Trauma-exposed Individuals Research Articles

Predictors of Trauma-Related Diagnostic Overshadowing Bias

Diagnostic overshadowing occurs when healthcare professionals misattribute an individual’s presenting symptoms to other features of an individual’s clinical presentation. Mental health providers may incorrectly diagnose and treat trauma-exposed individuals due to trauma-related diagnostic overshadowing bias. No research has investigated provider factors associated with this bias. Mental health provider background and training characteristics were examined as predictors of trauma-related diagnostic overshadowing in a sample of mental health providers (N = 210). Hierarchical regression modeling was used to evaluate predictors related to trauma-related diagnostic overshadowing in diagnostic and treatment decision-making. Providers with diagnostic responsibilities in their professional role were significantly less likely to demonstrate bias in some diagnostic and treatment decisions. Older mental health providers and providers with more clients experiencing traumatic stress demonstrated greater bias in some diagnostic responses. Providers with doctoral degrees, compared to all other degree types, demonstrated less bias through some diagnostic and treatment responses. Bias in diagnostic decisions strongly predicted bias in treatment decision-making. Findings suggest that factors related to clinical experience may be important in predicting trauma-related diagnostic overshadowing. Future work should extend this research to understand which factors affect trauma-related diagnostic overshadowing in real-world settings.

Intrinsic functional connectivity of right dorsolateral prefrontal cortex and hippocampus subregions relates to emotional and sensory-perceptual properties of intrusive trauma memories.

Trauma-related intrusive memories (TR-IMs), unwanted and vivid, are core symptoms of posttraumatic stress disorder (PTSD). Prior research links voluntary TR-IM suppression to inhibitory control of the right dorsolateral prefrontal cortex (dlPFC) over the hippocampus (HPC). However, the potential relevance of tonic resting-state inhibition has not been examined, nor has the functional differentiation of the anterior and posterior hippocampus (aHPC/HPC). This study examined relationships of TR-IM frequency and properties with resting-state negative coupling between the right dlPFC and right aHPC/pHPC in trauma-exposed individuals with PTSD symptoms. Participants (N=109; 88 female) completed two weeks of ecological momentary assessments capturing TR-IM frequency and properties (intrusiveness, emotional intensity, vividness, visual properties, and reliving). Using 3T resting-state magnetic resonance imaging, participant-specific 4-mm spheres were placed at the right dlPFC voxel most anticorrelated with the right aHPC and pHPC. Quasi-Poisson and linear mixed-effects models assessed relationships of TR-IM frequency and properties with right dlPFC-right aHPC and pHPC anticorrelation. TR-IM emotional intensity was positively associated with right dlPFC-aHPC connectivity, while vividness and visual properties were linked to right dlPFC-pHPC connectivity. No significant associations were found between TR-IM frequency, intrusiveness, or reliving, and anticorrelation with either HPC subregion. This study provides novel insights into the neural correlates of TR-IMs, highlighting the relevance of intrinsic negative coupling between the right dlPFC and aHPC/pHPC to their emotional impact and perceptual properties. Further research on inhibitory mechanisms in this circuit could improve understanding of component processes of intrusive reexperiencing, a severe and treatment-refractory PTSD symptom.

Cortical morphological changes and associated transcriptional signatures in post-traumatic stress disorder and psychological resilience.

