Posttraumatic Stress Disorder Symptom Clusters Research Articles

A Network Analysis of Symptoms of Post-Traumatic Stress Disorder and Facets of Mindfulness

Post-traumatic Stress Disorder (PTSD) is a mental health concern impacting a large proportion of the population. There is a growing interest in mindfulness-based treatments for PTSD. However, some individuals with PTSD do not respond to treatment. Identifying factors that may provide a more precise treatment approach has the potential to enhance response. Network analysis is a data-driven methodology that has been used to suggest specific targets for treatment. To date, there has not been a network analysis examining the interrelation between PTSD symptoms and trait mindfulness. The current study is an exploratory analysis of N = 214 adults from a non-clinical sample who endorsed a Criterion A traumatic event and completed the PTSD Checklist for DSM-5 and the Five Facet Mindfulness Questionnaire. Both undirected and directed networks were generated to identify links between PTSD symptom clusters and the facets of mindfulness. Both networks highlighted the connection between the PTSD symptom cluster Alterations in Arousal and Reactivity and the Awareness facet of mindfulness; and the PTSD symptom cluster Negative Alterations in Cognitions and Mood with the Non-judging facet of mindfulness. Taken together, these findings provide further evidence that greater mindfulness is generally associated with lower PTSD symptoms. Importantly, the findings highlight Non-judgement and Awareness as facets that might warrant further investigation in the context of mindfulness-based treatment efforts for PTSD.

Randomized controlled trial of two internet-based written therapies for world trade center workers and survivors with persistent PTSD symptoms

Posttraumatic stress disorder (PTSD) remains prevalent among individuals exposed to the 9/11 World Trade Center (WTC) terrorist attacks. The present study compared an Internet-based, therapist-assisted psychotherapy for PTSD to an active control intervention in WTC survivors and recovery workers with WTC-related PTSD symptoms (n = 105; 75% syndromal PTSD). Participants were randomized to integrative testimonial therapy (ITT), focused on WTC-related trauma, or modified present-centered therapy (I-MPCT), each comprising 11 assigned written narratives. The primary outcome was baseline-to-post-treatment change in PTSD symptoms on the PTSD Checklist for DSM-5 (PCL-5). Secondary measures included PTSD symptom clusters, depressive/anxiety symptoms, functioning, and quality of life. A significant main effect of time was observed for the primary outcome (average “large” effect size improvement, d = 1.49). Significant and “moderate-to-large” main effects of time were also observed for all PTSD symptom clusters, depressive symptoms, quality of life, and mental health-related functioning (d range=0.62–1.33). Treatment and treatment-by-time interactions were not significant. In planned secondary analyses incorporating 3-month follow-up measures, ITT was associated with significantly greater reductions than I-MPCT in PTSD avoidance and negative alterations in cognitions and mood, anxiety, and mental health-related functioning. Both therapies significantly lowered PTSD symptoms, suggesting they may benefit hard-to-reach individuals with chronic WTC-related PTSD symptoms.

Quality of Life in Posttraumatic Stress Disorder: The Role of Posttraumatic Anhedonia and Depressive Symptoms in a Treatment-Seeking Community Sample

Posttraumatic stress disorder (PTSD) is associated with functional impairment and poor quality of life (QoL) across multiple domains, such as social functioning, occupational and educational attainment, physical health, and overall life satisfaction and wellbeing. Yet, there is limited evidence for which PTSD symptom clusters may be more strongly associated with functional impairment and decreased QoL. We used a seven-factor model of PTSD (re-experiencing, avoidance, negative alterations, anhedonia, externalizing, dysphoric arousal, and anxious arousal) to predict QoL using a latent regression model in a sample (N = 537) of adult patients participating in exposure-based PTSD partial hospitalization programs (PHP). QoL was measured by the Quality-of-Life Satisfaction Questionnaire—Short Form (Q-LES-Q-SF). Among posttraumatic symptoms, anhedonia emerged as the only significant predictor in the model (β = −8.60, SE = 3.02, p = 0.004), when controlling for depression scores. The overall model accounted for 40% of the variance in QoL. Depression was also significantly associated with QoL (β = −1.67, SE = 0.15, p < 0.001), controlling for PTSD symptoms. Our findings are congruent with prior research supporting the role of anhedonia and emotional numbing in functional impairment, yet differ in that other factors of PTSD (e.g., re-experiencing, avoidance, negative alterations) were not significant. Understanding which PTSD symptom clusters are more strongly associated with QoL may inform treatment approaches or allow clinicians to tailor treatments. We discuss implications for treatment and future research.

