Traumatic Stress Studies Research Articles

What I was thinking/what I would do differently: Technology-enabled traumatic stress support.

At the 39th meeting of the International Society of Traumatic Stress Studies, three leading researchers and clinicians in technology-enabled traumatic stress support were invited to reflect on their careers and contributions to the field. Dr. Brian P. Marx has led the development of large-scale technologies to screen, assess, and treat traumatic stress pathology across diverse etiologies and needs. Dr. Barbara O. Rothbaum, a pioneer in the development of virtual reality for exposure therapy, has demonstrated the efficacy and scalability of digital treatment for traumatic stress. Retired Col. Dr. Eric Vermetten has worked extensively on the intersection of basic mechanisms, novel psychological and biological treatment, and technology for scalable assessment and treatment, primarily in military and mass casualty contexts. The panelists were asked to reflect on their initial ambitions, concerns, unexpected challenges, and the influence of their work on new research trajectories. Their insights provide valuable lessons about the process and content of their work, and their pioneering efforts have significantly advanced the field of technology-enabled traumatic stress support.

What I was thinking/what I would do differently: Biological markers and mechanisms of mental health.

At the 39th meeting of the International Society of Traumatic Stress Studies, four leading scientists and clinicians were invited to reflect on their careers, focusing on the biological mechanisms and markers of traumatic stress. Dr. Raul Andero has contributed to understanding how stress alters memory networks in the brain, influencing the development of novel treatments. Dr. Tanja Jovanovic has pioneered the measurement and mechanistic understanding of fear learning, bridging basic and clinical research. Dr. Murray B. Stein has scaled up clinical and lab observations to large populations, refining the field's understanding of traumatic stress. Dr. Arieh Y Shalev has shaped the definition of traumatic stress, pioneering the longitudinal investigation of stress and integrating advanced computational methods to identify individuals at risk. These panelists were asked to reflect on their initial problems, ambitions, concerns, and unexpected challenges, as well as the influence of their work, on new research trajectories. Their insights provide valuable lessons about the process and content of their work, and their pioneering efforts have significantly advanced our understanding of the biological mechanisms and markers of traumatic stress.

Fifty Years of Psychiatric Classification and Epidemiology Interactions: What is a Mental Disorder?

Psychiatric clinical diagnostic formulation has evolved over time. The changes alter our understanding and our ability to provide a public health perspective on the epidemiology of mental disorders in large populations. Epidemiology is an important perspective and set of tools to assess prevalence, treated prevalence, untreated prevalence, individual risks for mental disorders, and possible links to the etiology of disorders by following the trails of environmental exposures, biological measures, interpersonal dynamics, and genetic risk factors. As communities develop health-care services to treat individuals with mental disorders, knowledge about their prevalence and treatment requirements is also important. Since severe mental disorders may require institutional care, the diagnostic criteria used may either protect an individual’s liability for dangerous behavior (i.e. the insanity defense) or be used to control political and social dissidents. The criteria may also be used to determine evidence-based treatment options and eligibility for disability benefits. In this paper, using my vantage points as a physician scientist and public health officer, with leadership positions in national federal and professional mental health organizations, I address the developments in these areas over the past 50 years that have influenced institutional positions in the U.S. National Institute of Mental Health, the World Health Organization, the American Psychiatric Association, and the Center for the Study of Traumatic Stress. These perspectives may aid the next generation of investigators to advance the epidemiological and mental disorder classification scientific fields.

What I was thinking/what I would do differently: Clinical research.