Individuals who have experienced severe traumatic events are estimated to have a post-traumatic stress disorder (PTSD) prevalence rate ranging from 10 to 50%, while those not affected by trauma exposure are often considered to possess psychological resilience. However, the neural mechanisms underlying the development of PTSD, especially resilience after trauma, remain unclear. This study aims to investigate changes of cortical morphometric similarity network (MSN) in PTSD and trauma-exposed healthy individuals (TEHI), as well as the associated molecular alterations in gene expression, providing potential targets for the prevention and intervention of PTSD. We recruited PTSD patients and TEHI who had experienced severe earthquakes, and healthy controls who had not experienced earthquakes. We identified alterations in the whole-brain MSN changes in PTSD and TEHI, and established associations between these changes and brain-wide gene expression patterns from the Allen Human Brain Atlas microarray dataset using partial least squares regression. At the neuroimaging level, we found not only trauma-susceptible changes in TEHI same as those in PTSD, but also unique neurobiological alterations to counteract the deleterious impact of severe trauma. We identified 1444 and 2214 genes transcriptionally related to MSN changes in PTSD and TEHI, respectively. Functional enrichment analysis of weighted gene expression for PTSD and TEHI revealed distinct enrichments in Gene Ontology biological processes and Kyoto Encyclopedia of Genes and Genomes pathways. Furthermore, gene expression profiles of astrocytes, excitatory neurons, and microglial cells are highly related to MSN abnormalities in PTSD. The formation of resilience may be by an active compensatory process of the brain. The combination of macroscopic neuroimaging changes and microscopic human brain transcriptomics could offer a more direct and in-depth understanding of the pathogenesis of PTSD and psychological resilience, shedding light on new targets for the prevention and treatment of PTSD.

Change processes associated with functional improvement in a web-based version of Skills Training in Affective and Interpersonal Regulation (webSTAIR) for trauma-exposed veterans.

In spite of the evidence that both symptom reduction and functional improvement are important for supporting recovery from trauma, psychotherapy process research has largely focused on mechanisms of symptom reduction. A better understanding of how change occurs in treatments that emphasize functional improvement rather than trauma processing is critical for optimizing effective, patient-centered care. This study involved secondary analysis of data collected in three multisite trials of a 10-module web-based version of Skills Training in Affective and Interpersonal Regulation, a skills-focused transdiagnostic intervention. The sample included 314 trauma-exposed veterans (38% male; 64% non-Hispanic White) who screened positive for elevated symptoms of posttraumatic stress disorder and/or depression. Latent change score modeling examined prospective relationships between changes from pre-to-mid and mid-to-post treatment in four potential mechanisms (emotion regulation, interpersonal problems, posttraumatic stress disorder symptoms, and depression symptoms) and the association of these changes with overall functional improvement (at posttreatment and follow-up). Emotion regulation change during the first half of treatment predicted interpersonal and symptom improvements during the second half of treatment, but not vice versa. Changes in each potential mechanism were uniquely associated with functional improvement and together statistically accounted for 78% additional variance in functional improvement beyond what was associated with baseline functioning and covariates. Results support emotion regulation as an early mechanism of transdiagnostic therapeutic change in web-based version of Skills Training in Affective and Interpersonal Regulation and highlight the relevance of all four potential mechanisms to functional improvement. The study contributes to an understanding of how change occurs in skills-focused interventions for trauma-exposed individuals. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Characterizing the heterogeneity of disruptions in the resolution of trauma among women exposed to childhood maltreatment.

The previously observed heterogeneity in developmental and intergenerational trajectories of childhood trauma may root from interindividual differences in the way trauma-exposed individuals have resolved these experiences. The current study explored whether distinctive patterns of impaired mentalization in relation to trauma could be identified in a sample of 825 pregnant women who experienced childhood maltreatment and whether these heterogeneous patterns were marked by significant differences in internalized and externalized problems during pregnancy, intimate partner violence, personality dysfunctions, and antenatal attachment. A latent profile analysis applied to the seven subscales of the Failure to Mentalize Trauma Questionnaire unraveled interindividual variability in mentalizing impairments among pregnant women exposed to childhood maltreatment by identifying five distinctive types of psychological responses to trauma, each being associated in cross-sectional analyses with a specific set of symptoms and dysfunctions. Overall, the study highlights the need for tailored interventions based on the individuals' specific impairments in mentalizing trauma and calls for future developmental research exploring the longitudinal correlates of the five documented profiles of trauma processing.