Associations of Posttraumatic Stress Disorder Symptom Clusters and Pain Interference in Post-9/11 Veterans: Exploring Sleep Impairment and Physical Activity as Underlying Mechanisms.

Posttraumatic stress disorder (PTSD) symptoms and pain are highly prevalent and comorbid, particularly in veterans, but mechanisms explaining their linkage remain unclear. The aims of this study were to determine: (1) whether sleep impairment and physical activity (PA) mediate relations between PTSD symptoms and pain interference (assessed both longitudinally and as residual change) and (2) the unique roles of each PTSD symptom cluster in those relationships. The present study is a secondary analysis of a longitudinal observational investigation of 673 post-9/11 veterans (45.8% women). Surveys were administered at baseline and 3-month and 6-month follow-ups. PTSD symptoms were significantly associated with pain interference longitudinally and worsening pain interference over time. Sleep impairment, but not PA, significantly mediated the relationship between PTSD symptoms and subsequent pain interference. Hyperarousal symptoms were found to be the primary driver of the relationship between PTSD symptoms and pain interference and re-experiencing symptoms were associated with change in pain interference via sleep impairment. Men and women did not differ on any of the study variables with the exception of PA. Findings underscore the importance of targeting sleep as a key modifiable health factor linking PTSD symptoms to pain interference in post-9/11 veterans.

Differential indirect effects of military sexual trauma on posttraumatic stress disorder symptom clusters via past-year intimate partner violence experiences.

Differential indirect effects of military sexual trauma on posttraumatic stress disorder symptom clusters via past-year intimate partner violence experiences.

Associations between International Trauma Questionnaire complex posttraumatic stress disorder symptom clusters and moral injury in a sample of U.K. treatment-seeking veterans: A network approach.

Complex posttraumatic stress disorder (CPTSD) and moral injury are receiving increasing empirical attention. The network approach offers a novel method to understand the association between such mental health constructs. The present study investigated: (a) the network structure of CPTSD symptom clusters according to the International Trauma Questionnaire to determine centrality (i.e., the most influential symptom cluster) and (b) the network structure of CPTSD symptom clusters and moral injury symptoms according to the Moral Injury Outcome Scale to determine bridge symptoms (i.e., the symptoms linking comorbid presentation of CPTSD and moral injury) within a clinical sample of veterans. Emotional dysregulation, avoidance, and interpersonal difficulties were found to be most central in the CPTSD network, and interpersonal difficulties, negative self-concept, and emotional dysregulation were found to be the strongest bridge symptoms in the CPTSD and moral injury network. The two networks suggest a key role of disturbance in self-organization symptoms in the presentation of CPTSD and its association with moral injury among treatment-seeking veterans. Despite the limitations of the present study, it offers an insightful starting point as the first network analysis study of CPTSD in treatment-seeking veterans as well as its association with moral injury. Implications in terms of points of intervention and further research are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Correlates of Posttraumatic Stress Disorder in the Aftermath of the February 2023 Earthquake in Turkey