At the 2023 International Society for Traumatic Stress Studies annual meeting, a panel of three distinguished investigators and clinicians convened to reflect on their careers, their contributions to the field of traumatic stress disorders, and the lessons learned over the years. Dr. Terence M. Keane has guided the development and deployment of evidence-based care, shaping evaluation guidelines and best treatment practices for traumatic stress pathology. Dr. Sheila Rauch, a pioneer in the development of prolonged exposure therapy, has significantly contributed to the treatment of posttraumatic stress disorder (PTSD) and other traumatic stress disorders. Dr. Richard Bryant has developed targeted psychological treatments for traumatic stress and prolonged grief, adapting to the diverse needs, mechanisms, and cultural contexts of patients. These individuals' collective experiences span from the establishment of the PTSD diagnosis to the current proliferation of scientific knowledge on its epidemiology, assessment, and treatment. Their unique yet overlapping contributions have provided invaluable guidelines for the next generation of clinicians and investigators. This panel discussion offers a retrospective look at their careers and a forward-looking perspective on the future of traumatic stress treatment.

Introduction to the Special Issue on the 39th Annual Meeting of the International Society for Traumatic Stress Studies: Scalable strategies to address the impact of trauma worldwide.

This editorial summary provides an overview of the 39th annual meeting of the International Society for Traumatic Stress Studies (ISTSS) held from November 1-4, 2023. The meeting, themed "Scalable Strategies to Address the Impact of Trauma Worldwide: Innovations and Implementation," encouraged presenters to focus on the scalability of traumatic stress research and practice. The articles presented at the meeting, which form this issue, cover a broad spectrum of topics, from basic biological mechanisms to innovative digital engagement to population-wide treatments. These articles emphasize eliminating biases in research design and psychiatric practice, promoting health equity, and addressing the unique challenges of traumatic stress. This summary underscores the importance of scalability in developing flexible, dynamic, and inclusive mental health care interventions.

Conceptualizing disparities and differences in the psychobiology of traumatic stress.

Understanding biological pathways that mediate trauma-related psychopathology is a major goal for traumatic stress studies. There is growing interest in studying differences in neural, physiological, and behavioral correlates of traumatic stress across demographic groups (e.g., sex/gender, race/ethnicity). However, challenges remain in how to appropriately conceptualize the source, mechanisms, and practical utility of between-group variation. The present brief conceptual review discusses ethnicity, race, and sex/gender-related variability relevant to understanding the psychobiology of traumatic stress in the context of traumatic stress studies. We discuss recent evidence related to socioenvironmental influences on ethnoracial variability in the brain and behavior relevant to traumatic stress, as well as sex/gender associations in neurophysiology that may contribute to the development of adverse posttraumatic sequelae. We further synthesize these findings by discussing intersectional influences of sex/gender- and race/ethnicity-related factors on trauma-related physical and mental health outcomes. The present review provides an important foundation for future research on disparities and individual differences in traumatic stress to move the field toward more effective assessment and treatment approaches.

Tipping the scales for global mental health: A summary of the Presidential Panel at the 39th Annual Meeting of the International Society for Traumatic Stress Studies.

In the past decade, there has been an increasing focus within scientific research on how to assist people affected by the negative consequences of trauma and crises around the globe. As many countries struggle with a lack of resources to deliver mental health interventions, scalable strategies have been developed to help more people in need. These scalable strategies were the theme of the 39th annual meeting of the International Society for Traumatic Stress Studies (ISTSS). The presidential panel, chaired by Marit Sijbrandij during her ISTSS presidency, brought together a group of experts in the field of scalable interventions: Kenneth Carswell, Syed Usman Hamdani, Judy Bass, and Eirini Karyotaki. The panel highlighted the current state of the evidence on scalable interventions for adults and children and outlined important next steps for research and implementation. These recommendations include further improving the availability of, and evidence for, scalable interventions through increased training and sustained funding; conducting more studies in underrepresented samples, such as children and adolescents; and promoting open access availability of research findings worldwide. In this paper, we provide an overview of the topics discussed in the panel as well as the key takeaways.

Medical traumatic stress: Integrating evidence-based clinical applications from health and trauma psychology.