Assessing social anhedonia in a transdiagnostic sample: Insights from a computational psychiatry lens.

Anhedonia, a reduced ability to experience positive affect and seek rewards, is present across many psychiatric disorders, notably among individuals who experienced trauma. Within the social domain, anhedonia manifests as an altered sense of belonging and social isolation and is associated with poorer clinical outcomes. Yet, mechanistic operationalizations of social anhedonia are lacking, limiting our understanding of the relationship between these mechanisms and affective symptoms. To address these questions, we developed a social reward exploration task which was administered to a transdiagnostic sample of trauma-exposed Veterans (N = 33) while they underwent functional magnetic resonance imaging. The goal was to maximize compliments from two unknown partners, as participants were told these partners selected compliments based on seeing their picture. A Bayesian reinforcement learning modeling approach was used to extract cognitive and neural markers of compliment (reward) exploration. To address these questions, we developed a social reward exploration task which was administered to a transdiagnostic sample of trauma-exposed Veterans (N = 33) while they underwent functional magnetic resonance imaging. The goal was to maximize compliments from two unknown partners, as participants were told these partners selected compliments based on seeing their picture. A Bayesian reinforcement learning modeling approach was used to extract cognitive and neural markers of compliment (reward) exploration. Higher social connectedness (β = 0.51; 95 % CI=[0.11,0.94]) and anxiety (β = 0.57; 95 % CI=[0.13,1.00]) were independently associated with more model-based choices of the partner they anticipated to be most complimenting. In the dorsal anterior cingulate cortex (ACC; z = 3.89, p .001) and left inferior parietal lobule (z = 3.96, p .001), neural responses to reward prediction errors (RPE) were more positive in response to compliment relative to non-compliment outcomes. Greater positive RPE ACC activation was associated with lower anxiety (β = −0.51; 95 % CI=[−0.99,−0.10]. Computational approaches to social reinforcement learning can help identify important neurocognitive differences in social reward sensitivity among individuals with complex affective profiles, such as trauma-exposed individuals. Understanding these differences may help develop new prediction and treatment tools for social anhedonia.

Amygdala Cannabinoid 1 Receptor, Pain Response, and Emotional Numbing in Trauma-Exposed Individuals.

This case-control study assesses associations of amygdala cannabinoid 1 receptor availability with amygdala response to shock-induced pain and severity of emotional numbing symptoms of veterans with posttraumatic stress disorder.

Medically unexplained symptoms and experiences with healthcare among emerging adults exposed to multiple types of potentially traumatic events.

Experiencing multiple types of traumatic events can increase the risk of developing somatic and posttraumatic stress symptoms (PTSS). Medically unexplained symptoms (MUS), or somatic symptoms that lack a distinct medical explanation, often coexist with PTSS in emerging adults and may be due to common underlying mechanisms. Coping strategies have been associated with PTSS, but have not been studied in trauma-exposed individuals with MUS. The current study examined the relationship between the number of types of potentially traumatic events experienced and MUS among emerging adults, considering the influence of PTSS and engagement and disengagement coping. A sample of 363 emerging adults (Mean = 18.91) completed self-report measures of trauma history, PTSS, MUS, experiences with healthcare providers, and coping strategies. Dissatisfaction with healthcare providers was reported by 11.3% of participants reporting MUS, with over half (52.8%) feeling their concerns were dismissed. Hierarchical linear regression showed that the number of types of traumatic events experienced did not predict MUS after accounting for PTSS. Moderation hypotheses linking traumatic events and coping strategies were not supported. Results suggest that PTSS explains the relationship between exposure to different traumatic events and MUS. Findings may have diagnostic and treatment implications for healthcare providers working with emerging adults who have experienced trauma.