On February 6, 2023, an earthquake registering 7.8 on the Richter scale struck southeast Turkey, and this was followed by a second earthquake of magnitude 7.5. The earthquake resulted in widespread loss, devastation, and destruction, and is anticipated to bear a significant psychological toll on survivors. This study aimed to investigate the prevalence and correlates of ICD-11 posttraumatic stress disorder (PTSD) in those living in earthquake-affected areas of Turkey. The sample was a convenience sample of 527 adults living in earthquake-affected areas of Turkey. Prevalence rates and gender differences in exposure to earthquake-related traumatic events were investigated. Moreover, prevalence rates of ICD-11 PTSD were computed, and demographic and trauma-related correlates of ICD-11 PTSD were assessed using logistic regression analyses. Most of the sample (99.2%; n = 523) experienced at least one earthquake-related traumatic event, with the majority experiencing multiple events. Findings demonstrated high endorsement of the ICD-11 PTSD symptom clusters, with 54.1% meeting criteria for diagnosis of probable ICD-11 PTSD. Correlates associated with increased risk of PTSD include female gender, physical injury in the earthquake, physical injury of family or loved ones in the earthquake and being in the higher earthquake-related traumatic events exposure quartiles. These findings indicate high levels of trauma exposure and PTSD among survivors of the recent earthquakes which occurred in Turkey. The identification of correlates associated with increased risk of PTSD is useful for identifying Turkish earthquake survivors who are most likely to need psychological support.

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).

Associations Between Child Maltreatment Types and Pre- and Post-Partum Posttraumatic Stress Disorder Symptoms: A Brief Report

Objective: To foster resilience through reducing posttraumatic stress disorder (PTSD) symptoms in pregnant mothers with child maltreatment (CM) histories, it is important to understand factors impacting their well-being. This study explored whether CM predicted the severity of PTSD symptoms and symptom clusters during pregnancy and change in symptoms from pregnancy (Time 1; T1) to 3 months postpartum (Time 2; T2).
 Methods: 88 pregnant women (aged 18 to 29) completed surveys on CM exposure, adult interpersonal trauma experiences, and PTSD symptoms at T1; 58 participated at T2.
 Results: Stepwise regressions were conducted with the covariates age, family status, and adult interpersonal traumas. When accounting for all CM types, only neglect remained associated with overall PTSD symptoms (Ft1(1, 71) = 28.93, p < .001) and for each of the PTSD symptom clusters (ps < .01). Physical abuse remained associated with the alterations in cognition and mood cluster. No CM types were associated with changes in PTSD symptoms from T1 to T2.
 Implications: In future research, the implications of neglect for pregnant mothers should be explored in depth. Perinatal care should be trauma-informed, including assessing for CM histories, to foster greater resilience by reducing perinatal PTSD symptoms.

Functional correlates of a novel 8-factor model of PTSD in U.S. military veterans: Results from the National Health and Resilience in Veterans Study

Emerging evidence indicates that more nuanced models of posttraumatic stress disorder (PTSD) may better capture the condition's symptom structure. Recent theoretical and empirical work suggest that an 8-factor model of PTSD with separate internally- (e.g. flashbacks) and externally- (e.g. trauma-cue related physiological reactivity) generated intrusive symptom clusters may advance understanding of PTSD and its treatment and course. However, the model's functional and clinical significance still requires evaluation. To this end, we analyzed data from the National Health and Resilience in Veterans Study, a nationally representative sample of 3847 trauma-exposed U.S. military veterans. Multivariable regressions were performed to assess the relationship between the 8 PTSD symptom clusters, assessed using the PTSD Checklist for DSM-5, and clinical and functional measures. Results revealed that externally-generated intrusions were associated with higher odds of current depression and anxiety and worse mental, cognitive, and psychosocial functioning. Anhedonia (e.g., loss of interest in enjoyable activities) symptoms were associated with all the correlates tested, while negative affect (e.g., having strong negative feelings such as fear) symptoms were associated with all measures except depression. Avoidance symptoms were associated with lower odds of current anxiety while externalizing behavior symptoms were linked to higher odds of suicidal ideation. Anxious arousal symptoms were associated with lower odds of suicidal ideation but higher odds of PTSD-related impairment/distress, while dysphoric arousal symptoms were associated with higher odds of current depression, PTSD-related impairment/distress and worse mental and cognitive functioning. Results suggest that a more nuanced 8-factor model of PTSD symptoms may help inform understanding of the clinical and functional correlates of this multi-faceted disorder.

Peritraumatic dissociation and posttraumatic stress symptoms: the moderating role of perceived threat.