Medical events in both childhood and adulthood, including components of the illness or injury and subsequent medical intervention, recovery, and disability, are increasingly being recognized as potentially traumatic. There has been an increased focus on scholarly work related to medical trauma and medically induced posttraumatic stress disorder (PTSD). Existing evidence suggests that trauma-focused treatment can promote both physical and psychological recovery. However, there continues to be a dearth of clinical guidance on how to (a) best identify and treat prior trauma exposure that complicates adjustment to illness and increases the risk for medically induced PTSD and (b) address medically induced PTSD while concurrently targeting health-related concerns (e.g., pain, adjustment to illness, acquired disability) that may negatively impact recovery. Originally presented as a premeeting institute at the 2023 Annual Meeting of the International Society for Traumatic Stress Studies, this paper describes the biopsychosocial impacts of medical trauma on adults and considerations for assessment and intervention in both traditional trauma and integrated care settings. This includes clinical applications, including assessment, case conceptualization, and health and rehabilitation interventions, that can promote health-related adjustment and coping within the context of trauma-focused treatment.

A functional approach to defining and repairing moral injury: Evidence, change agents, clinical strategies, and lessons learned.

This is a conceptual overview of a premeeting institute (PMI) I presented at the 39th International Society for Traumatic Stress Studies (ISTSS) annual meeting in November 2023 entitled, "A Functional Approach to Repairing Moral Injury and Traumatic Loss in Context: Evidence, Change Agents, Clinical Strategies, and Lessons Learned." This paper was invited by the co-chairs of the Scientific Program Committee, Isaac Galatzer-Levy and Katharina Schultebraucks. I first describe the aims of the PMI and then summarize the foundational assumptions that led me to expand adaptive disclosure and create adaptive disclosure-enhanced (AD-E). The foundational assumptions are that (a) moral injury is a unique measurable potential clinical problem, (b) moral injury damages the sustaining building blocks to personal and collective humanity, and (c) repairing moral injury requires corrective humanizing and virtuous experiences and connections. I then provide an overview of AD-E and describe two new change agents- loving-kindness meditation and letter writing-that augment the original AD in service of promoting corrective experiences in the social world that are valued, valuing, and promote the experience of belonging.

A longitudinal study of risk and protective factors for symptoms of adjustment disorder during the COVID-19 pandemic

ABSTRACT Background: The COVID-19 pandemic caused multiple stressors that may lead to symptoms of adjustment disorder. Objective: We longitudinally examined relationships between risk and protective factors, pandemic-related stressors and symptoms of adjustment disorder during the COVID-19 pandemic, as well as whether these relationships differed by the time of assessment. Method: The European Society for Traumatic Stress Studies (ESTSS) ADJUST Study included N = 15,169 participants aged 18 years and above. Participants from 11 European countries were recruited and screened three times at 6-month intervals from June 2020 to January 2022. Associations between risk and protective factors (e.g. gender), stressors (e.g. fear of infection), and symptoms of adjustment disorder (AjD, ADNM-8) and their interaction with time of assessment were examined using mixed linear regression. Results: The following predictors were significantly associated with higher AjD symptom levels: female or diverse gender; older age; pandemic-related news consumption >30 min a day; a current or previous mental health disorder; trauma exposure before or during the pandemic; a good, satisfactory or poor health status (vs. very good); burden related to governmental crisis management and communication; fear of infection; restricted social contact; work-related problems; restricted activity; and difficult housing conditions. The following predictors were associated with lower AjD levels: self-employment or retirement; working in healthcare; and face-to-face contact ≥ once a week with loved ones or friends. The effects of the following predictors on AjD symptoms differed by the time of assessment in the course of the pandemic: a current or previous mental disorder; burden related to governmental crisis management; income reduction; and a current trauma exposure. Conclusions: We identified risk factors and stressors predicting AjD symptom levels at different stages of the pandemic. For some predictors, the effects on mental health may change at different stages of a pandemic.

Dimensional approaches to studying, assessing, and treating traumatic stress: Introduction to the Special Section.

Dimensional models of psychopathology are gaining empirical support and are, thus, increasingly common in research and clinical practice. This is true for traumatic stress studies, although the movement toward dimensional conceptualizations of traumatic stress may be somewhat slower, perhaps due at least in part to how trauma is diagnosed. The purpose of this special section is to collect and showcase cutting-edge basic, applied, and conceptual work on dimensional models of traumatic stress. Its goal is to highlight the utility of such models and to facilitate greater connection between traumatic stress studies and the broader dimensional movement in psychopathology.