Examining the Impact of Organizational Support on the Secondary Traumatic Stress of Mental Health Professionals Exposed to Workplace Violence

Mental health professionals are at a heightened risk of secondary traumatic stress (STS) due to the higher prevalence of trauma-exposed individuals seeking clinical help compared to the general population. The aims of this study were as follows: (1) to explore the association between exposure to workplace violence (WPV) and secondary traumatic stress, and the potential mitigating effects of organizational support and (2) to examine how the workplace setting (inpatient vs outpatient) affects the experience of STS. The study was cross-sectional. Over 58 days, survey data was collected from mental health professionals working in both inpatient and outpatient settings. A total of 2,549 professionals responded. The overall prevalence of STS across settings was 87%. The highest reported secondary traumatic stress levels were among nurse practitioners/APRNs (49.29%), followed by nurses (47.94%) and psychiatrists (46.85%). Levels of STS occurred at slightly higher levels among professionals in outpatient settings (48.39%) than those in inpatient settings (45.11%). Increased exposure to WPV correlated with higher levels of STS, while higher levels of perceived organizational support (POS) had a moderating effect on STS levels. This study suggests that STS is a significant phenomenon and that mental health professionals are at risk for developing the condition. Organizational support can play a role in mitigating the effects of WPV and STS. Interventions aimed at improving organizational support and building psychological resilience may help reduce the prevalence of STS among this population.

Trauma, PTSD, and Self-Efficacy: Predictors of Cervical Cancer Screening in Sexual Violence Survivors.

Sexual violence is highly prevalent in the United States and is associated with a host of negative physical and mental health outcomes. Specifically, sexual violence is associated with increased rates of cervical cancer, one of the most common cancers found in women. Furthermore, sexual violence survivors report reduced participation in preventive healthcare behaviors (e.g., Pap tests) which may reduce individuals' risk of developing reproductive health conditions such as cancer. Sexual violence exposure is also associated with increased symptoms of posttraumatic stress disorder (PTSD) and reduced trauma-coping self-efficacy (TCSE), two factors that may impact trauma-exposed individuals' level of avoidance of cervical cancer screens. Current research on the connection between sexual violence and reproductive healthcare often fails to examine potential underlying mechanisms behind this association, nor does it account for confounding factors such as healthcare accessibility and need. Accordingly, the present study tested a proposed moderated mediation model to explore the association between sexual violence and cervical cancer screening participation, including analysis of the indirect effect of TCSE and potential moderation of this effect by PTSD symptoms. Participants were 554 participants who reported experiences of sexual violence on Amazon's Mechanical Turk. Severity of sexual violence was significantly associated with reduced likelihood of participation in recommended cervical cancer screening. TCSE did not mediate nor did PTSD moderate this association. Findings of this study suggest that individuals' reproductive healthcare behaviors are influenced by their experiences of sexual trauma, as well as by structural factors such as insurance and income. Limitations, directions for future research, and clinical implications of study findings are discussed.

Prefrontal metabolite alterations in individuals with posttraumatic stress disorder: a 7T magnetic resonance spectroscopy study.

Evidence from animal and human studies suggests glutamatergic dysfunction in posttraumatic stress disorder (PTSD). The purpose of this study was to investigate glutamate abnormalities in the dorsolateral prefrontal cortex (DLFPC) of individuals with PTSD using 7T MRS, which has better spectral resolution and signal-to-noise ratio than lower field strengths, thus allowing for better spectral quality and higher sensitivity. We hypothesized that individuals with PTSD would have lower glutamate levels compared to trauma-exposed individuals without PTSD and individuals without trauma exposure. Additionally, we explored potential alterations in other neurometabolites and the relationship between glutamate and psychiatric symptoms. Individuals with PTSD (n=27), trauma-exposed individuals without PTSD (n=27), and individuals without trauma exposure (n=26) underwent 7T MRS to measure glutamate and other neurometabolites in the left DLPFC. The severities of PTSD, depression, anxiety, and dissociation symptoms were assessed. We found that glutamate was lower in the PTSD and trauma-exposed groups compared to the group without trauma exposure. Furthermore, N-acetylaspartate (NAA) was lower and lactate was higher in the PTSD group compared to the group without trauma exposure. Glutamate was negatively correlated with depression symptom severity in the PTSD group. Glutamate was not correlated with PTSD symptom severity. In this first 7T MRS study of PTSD, we observed altered concentrations of glutamate, NAA, and lactate. Our findings provide evidence for multiple possible pathological processes in individuals with PTSD. High-field MRS offers insight into the neurometabolic alterations associated with PTSD and is a powerful tool to probe trauma- and stress-related neurotransmission and metabolism in vivo.

