences in treatment outcome effect sizes and treatment dropout between the two protocol versions. Sample type (military/veteran versus non-military/non-veteran) as a moderator was examined, given that less robust PTSD treatment outcomes have been typically observed in military and veteran samples. Meta-regression analyses revealed that there were no significant differences between the two CPT protocol versions in pre-post PTSD treatment effect sizes, t(26) = -0.743, p = .463. As expected, studies that enrolled a military or veteran sample reported an average smaller symptom reduction (g = 0.95) than studies that enrolled a non-military or non-veteran sample (g = 1.41), t(26) = 2.48, p = .019. There were also no significant differences between the two CPT protocols for treatment dropout, t(26) = 1.69, p = .104, or between studies enrolling military/veteran and non-military/non-veteran samples t(26) = -1.10, p = .282. The findings support the use of either CPT protocol in practice, but also demonstrate that veterans and service members may be less responsive to either CPT protocol than other trauma samples.

Assessment, Decision, Adaptation, Production, Topical Experts-Integration, Training, and Testing (ADAPT-ITT) Framework to Tailor Evidence-Based Posttraumatic Stress Disorder Treatment for People With HIV to Enhance Engagement and Adherence: Qualitative Results from a Feasibility Randomized Controlled Trial.

Individuals with co-occurring posttraumatic stress disorder (PTSD) and HIV are at high-risk for negative HIV-related outcomes, including low adherence to antiretroviral therapy, faster disease progression, more hospitalizations, and almost twice the rate of death. Despite high rates of PTSD in persons with HIV (PWH) and poor HIV-related health outcomes associated with PTSD, an effective evidence-based treatment for PTSD symptoms in PWH does not exist. This study aimed to describe the adaptation and theater testing of an evidence-based intervention designed for people with co-occurring PTSD and HIV. The Assessment, Decision, Adaptation, Production, Topical experts-integration, Training, and Testing (ADAPT-ITT) framework guided the formative process used to modify an evidence-based PTSD treatment (cognitive processing therapy; CPT) to meet the unique needs of PWH experiencing PTSD. With the integration of Life-Steps for Medication Adherence (Life-Steps), the adapted protocol (CPT-Life-Steps for integration of adherence; CPT-L) targeted HIV-related stigma and HIV medication adherence within a trauma-informed framework. Theater testing was completed with 7 participants to evaluate acceptability of CPT-L for PWH. The qualitative data (N=54 recordings) used to evaluate and adapt CPT-L emerged from individual interviews conducted with participants after each therapy session as well as exit interviews conducted at posttreatment data collection. After challenging stigma-related appraisals, participants expressed feeling less constrained by maladaptive thoughts. These shifts translated to increased self-efficacy with both HIV-related care and mental health. These results indicate that trauma-informed work with PWH should consider the impact of HIV on trauma-related stuck points, intersecting identities (including living with HIV), and challenging internalized stigma. Findings provide evidence that CPT-L is acceptable and effective in addressing internalized HIV stigma that impacts PTSD symptom maintenance and HIV treatment engagement. ClinicalTrials.gov; NCT05275842; https://clinicaltrials.gov/study/NCT05275842?id=NCT05275842&rank=1. RR2-10.1016/j.conctc.2023.101150.

Post-traumatic stress disorder: evolving conceptualization and evidence, and future research directions.

The understanding of responses to traumatic events has been greatly influenced by the introduction of the diagnosis of post-traumatic stress disorder (PTSD). In this paper we review the initial versions of the diagnostic criteria for this condition and the associated epidemiological findings, including sociocultural differences. We consider evidence for post-traumatic reactions occurring in multiple contexts not previously defined as traumatic, and the implications that these observations have for the diagnosis. More recent developments such as the DSM-5 dissociative subtype and the ICD-11 diagnosis of complex PTSD are reviewed, adding to evidence that there are several distinct PTSD phenotypes. We describe the psychological foundations of PTSD, involving disturbances to memory as well as to identity. A broader focus on identity may be able to accommodate group and communal influences on the experience of trauma and PTSD, as well as the impact of resource loss. We then summarize current evidence concerning the biological foundations of PTSD, with a particular focus on genetic and neuroimaging studies. Whereas progress in prevention has been disappointing, there is now an extensive evidence supporting the efficacy of a variety of psychological treatments for established PTSD, including trauma-focused interventions - such as trauma-focused cognitive behavior therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) - and non-trauma-focused therapies, which also include some emerging identity-based approaches such as present-centered and compassion-focused therapies. Additionally, there are promising interventions that are neither psychological nor pharmacological, or that combine a pharmacological and a psychological approach, such as 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. We review advances in the priority areas of adapting interventions in resource-limited settings and across cultural contexts, and of community-based approaches. We conclude by identifying future directions for work on trauma and mental health.