Sex and gender considerations in cross-cultural traumatic stress studies.

Following the 1st Conference of the Global Collaboration on Traumatic Stress, the consortium committed to systematically integrating sex and gender considerations in their endeavours, which aligns with the European Journal of Psychotraumatology's Gender Policy. This initiative is vital for understanding trauma's complex impacts, but also presents significant challenges in cross-cultural research. This letter, co-authored by researchers from across the globe, outlines these challenges and proposes mitigation strategies. First, definitions of sex and gender are provided from a Western perspective, while acknowledging cultural differences in these concepts. Second, the relevance of integrating sex and gender considerations in traumatic stress studies is briefly described. Third, cultural distinctions and legal contexts shaping the understanding and inclusion of these concepts, with non-Western and low-to-middle income regions facing significant legal and ethical obstacles are highlighted. Methodological challenges including measurement, recruitment, and statistical modelling are discussed, followed by recommendations including participatory approaches that involve members of the community, including sexual and gender minority individuals, as possible, throughout the research process, conducting risk analyses, employing sensitive quantitative and qualitative methods, and ensuring clear reporting and participant protection. To conclude, with this letter, we hope to instigate dialogue and foster innovative approaches to incorporating sex and gender considerations in cross-cultural studies of traumatic stress. Addressing these considerations is essential for ethical, meaningful research that respects and safeguards diverse experiences.

Psychological treatment of PTSD with comorbid substance use disorder (SUD): expert recommendations of the European Society for Traumatic Stress Studies (ESTSS)

ABSTRACT Background: Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) are often comorbid and difficult to treat. The availability of evidence-based treatment guidelines is very limited and there is significant uncertainty about what best practice looks like. Objective: This paper describes the methodology used to develop expert recommendations for the assessment and psychological treatment of PTSD and comorbid SUD and presents the final recommendations. Methodology: A small committee of experts in the field of PTSD and SUD was formed on behalf of the European Society for Traumatic Stress Studies (ESTSS) Board. The committee developed recommendations based on a two-stage process. In the first stage a systematic review of randomised controlled trials of psychological interventions aimed at treating PTSD-SUD comorbidity was completed, and other recent relevant reviews systematic were also considered. To complement the recommendations based on systematic review, the second stage involved the review and collation of existing guidance, good practice and consensus recommendations made in methodologically rigorous clinical practice guidelines. Results: The two-stage process resulted in 9 recommendations related to assessment and 21 recommendations related to treatment planning and delivery. Conclusions: To our knowledge, this is the first attempt to provide expert recommendations based on a systematic review of the literature and through collation of guidance provided in other authoritative and reliable sources. These expert recommendations will provide helpful guidance to clinicians and service providers in both addiction and mental health settings about appropriate clinical care for those with PTSD SUD comorbidity.

The TT-AT trauma protocol piloted in different international settings: Zambia, UK, Italy