The effects of acute versus repeated cannabidiol administration on trauma-relevant emotional reactivity: A double-blind, randomized, placebo-controlled trial.

Despite the widespread use and perceived efficacy of cannabidiol (CBD) as an anxiolytic, few controlled studies have evaluated the effects of CBD on anxiety-relevant indications, and only one has done so in the context of trauma-related symptoms. The current study was designed to address this gap in the literature. Participants were 42 trauma-exposed individuals (Mage = 23.12 years, SDage = 6.61) who endorsed elevated stress. They were randomly assigned to take 300 mg of oral CBD or placebo daily for 1 week. Acute (i.e., following an initial 300 mg dose) and repeated (i.e., following 1 week of daily 300 mg dosing) effects of CBD were evaluated in relation to indicators of anxious arousal (i.e., anxiety, distress, heart rate) in response to idiographic trauma script presentation. The results of the current study suggest that relative to placebo, 300 mg CBD did not significantly reduce anxiety, B = 13.37, t(37) = 1.71, p =.096, d = 0.09, Bayes factor (BF10) = 0.54; distress, B = 15.20, t(37) = 1.31, p =.197, d = 0.07, BF10 = 0.51; or heart rate, B = -1.09, t(36) = -0.32, p =.755, d = 0.02, BF10 = 0.29, evoked by idiographic trauma script presentation in the context of acute or repeated administration. These data suggest that CBD may not effectively reduce trauma-relevant emotional arousal; however, more work is needed to confidently assert such claims due to the small sample size. The current study extends the groundwork for additional studies in this important area.

An exploratory study on lipidomic profiles in a cohort of individuals with posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) can develop after trauma exposure. Some studies report that women develop PTSD at twice the rate of men, despite greater trauma exposure in men. Lipids and their metabolites (lipidome) regulate a myriad of key biological processes and pathways such as membrane integrity, oxidative stress, and neuroinflammation in the brain by maintaining neuronal connectivity and homeostasis. In this study, we analyzed the lipidome of 40 adults with PTSD and 40 trauma-exposed non-PTSD individuals (n = 20/sex/condition; 19–39 years old). Plasma samples were analyzed for lipidomics using Quadrupole Time-of-Flight (QToF) mass spectrometry. Additionally, ~ 90 measures were collected, on sleep, and mental and physical health indices. Poorer sleep quality was associated with greater PTSD severity in both sexes. The lipidomics analysis identified a total of 348 quantifiable known lipid metabolites and 1951 lipid metabolites that are yet unknown; known metabolites were part of 13 lipid subclasses. After adjusting for BMI and sleep quality, in women with PTSD, only one lipid subclass, phosphatidylethanolamine (PE) was altered, whereas, in men with PTSD, 9 out of 13 subclasses were altered compared to non-PTSD women and men, respectively. Severe PTSD was associated with 22% and 5% of altered lipid metabolites in men and women, respectively. Of the changed metabolites, only 0.5% measures (2 PEs and cholesterol) were common between women and men with PTSD. Several sphingomyelins, PEs, ceramides, and triglycerides were increased in men with severe PTSD. The correlations between triglycerides and ceramide metabolites with cholesterol metabolites and systolic blood pressure were dependent upon sex and PTSD status. Alterations in triglycerides and ceramides are linked with cardiac health and metabolic function in humans. Thus, disturbed sleep and higher body mass may have contributed to changes in the lipidome found in PTSD.