Trauma-focused evidence-based psychotherapy for post-traumatic stress disorder delivered via video telehealth in the Veterans Health Administration.

Trauma-focused evidence-based psychotherapy (EBP) is the recommended treatment for post-traumatic stress disorder (PTSD). During and after the COVID-19 pandemic, veterans began to initiate general mental health services delivered via video telehealth at high rates. Our goal in the current project was to describe the percentage as well as the demographic, military, and clinical characteristics of veterans receiving PTSD EBPs via video telehealth versus in-person. Using data from the VA electronic health record, we identified a national cohort of all-era veterans who received individual PTSD EBP between April 2022 and April 2023 (n = 24,447). We used multivariable hierarchical Bayesian logistic regression to model the probability of receiving at least 50% of their EBP care via video telehealth. In our sample, 74.4% of veterans who received PTSD EBP used video telehealth for at least one EBP session and 66.8% of veterans received at least half of their EBP sessions by video telehealth. Female veterans, younger veterans, and veterans with fewer mental health comorbidities were more likely to have received their PTSD EBP via video telehealth. Additional strong interaction effects for Black female veterans, Hispanic female veterans, female officer veterans, and Black officer veterans. Video telehealth delivery of PTSD EBPs was more common than in-person delivery of PTSD EBPs. Consistent with underlying trends in telehealth services, female veterans, and particularly female, racial/ethnic minority veterans were more likely to receive PTSD EBP via video telehealth. Future research designed to contextualize the observed differences in video telehealth delivery of PTSD EBPs should consider the role of social determinants of health.

Guilu Erxian Jiao remodels dendritic spine morphology through activation of the hippocampal TRPC6-CaMKIV-CREB signaling pathway and suppresses fear memory generalization in rats with post-traumatic stress disorder.

Guilu Erxian Jiao (GLEXJ) is a renowned traditional Chinese herbal formula used to tonify the kidney. It is employed to treat psychiatric disorders, and alleviate memory impairment, cognitive dysfunction, and behavioral disorders. Modern pharmacological studies have demonstrated GLEXJ's ability to significantly inhibit the fear response in post-traumatic stress disorder (PTSD) and facilitate the extinction of fear memory. However, the underlying pharmacological mechanisms remain elusive. Fear memory generalization, a fundamental characteristic of PTSD, remains poorly understood, and optimal pharmacological treatments are lacking. This study aimed to investigate GLEXJ's inhibitory effects on fear memory generalization in PTSD rats and elucidate its underlying mechanisms. PTSD rats were induced using the single prolonged stress and electrical stimulation (SPS&S) protocol and treated with GLEXJ or paroxetine (PRX). Fear memory generalization was assessed using a contextual fear memory test. Hippocampal dendritic spine morphology was analyzed using Golgi-Cox staining. The chemical composition of GLEXJ was determined using ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). Network pharmacology was employed to predict GLEXJ's therapeutic mechanism in PTSD treatment. Western blotting and immunofluorescence were used to measure indicators of the transient receptor potential channel 6 (TRPC6)-mediated calcium/calmodulin-dependent protein kinase IV-cAMP response element-binding protein (CaMKIV-CREB) signaling pathway. In vitro, TRPC6 was suppressed in rat adrenal pheochromocytoma (PC12) cells using lentiviral vectors, and phalloidin staining was employed to examine changes in Fibros actin (F-actin), elucidating the mechanistic effects of GLEXJ-containing serum. GLEXJ significantly mitigated fear memory generalization in PTSD rats, even with repeated stress exposure. It also alleviated abnormal hippocampal dendritic spine morphology. Network pharmacology analysis confirmed that GLEXJ was closely related to the Ca2+ signaling pathway in PTSD treatment. PTSD rats exhibited disrupted TRPC6-mediated CaMKIV-CREB signaling and impaired synaptic plasticity. GLEXJ upregulated TRPC6 expression, reactivated the CaMKIV-CREB pathway, and promoted synaptic remodeling. In vitro studies confirmed that TRPC6 suppression reduced F-actin levels while GLEXJ-containing serum increased TRPC6 expression and F-actin content. GLEXJ activates CaMKIV-CREB signaling by upregulating TRPC6 in the hippocampus of PTSD rats, leading to the positive modulation of dendritic spine morphology and synaptic remodeling. This mechanism contributes to the attenuation of fear memory generalization. Given the limitations of current PTSD treatments, these findings offer potential avenues for developing more effective therapeutic strategies.