Background: Although peritraumatic dissociation (PD) is viewed as a risk factor for posttraumatic stress disorder (PTSD), prospective studies taking into account other well-known risk factors for PTSD have been scarce, and the exploration of potential moderators within the relations between PD and PTSD has been lacking.Objective: Filling this gap, this prospective study explored the moderating role of perceived threat within the relations between PD and PTSD, above and beyond age, gender, education, and early trauma-related symptoms.Method: A convenience sample of 200 Israeli civilians filled out self-report questionnaires during the peritraumatic phase (T1) and one to two months after the posttraumatic phase (T2) of being exposed to rocket attacks.Results: The results showed that perceived threat and PD were associated with early trauma-related symptoms and PTSD symptoms. Moreover, perceived threat moderated the relationship between PD and all PTSD symptom clusters apart from avoidance.Conclusions: The present results suggest that the implications of PD are shaped by levels of perceived threat, so that detriments of PD are evident when the trauma is appraised as being highly threatening. Therefore, early interventions that aim to decrease PD may be beneficial in preventing PTSD symptoms of intrusion, hyper arousal, and negative alterations in mood and cognition, for individuals who perceive traumatic events as highly threatening.

Associations between posttraumatic stress disorder and eating disorder symptoms among women veterans

Recent research suggests high rates of posttraumatic stress disorder (PTSD) and eating disorder (ED) comorbidity in women veterans. This study aims to expand the literature by examining associations between PTSD and ED diagnoses and symptoms in this population. We assessed probable PTSD diagnosis and symptom clusters (intrusion, avoidance, arousal and reactivity, and negative alterations in cognition and mood [NACM]), as well as probable Binge Eating Disorder (BED) diagnosis and ED subscales (dietary restraint, shape/weight overvaluation, and body dissatisfaction) in a sample of women veterans (N = 371). We investigated significance at the standard p < .05, and the Bonferroni-corrected p < .005 cut-off to adjust for experiment-wise error. Overall, we found that probable PTSD was associated with provisional BED (p < .001) using logistic regression at both cut-offs. Probable PTSD was associated with all ED subscales (all p's < 0.003) using linear regression models also at both cut-offs. Provisional BED was associated with NACM at p < .05 (p = .046), though it did not meet significance at our conservative cut-off. NACM was also associated with shape/weight overvaluation (p = .02) and a global ED score (p = .01) at p < .05, but not at our conservative cut-off; arousal was associated with shape/weight overvaluation (p = .04) and the global ED score (p = .02) at p < .05, but not at our conservative cut-off. Our findings may further guide how ED-related topics can be integrated in PTSD treatment for women veterans with comorbid PTSD and ED.

Is a Criterion A trauma necessary to elicit posttraumatic stress symptoms?

ObjectiveThe posttraumatic stress disorder (PTSD) diagnosis has undergone substantial revision since its first appearance in the DSM-III. Much of the controversy surrounds the definition of trauma, or Criterion A. Our study sought to evaluate the DSM-5-TR's Criterion A and severity of PTSD symptoms in college students. MethodParticipants were 1500 college students who completed an online questionnaire about mental health symptoms. Responses to the Criterion A assessment were double coded by researchers to determine if the DSM-5-TR's Criterion A was met. Interpersonal agreement between raters was high (kappa = .81). Participants were compared across groups based on their PTSD Criterion A status: (1) DSM-Congruent, (2) DSM-Incongruent, (3) DSM-Ambiguous, and (4) Denied Trauma, using analysis of variance and multiple regression. ResultsParticipants who reported a trauma that was coded as Criterion A by researchers had the highest levels of PTSD symptoms, even after controlling for perceived stress, depression, anxiety, and gender (p < .001). Comparing across groups, the DSM-Congruent Criterion A group had significantly higher overall PTSS than those in the DSM-Incongruent Criterion A group and also significantly higher hyperarousal symptoms. However, the DSM-Congruent Criterion A group did not differ from the DSM-Ambiguous trauma group on any PTSD symptom cluster. ConclusionsThe lack of significant differences in scores between individuals with DSM- Congruent, DSM-Incongruent, and DSM-Ambiguous traumas provides evidence about the subjective nature of trauma and how college-age individuals interpret their symptoms of PTSD. Clinical implications are discussed.