The impact of emotion regulation and dyadic coping within posttraumatic stress symptoms and risky drinking patterns on relationship distress among trauma-exposed individuals.

Individuals with posttraumatic stress symptoms (PTSS) often consume alcohol to manage PTSS-related discomfort, which can negatively impact individual and interpersonal functioning. Processes including emotion regulation and dyadic coping may influence the effects of PTSS and drinking patterns on relationship functioning. The present study examined how PTSS and risky drinking may function through the associations between maladaptive individual and interpersonal coping strategies and relationship distress among trauma-exposed individuals. Participants were 237 adults in a romantic relationship who endorsed lifetime trauma exposure and alcohol consumption within the past year and completed an online battery of self-report measures. Path analyses showed mixed support for the hypothesized theoretical causal model. PTSS was associated with maladaptive emotion regulation, β =.537, p =.010, and negative dyadic coping, β =.264, p =.009, whereas risky drinking was only related to negative dyadic coping, β =.193, p =.024. Negative dyadic coping was significant in the pathways between PTSS and relationship distress, β =.021, p =.009, and risky drinking and relationship distress, β =.030, p =.014. Exploratory analyses based on trauma type did not significantly change the overall model; however, a direct path suggested PTSS may have a stronger negative impact on relationship distress among individuals who experienced assault trauma (e.g., physical or sexual assault), β =.340, p =.012. Findings highlight the interrelations among intra- and interpersonal regulation and provide clinical targets of maladaptive emotion regulation and dyadic coping strategies for individuals with PTSS and harmful drinking.

Evaluation of the Posttraumatic Stress Disorder Checklist for DSM-5 across United States and India samples: An item response theory analysis using the graded response model.

The Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) is frequently used to assess PTSD symptoms. Extending its psychometric investigations across distinct samples (United States and India), the aims of the present study included investigating the item characteristics, person fit, and differential item functioning (DIF) across the two samples. We (a) conducted item analysis using the graded response model to examine item characteristics (thresholds and discrimination parameters) and (b) examined person fit to determine participants' response patterns. The U.S. sample included 176 trauma-exposed individuals seeking mental health treatment, and the Indian sample included 148 trauma-exposed ex-military personnel. Results indicated low discrimination for Item 8 and low but acceptable discrimination for Item 17 for the U.S. and Indian samples, respectively. Across both samples, the most unused response categories were the middle-point or extreme (higher severity) categories (all response categories were better utilized in the Indian sample), and half the participants exhibited person misfit. Supplemental DIF analysis indicated that five items exhibited DIF indicating potential item bias; however, effect sizes for DIF were negligible. Although the PCL-5 demonstrated strong psychometric properties and showed promise for use across the samples differing on cultural and demographic characteristics, some of the items and the number of categories used to measure them could be revisited to create a more efficient instrument. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Emotional State Transitions in Trauma-Exposed Individuals With and Without Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is marked by the contrasting symptoms of hyperemotional reactivity and emotional numbing (ie, reduced emotional reactivity). Comprehending the mechanism that governs the transition between neutral and negative emotional states is crucial for developing targeted therapeutic strategies. To explore whether individuals with PTSD experience a more pronounced shift between neutral and negative emotional states and how the intensity of emotional numbing symptoms impacts this shift. This cross-sectional study used hierarchical bayesian modeling to fit a 5-parameter logistic regression to analyze the valence ratings of images. The aim was to compare the curve's slope between groups and explore its association with the severity of emotional numbing symptoms. The study was conducted online, using 35 images with a valence range from highly negative to neutral. The rating of these images was used to assess the emotional responses of the participants. The study recruited trauma-exposed individuals (witnessed or experienced life-threatening incident, violent assault, or someone being killed) between January 17 and March 8, 2023. Participants completed the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) (PCL-5). On the basis of DSM-5 criteria (endorsing at least 1 symptom from clusters B and C and 2 from D and E), participants were categorized as having probable PTSD (pPTSD) or as trauma-exposed controls (TECs). The main outcome was the slope parameter (b) of the logistic curve fitted to the valence rating. The slope parameter indicates the rate at which emotional response intensity changes with stimulus valence, reflecting how quickly the transition occurs between neutral and negatively valenced states. The secondary outcome was the association between emotional numbing (PCL-5 items 12-14) and the slope parameter. A total of 1440 trauma-exposed individuals were included. The pPTSD group (n = 445) was younger (mean [SD] age, 36.1 [10.9] years) compared with the TEC group (mean [SD] age, 41.5 [13.3] years; P < .001). Sex distribution (427 women in the TEC group vs 230 in the pPTSD group) did not significantly differ between groups (P = .67). The pPTSD group exhibited a steeper slope (mean slope difference, -0.255; 89% highest posterior density [HPD], -0.340 to -0.171) compared with the controls. Across all individuals (n = 1440), a robust association was found between the slope and emotional numbing severity (mean [SD] additive value, 0.100 [0.031]; 89% HPD, 0.051-0.15). Additional analysis controlling for age confirmed the association between emotional numbing and transition sharpness (mean [SD] additive value, 0.108 [0.032]; 89% HPD, 0.056-0.159), without evidence of an age-related association (mean [SD] additive value, 0.031 [0.033]; 89% HPD, -0.022 to 0.083). These findings support that individuals with PTSD undergo rapid transitions between neutral and negative emotional states, a phenomenon intensified by the severity of emotional numbing symptoms. Therapeutic interventions aimed at moderating these swift emotional transitions could potentially alleviate PTSD symptoms.