ABSTRACT Background Art therapists have worked with traumatised individuals from the very beginning. Nevertheless, the effectiveness of art therapy in the treatment of Post Traumatic Stress Disorder (PTSD) and Complex Post Traumatic Stress Disorder (C-PTSD) is not yet evidence-based. Studies suggest innovative treatments should describe clearly both the intervention, in order to facilitate replication, and the treatment targets, in order to facilitate assessment and research. Context In the ‘Trauma Treatment through Art Therapy’ (TT-AT) protocol, the intervention is described clearly, and the treatment targets are the six client symptom clusters listed by the International Society for Traumatic Stress Studies (ISTSS): (1) emotion regulation; (2) relationships with others; (3) relationship with self; (4) awareness of trauma; (5) distancing; (6) resources. The intervention consists of six sessions, one for each symptom and related need. Approach The TT-AT protocol – that was developed and piloted in Tanzania – is now being applied in three other countries (Zambia, the UK and Italy). Outcomes The group participants in the three countries followed the six themes easily. Some shared the history of traumas, even though verbal sharing was optional, and sometimes for the first time hidden traumas of the past. After the intervention they described being able to leave the past in the past, feeling stronger in the present, and more hopeful about their future. Conclusions and implications for research The TT-AT protocol can be replicated easily and it has clear treatment targets. This makes it suitable for use in research. Plain-language summary This article reports on the implementation of an innovative trauma treatment intervention (the TT-AT protocol) in three countries: Zambia, the UK and Italy. The format is group art therapy and all the participants are women with a history of traumatic experience presenting with a variety of PTSD and C-PTSD symptoms. The six art therapy workshops addressed the six symptoms listed by the International Society of Traumatic Stress Studies (ISTSS). The groups are: (a) a group of six medical students in Zambia; (b) a group of five in a community mental well-being project in the UK; (c) a group of four private practice clients in Italy. The article illustrates the art therapy process in each group. The participants moved through three stages, from the initial strengthening phase to the stage of becoming more aware of their trauma, to the final stage of trusting their own resources. Feedback shows improvements in dealing with their past and in coping with present life challenges. This report suggests that the protocol is suitable to be applied to diverse countries and cultures.

How to deal with the past? How collective and historical trauma psychologically reverberates in Eastern Europe.

Traumatic stress studies have recently addressed the issue of 'historical trauma' that well explain the impact of collective or totalitarian trauma. The example of former communist Eastern Europe shows that there are many individual and socio-psychological consequences that still have effects today. This paper summarizes concepts and findings on 'historical traumas' that describe such long-lasting effects. The focus is on the side of the victims and their family descendants and thus also on the moral heirs of the dissidents, e.g., the Russian NGO Memorial. Analogous to developments in psychotraumatology, increasing knowledge in this area can explain psychosocial pathologies but also help develop effective remedies. This includes the development of a culture of remembrance, socio-therapeutic interventions and increased sensitivity towards those patients and clients who have such a personal legacy.

Reimagining traumatic stress studies as a participatory science grounded in critical self-reflection: A call to action.

Recognizing the need for a transformative shift to advance scholarship and practice focused on traumatic stress, this paper emerged from a special invited panel at the 38th Annual Meeting of the International Society for Traumatic Stress Studies (ISTSS). The panel brought together scholars from interdisciplinary backgrounds, including psychology, public health, and social work, to share their unique perspectives and experiences harnessing a collaborative, critical, and strengths-based lens in research. This piece invites the field to consider the importance of cultural humility as a foundational, nonnegotiable practice in traumatic stress studies. Details about participatory science and healing-centered practice are presented along with key questions to support the application of these frameworks in studies of traumatic stress.

A summary of the 38th Annual International Society for Traumatic Stress Studies Presidential Panel: How the traumatic stress community can assist individuals affected by the war in Ukraine.

As the premier global traumatic stress society,the International Society for Traumatic Stress Studies (ISTSS)has an important role to play in educating and raising awareness about the consequences of traumatic events, such as the war in Ukraine. On November 12, 2022, during its 38th annual meeting, the ISTSS hosted an invited Presidential Panel, chaired by Ananda Amstadter during her term as ISTSS President, that brought together trauma experts Peter Ventevogel, Marit Sijbrandij, Vitalii Klymchuck, Iryna Frankova, and Angela Nickerson to highlight how traumatic stress professionals can assist individuals affected by the war in Ukraine. The present paper summarizes the key points from the panel and discusses future challenges anticipated for people affected by the war.

Intergenerational transmission of trauma: A biological perspective.

This commentary is based on an invited panel for the 2022 International Society of Traumatic Stress Studies (ISTSS) annual meeting entitled "Perspective Discourses On…Intergenerational Transmission of Trauma: A Biological Perspective." This was a new format introduced by ISTSS to facilitate discussion around timely topics. This session included scholars from different backgrounds (e.g., epidemiology, neuroscience, environmental health) who shared their approaches to understanding the biological bases of the intergenerational transmission of trauma. Specifically, the panel presented information about putative direct and indirect mechanisms of transmission, including epigenetic and environmental factors, and pointed to behavioral and neurobiological outcomes in offspring. This commentary synthesizes some of the current knowledge gained by these different approaches and identifies key areas to advance in future work.