Sexual Objectification Racial Microaggressions Amplify the Positive Relation Between Sexual Assault and Posttraumatic Stress Among Black Women

Black women report higher rates of adult sexual assault (ASA) and sexual objectification compared to White women. Sexual objectification serves as a reminder that Black women's bodies are viewed as sexual objects based on racist/sexist ideologies, though trauma research rarely includes race-specific stressors. In this study, we examined sexual objectification racial microaggressions as a moderator of the relation between ASA severity and posttraumatic stress disorder (PTSD) symptoms among Black women. Data were collected from 129 Black college and community women ( Mage = 33.84). ASA severity was associated with greater overall PTSD symptoms and symptom clusters. The interaction between ASA severity and sexual objectification microaggressions was associated with greater PTSD symptoms and the PTSD symptom cluster, negative alterations in cognition and mood. ASA severity was associated with PTSD at mean and high sexual objectification racial microaggressions but not low levels. Associations with other PTSD symptom clusters were not significant. Findings suggest sexual objectification racial microaggressions amplify the positive relation between ASA and PTSD symptoms, specifically symptoms related to cognition and mood. It is essential that clinicians assess for race-specific stressors during trauma interventions to help reduce mental health disparities. Post-assault interventions should be tailored with multiculturally sensitive practices to address the ways racial discrimination can exacerbate trauma symptoms.

The associations of hair cortisol and DHEA with posttraumatic stress disorder symptoms in refugees

BackgroundExposure to traumatic events, ongoing adversity, and posttraumatic stress disorder (PTSD) are associated with altered activity of the hypothalamic-pituitary-adrenal (HPA) axis, but findings are mixed. This may be explained in part by heterogeneity in PTSD symptom profiles. AimThe aim of this study was to investigate the complex relationships between the number of traumatic events and post-displacement stressors, individual symptoms of PTSD, and HPA-axis hormones cortisol and dehydroepiandrosterone (DHEA) in refugees. MethodsAdult (18+ years) Syrian refugees with increased levels of distress participating in a randomized controlled trial completed baseline measures to assess traumatic events (trauma checklist), post-displacement stressors (Post-Migration Living Difficulties checklist), symptoms of PTSD (PTSD Checklist for DSM-5; PCL-5), and provided a hair sample for additional stress hormone analyses. We used R-packages qgraph and bootnet to perform network analysis on the number of traumatic events and post-displacement stressors, individual symptoms of PTSD, and HPA-axis hormones cortisol and DHEA. The final network model was corrected for depression severity. Results115 (53% male, M age = 36.9, SD = 12.7) of 206 participants provided a hair sample. A higher number of traumatic events was directly associated with three symptoms of the PTSD cluster arousal and reactivity, i.e., sleep disturbance, hypervigilance and physiological reactivity, and with three other PTSD symptoms, namely flashbacks, avoidance of reminders, and self-destructive behavior. A higher number of post-displacement stressors was associated with four symptoms of the PTSD cluster cognition and mood, i.e., trauma-related amnesia, negative beliefs, blaming of self/others, and detachment, as well as with intrusive thoughts, sleep disturbance, hypervigilance, and exaggerated startle response. The number of traumatic events and post-displacement stressors were not associated with cortisol or DHEA. Cortisol was positively associated with two symptoms of the PTSD cluster cognition and mood, i.e., negative beliefs and negative trauma-related emotions, and negatively associated with avoidance of reminders. DHEA was positively associated with restricted affect and with three symptoms of the PTSD symptom cluster arousal and reactivity, i.e., irritability/anger, sleep disturbance, and self-destructive behavior, and negatively associated with avoidance of thoughts. ConclusionsThis study demonstrated that exposure to traumatic events and post-displacement stressors is not related to cortisol and DHEA, but that cortisol and DHEA are differentially related to individual symptoms of PTSD. While lower levels of both cortisol and DHEA were associated with increased avoidance, higher levels of cortisol were mostly associated with symptoms of the PTSD cluster cognition and mood and higher levels of DHEA were mostly associated with symptoms of the PTSD cluster arousal and reactivity. These findings contribute to explaining the variability of findings in the literature on HPA-axis activity in PTSD. EthicsThe study was approved by the Research Ethics Review Committee at VU Medical Center, the Netherlands (Protocol ID: NL61361.029.17, 7 September 2017) and prospectively registered online (https://www.trialregister.nl/trial/6665).