Does disconfirmatory evidence shape safety-and danger-related beliefs of trauma-exposed individuals?

ABSTRACT Recent accounts of predictive processing in posttraumatic stress disorder (PTSD) suggest that trauma-exposed individuals struggle to update trauma-related hypotheses predicting danger, which may be involved in the etiology and maintenance of this disorder. Initial research supports this account, documenting an association between trauma-exposure, impaired expectation updating, and PTSD symptoms. Yet, no study to date has examined biased belief updating in PTSD using a scenario-based approach. Objective: Here, we examined the predictive processing account among trauma-exposed and non-trauma-exposed individuals using a modified Trauma-Related version of the Bias Against Disconfirmatory Evidence task. Method: The task presents both danger-and safety-related scenarios highly relevant for trauma-exposed individuals. For each scenario, participants viewed several explanations and rated their plausibility. Their ability to update their initial interpretation following new-contradictory information was assessed. Results: Preregistered analyses did not reveal any significant findings. Based on indications that our sample may not have been sufficiently powered, we conducted exploratory analyses in an extended sample of participants. These analyses yielded a significant association between reduced belief updating and PTSD symptoms which was evident for disconfirming both safety and danger scenarios. However, the effect sizes we found were in the small-to-medium range. Conclusion: Although preliminary, our current findings support initial evidence that individuals with higher PTSD symptoms show a higher resistance to update their beliefs upon new disconfirmatory evidence. Our results should be interpreted cautiously in light of the extended sample and the limitations of the current study.

Posttraumatic stress disorder symptoms and posttraumatic growth among college students with a history of childhood maltreatment in China: A latent profile analysis.