Resilience trajectories and links with childhood maltreatment in adolescence: a latent growth modeling approach

BackgroundThe current definitions of resilience can be addressed as a process, an outcome, or a trait. Empirical studies should be carried out to determine the most appropriate definition for it. Therefore, the main aim of the current study was to investigate changes in adolescents’ resilience over two years and explore the links between resilience and different forms of child maltreatment.MethodsThe three-wave longitudinal study “Stress and resilience in adolescence” (STAR-A) sample was comprised of a general school-based sample of Lithuanian adolescents [baseline N = 1295, 56.7% females; M(SD)age = 14.24 (1.26)]. Resilience was measured using the 14-item Resilience Scale (RS-14), lifetime exposure to maltreatment was measured at wave 1 using a questionnaire developed by the Norwegian Center for Violence and Traumatic Stress Studies (NKVTS), risk of psychopathology—using the Strengths and Difficulties Questionnaire (SDQ). The changes in resilience scores over the period of two years were investigated using the latent growth modeling approach.ResultsThe analyses revealed two classes of resilience—stable higher and stable lower. We found that experience of at least one form of abuse was significantly more prevalent in the lower resilience group in comparison to the higher resilience group. Also, adolescents with lower resilience had a higher probability of psychopathology.ConclusionsThis study provided meaningful insights into the stability of resilience over time in adolescence and its relation to various types of child maltreatment. Experiences of maltreatment, as well as risk for psychopathology, were linked to lower resilience in adolescence.

ВЛИЯНИЕ ВНЕШНЕЙ КОГНИТИВНОЙ ОЦЕНКИ НА ИНТЕНСИВНОСТЬ НАВЯЗЧИВЫХ ВОСПОМИНАНИЙ

Background. Symptoms of compulsive repetition or “intrusion” (unwanted thoughts, [ ashbacks, images, disturbing dreams, nightmares) are o\ en considered as a distinctive feature of post-traumatic stress disorder (PTSD). Cognitive models claim that PTSD symptoms are stimulated and become chronic due to an overly negative assessment of the traumatic experience and/or its consequences. ] e relevance of the study is due to the possibility of using external assessments as an early psychological aid tool. Objective. ] e work aims to repeat the study of the University of New South Wales (Australia) on the degree of in[ uence caused by various types of external cognitive assessment of obsessive memories on the frequency and intensity of their subsequent occurrence. ] e research targets to create a precedent in Russia for the study of traumatic stress in the laboratory. Sample. 30 healthy psychology students participated in the study. ] eir stress level results did not exceed the level of normative values. Methods. ] e main method of research was the experiment. Participants who received one of two preliminary instructions giving either a benevolent or a control assessment of obsessive memories were o^ ered to watch a Z lm with scenes of a real car accident. Having watched a traumatic Z lm, the participants solved a problem on cognitive interference. ] en the presence/absence and intensity of intrusive memories were recorded with the use of the Intrusion subscale of the Traumatic Event Impact Assessment Scale (IES-R) and two questions on the beliefs about intrusions. Results. ] e study showed that watching a traumatic Z lm causes an equally low level of obsessive memories in groups with positive and control instructions. Conclusion. ] e results of two studies (University of New South Wales and Lomonosov Moscow State University) showed similar trends regarding the level of intensity of obsessive memories for groups with benevolent and control instructions. ] e study provides initial causal evidence that a maladaptive external assessment can enhance the occurrence of obsessive memories, despite the fact that a benevolent or control interpretation of symptoms has no such side e^ ect. ] is observation is important to take into account when conducting psychoeducation. ] e practice of studying traumatic stress in the laboratory is evaluated as positive and recommended for use in Russia.