Pathways Linking Cumulative Maltreatment and Revictimization: Posttraumatic Stress Symptoms, Anger, and Substance Use Among Women

ABSTRACT Maltreatment survivors are at a heightened risk for revictimization during adulthood. Yet, existing work has specifically focused on sexual revictimization, and it is unclear what factors increase one’s risk for revictimization more broadly. Posttraumatic stress symptoms (PTSS), anger, and substance use have been identified as factors associated with sexual revictimization; the function of these variables is ambiguous in the broader revictimization framework. There is also a lack of understanding regarding the roles of the DSM-5 posttraumatic stress disorder (PTSD) symptom clusters and revictimization. This study aimed to 1) examine the links between maltreatment and revictimization and three factors (i.e., PTSS, anger, and substance use), 2) determine whether there are indirect effects between maltreatment and revictimization through each factor, and 3) investigate whether PTSD clusters have indirect effects on the relationship between maltreatment and revictimization. The sample included 350 maltreated college women (M age  = 21.96, SD = 5.31; 54.2% White) from two universities. Findings indicated that maltreatment and revictimization were linked with PTSS (B = 4.65, B = 0.03, respectively). Only maltreatment was related to anger, B = 1.70, and revictimization was tied to substance use, B = 0.08. Only PTSS had an indirect effect on the link between maltreatment and revictimization (B = 0.13). Maltreatment was related to each of the four PTSD symptom clusters, but the clusters had no indirect effects on the association between maltreatment and revictimization. These findings indicate that PTSS may be uniquely important in increasing the risk for revictimization among women.

Exploring gender differences in the relationships among childhood maltreatment, PTSD, and depression in young adults through network analysis

Background and objectivesCollege students who have experienced childhood maltreatment commonly exhibit adverse psychological consequences such as post-traumatic stress disorder (PTSD) and depression. The aim of this study is to use network analysis to investigate the gender differences in complex connections among various types of childhood maltreatment, PTSD, and depression. MethodsThis study involved 481 participants (M = 19.25 years, 54.5 % female) who were selected from a larger sample of 5231 college students. These participants had experienced childhood maltreatment and exhibited significant clinical symptoms of PTSD and depression. The participants completed validated measures that assessed childhood trauma, PTSD, and depression. ResultsThe network analysis performed on the entire sample revealed robust connections among various types of childhood maltreatment, symptom clusters of PTSD, and depression. The most central symptom that emerged was negative alterations in cognitions and mood (NACM), with emotional abuse displaying the highest centrality measure among the various types of childhood maltreatment. Upon comparing the subnetworks, the centrality analysis identified significant gender differences in nodes such as sexual abuse, physical neglect, emotional neglect, and avoidance. ConclusionsThe study's findings confirm that various forms of childhood abuse have intricate and multifaceted connections with depression and PTSD symptoms in adulthood. The study suggests that NACM could be the most significant symptom, and emotional abuse may play a vital role in adverse psychological outcomes. Furthermore, notable gender discrepancies were identified in the relationship between various forms of maltreatment and psychopathological symptoms.

Hyperarousal symptoms linger after successful PTSD treatment in active duty military.