Childhood maltreatment is prevalent in China, and research indicates that trauma-exposed individuals may exhibit concurrent negative and positive posttraumatic psychological responses. To examine the co-occurring patterns of posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG) among college students in China having a history of childhood maltreatment. Participants (N = 2,968) were college students from China who had experienced childhood maltreatment and had completed the PTSD Checklist, a PTG inventory, and a childhood maltreatment questionnaire. The results revealed four heterogeneous profiles characterized by low symptoms (n = 666, 22.4%), growth (n = 960, 32.3%), struggle (n = 1,285, 43.3%), and distress (n = 57, 1.9%). The three-step approach revealed emotional abuse and sexual abuse as crucial risk factors for the distress profile. In addition, age, sex, parental education, and forms of childhood maltreatment play distinctive roles in the four profiles of posttraumatic reactions. Posttraumatic reactions exhibit heterogeneous characteristics among Chinese college students exposed to childhood maltreatment, and professionals provide the service targeting their needs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Preliminary Investigation Into the Effectiveness of Group webSTAIR for Trauma-exposed Veterans in Primary Care.

A substantial number of trauma-exposed veterans seen in primary care report significant symptoms of PTSD and depression. While primary care mental health integration (PCMHI) providers have been successful in delivering brief mental health treatments in primary care, few studies have evaluated interventions that combine mobile health resources with PCMHI groups. This pilot study assessed the potential benefits of webSTAIR, a 10-module transdiagnostic treatment for trauma-exposed individuals, supported by 5 biweekly group sessions delivered via telehealth. The transdiagnostic and mobile health nature of the treatment, as well as the therapist and peer support provided through group sessions, may offer an innovative approach to increasing access to patient-centered and trauma-informed treatment in primary care settings. Thirty-nine male and female veterans with trauma-related symptoms (i.e., PTSD and/or depression) participated in group webSTAIR. Mixed effects analyses were conducted to assess changes in PTSD and depression at pre-, mid-, and post-treatment. Baseline symptom severity was assessed as a predictor of module completion and group attendance. The project was part of a VHA quality improvement project, and IRB approval was waived by the affiliated university. Analyses revealed significant pre-to-post improvement in both PTSD and depression outcomes with a large effect size for PTSD (Hedges' gav = 0.88) and medium to large for depression (Hedges' gav = 0.73). Of participants who completed the baseline assessment, 90% began webSTAIR; of those, 71% completed the program. Baseline symptoms of PTSD and depression did not predict group attendance or module completion. Good outcomes and a satisfactory retention rate suggest that group webSTAIR may provide easily accessible, high-quality, and effective treatment for patients presenting with trauma-related problems without increasing therapist or system burdens. The results suggest the value of conducting a randomized controlled trial to test the effectiveness of group webSTAIR relative to PCMHI usual care or other evidence-based, disorder-specific (e.g., PTSD) treatments for trauma-exposed individuals in PCMHI.

The associations between repetitive negative thinking, insomnia symptoms, and sleep quality in adults with a history of trauma

ABSTRACT Background Posttraumatic stress disorder (PTSD) and sleep disturbance are highly comorbid and repetitive negative thinking (RNT) is associated with both sleep disturbance and PTSD. However, few studies have examined the association between RNT and sleep disturbance in individuals exposed to trauma, with and without PTSD. Method Associations between trait-level and trauma-related RNT, insomnia, and sleep quality were investigated in a trauma-exposed MTurk (N = 342) sample. Additionally, PTSD symptom severity was tested as a moderator of the associations between RNT and insomnia and sleep quality. Results Trait-level RNT predicted poorer sleep quality and greater insomnia, regardless of PTSD severity. Trauma-related RNT was also associated with greater insomnia, though the effect was moderated by PTSD severity such that it was significant for participants with low and moderate, but not severe, PTSD. Both trait- and trauma-related RNT were associated with several specific aspects of sleep quality, including: sleep disturbances, daytime dysfunction, use of sleep medications, sleep onset latency, and subjective sleep quality. Conclusions This study demonstrates significant associations linking RNT with insomnia and sleep disturbance in trauma-exposed individuals. Clinically, results suggest that it may be helpful to target both general and trauma-related RNT in sleep interventions for trauma-exposed individuals with insomnia.