Evidence-based psychotherapies are efficacious at reducing posttraumatic stress disorder (PTSD) symptoms, but military and veteran samples improve less than civilians. The objective of this secondary analysis of two clinical trials of cognitive processing therapy (CPT) was to determine if hyperarousal symptoms were more resistant to change compared with other PTSD symptom clusters in active duty service members. Service members completed the PTSD Checklist for the DSM-5 (PCL-5) pre- and post-CPT. Symptoms were coded present if rated 2 (moderate) or higher on a 0-4 scale. Cutoffs for reliable and clinically significant change classified 21%, 18%, and 61% of participants as recovered, improved, and suboptimal responders, respectively. Data analyses focused on the posttreatment status of symptoms that were present at baseline to determine their persistence as a function of treatment outcome. Generalized linear mixed effects models with items treated as a repeated measure estimated the proportions who continued to endorse each symptom and compared hyperarousal symptoms with symptoms in other clusters. Among improved participants, the average hyperarousal symptom was present in 69% compared with 49% for symptoms in other clusters (p < .0001). Among recovered patients, hyperarousal symptoms were present for 26%, while symptoms in the reexperiencing (2%), avoidance (3%), and negative alterations (4%) clusters were almost nonexistent (p < .0001). Even among service members who recovered from PTSD after CPT, a significant minority continue to report hyperarousal symptoms while other symptoms remit. Hyperarousal symptoms may require additional treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mechanisms through which exercise reduces symptom severity and/or functional impairment in posttraumatic stress disorder (PTSD): Protocol for a living systematic review of human and non-human studies

Background Exercise can play an important role in reducing symptom severity and improving functional impairment in patients with posttraumatic stress disorder (PTSD). However, the precise mechanisms underpinning the effect of exercise in PTSD management are not fully understood. This living systematic review aims to synthesize and triangulate the evidence from non-human and human studies to gain insight into the biopsychosocial mechanisms through which exercise reduces symptom severity and functional impairment. Methods Independent searches will be conducted in electronic databases to identify eligible studies. Two reviewers will independently conduct the study selection, data extraction, and risk of bias assessment. We will extract outcome data and variables that can act as effect modifiers or as mediators of the effect of exercise. For the non-human studies, outcome data will include the non-human equivalents of PTSD symptom clusters. For human studies, the primary outcome will be PTSD symptom severity. The secondary outcomes will be avoidance symptom severity, reexperiencing symptom severity, hyperarousal symptom severity, negative cognitions and mood severity, functional impairment, loss of PTSD diagnosis, and dropout rates. To explain the biopsychosocial mechanisms through which exercise affects the outcome of interest, we will extract effects that relate to the impact of exercise on potential mediating variables and the effect of the later outcomes. Comparison of within-study direct and indirect effects obtained from mediation analysis, when reported, will provide insight into the importance of the examined mediator. If appropriate, we will synthesize study results using meta-analyses. We will examine potential effect modifiers of the total exercise effect to understand better the impact of exercise on PTSD symptoms and function impairment (when possible). The evidence about the potential mediators of the association between exercise and PTSD-related outcomes will be considered in a consensus meeting when sufficient evidence is available. Protocol registration PROSPERO-ID: 453615

Neural processes of emotional conflict detection and prediction of posttraumatic stress disorder symptom clusters in traumatic injury survivors.

Given the prevalence and significant burden of posttraumatic stress disorder (PTSD), identifying early predictors of symptom development following trauma is critical. PTSD is a heterogeneous disorder comprised of distinct symptom clusters-reexperiencing, avoidance, negative mood, and hyperarousal-that contribute to the broad range of possible symptom profiles. Affective and attentional regulation processes, such as emotional conflict detection, are impaired in individuals with PTSD; however, the neural mechanisms underlying these alterations and their predictive utility for the development of PTSD symptoms remain unclear. Traumatic injury survivors (N = 49) without traumatic brain injury were recruited from the emergency department of an urban, Level-1 trauma center. Within 1 month of trauma exposure, participants completed a well-characterized emotional conflict task during a functional magnetic resonance imaging scan. Participants returned 6-month later for a clinical assessment of PTSD symptoms. Using a region-of-interest mask derived from whole-brain voxelwise analyses during emotional conflict detection (vs. no emotional conflict detection) we examined whether differential neural activity predicted 6-month PTSD symptom cluster severity. Greater activation of the right middle frontal gyrus during emotional conflict detection prospectively predicted lower PTSD avoidance symptom severity 6 months later (above and beyond the effects of self-reported baseline PTSD and depressive symptoms, previous traumatic life events, racial discrimination, age, sex, and injury severity). Neural processes of emotion conflict detection measured in the early aftermath of a potentially traumatic event are useful as predictors for the development of PTSD symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).