Robust non-rigid image-to-patient registration for contactless dynamic thoracic tumor localization using recursive deformable diffusion models.

Problem anger after experiencing trauma is a common mental health issue. Shift is a new cognitive-behavioral based app, co-designed with users and experts, that works by prompting users to report their current anger state, and delivering personalized support to manage anger accordingly. The aim of this study is to investigate whether prompting users to engage with Shift modules tailored to their in-the-moment anger state, as compared to no prompt, reduces near-term anger intensity. We also aim to investigate whether this effect is moderated by the anger state, or days in the study. Finally, we aim to evaluate the acceptability of the intervention. A micro-randomized trial will be implemented with 65 adults with problem anger and a history of trauma exposure. For 30days, four times a day, each participant will be prompted to self-report their current anger state and will be micro-randomized to be shown a Shift module tailored to their in-the-moment anger state. Post intervention surveys, and app use and engagement indices will be analyzed to evaluate the acceptability of the intervention. Self-report assessments of anger intensity will be analyzed to optimize decision rules for a just-in-time adaptive intervention (JITAI) to manage problem anger. This will be the first digital trial using micro-randomization to optimize a JITAI for problem anger in a population who have experienced trauma, and one of the few micro-randomized trials to optimize digital mental health tools to manage emotional dysregulation. Australia and New Zealand Clinical Trials Registry ACTRN12624001400550.

Linking childhood maltreatment to ICD-11 PTSD and CPTSD: Differential roles of insecure attachment and emotion dysregulation.

Neurobiological Signatures of Dyadic Transmission of Fear Extinction in Adolescent Trauma Exposure and Posttraumatic Stress.

Delirium is common in acute care, but its contribution to later posttraumatic stress disorder (PTSD) in adults remains unclear. This systematic review synthesizes evidence on post-delirium PTSD outcomes, including prevalence estimates, putative mechanisms, and associated risk/protective factors. Following PRISMA 2020, major scientific databases were searched for peer-reviewed studies in adults that (a) were conducted during an acute inpatient hospitalization (ICU or non-ICU) and (b) assessed subsequent PTSD via structured interviews and/or validated symptom measures. Given substantial heterogeneity in designs, assessments, follow-up timing, and reporting, a narrative synthesis was conducted. Twenty-one studies met inclusion criteria. PTSD prevalence ranged from 0% to 17.6% in studies using structured clinical interviews and from 5% to 74.5% in studies using self-report measures with heterogeneous timing and cut-offs. Nine studies reported meaningful associations between delirium and later PTSD outcomes, whereas several well-conducted cohorts reported null findings. Where associations were observed, they appeared more plausible when delirium was severe or prolonged and/or when patients reported highly threatening hallucinations/delusions and delusional ICU memories. Inconsistent adjustment for key confounders (e.g., illness severity, ventilation/sedation exposure, pre-existing mental health vulnerability) and variability in delirium/PTSD measurement likely contributed to mixed findings. Evidence is heterogeneous and does not support delirium as a uniformly traumatic exposure. Delirium may be relevant for PTSD outcomes in a subset of patients-particularly when perceived threat is high and memory integration is disrupted-within the broader context of severe illness and intensive care. Clinically, delirium prevention, trauma-informed care, and targeted follow-up screening after severe, prolonged or distressing delirium episodes appear warranted.

Childhood trauma is a well-known risk factor for somatic symptoms, but the psychological mechanisms behind this link remain insufficiently understood. This study explored the association between childhood trauma and somatic symptoms through epistemic trust and reflective functioning in emerging adults. Data from 2,041 emerging adults (M = 23.91 years, SD = 2.87; 72% identified as female) were analyzed. Latent profile analysis identified childhood trauma exposure profiles. Structural equation modeling tested a parallel-serial mediation model examining the direct and indirect effects of trauma on somatic symptoms (15-item Patient Health Questionnaire), with epistemic stances (trust, mistrust, credulity) and reflective functioning (uncertainty and certainty about mental states) as mediators. Indirect effects were estimated using bootstrapping with 1,000 resamples. Two trauma profiles emerged, high trauma (n = 626) and low trauma (n = 1,415), reflecting a pattern of generalized severity. Membership in the high-trauma profile was linked to greater somatic symptoms through two serial pathways. Trauma was associated with higher mistrust and credulity, which predicted greater uncertainty about mental states and, in turn, higher levels of somatic symptoms. In a second pathway, trauma-related mistrust, but not credulity, was linked to greater certainty about mental states, also predicting somatic symptoms. Findings highlight how early relational trauma is associated with maladaptive epistemic stances and impaired reflective functioning, which in turn was associated with greater vulnerability to somatic distress. Interventions aimed at restoring epistemic trust and tolerance for mental-state uncertainty may mitigate somatic symptoms among trauma-exposed emerging adults. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Sexual minority women, transgender people, and nonbinary (SMW/TNB) people experience disproportionately high rates of traumatic stressors (e.g., child abuse, sexual violence), which are associated with adverse trauma-related mental health outcomes, such as dissociation. SMW/TNB people also experience ongoing stressors related to their minoritized sexual and/or gender identities (e.g., discrimination). Dissociation has been associated with minority stressors in studies primarily using single-time point, cross-sectional approaches. Reliance on single-time point approaches may obscure how minority stressors and trauma-related outcomes, like dissociation, covary within individuals and unfold over time. We conducted a secondary analysis of data from a 14-day daily diary study with trauma-exposed SMW/TNB participants (N = 57) to examine whether variations in daily minority stressors were associated with same-day fluctuations in dissociation. Results indicated minority stressors and dissociation significantly covaried over the 14-day study period. Multilevel models showed that participants' reports of higher-than-average daily minority stressors were associated with same-day reports of higher-than-average dissociative symptoms, B = 0.24, 95% CI [0.07, 0.41], p =.007. Participants also reported small decreases in dissociation levels over the study period, B = -0.05, 95% CI [-0.08, -0.02], p =.004. The findings highlight the importance of considering the health impacts of consistent state elevations in dissociation associated with minority stressors for SMW/TNB people. Future time-varying approaches should investigate temporal sequencing of minority stressors and dissociation, assess whether minority stressors relate to dissociation independent of trauma exposure, and explore whether trauma exposure characteristics (e.g., identity-relatedness of trauma) moderate this association.

Sleep in children in foster care: A scoping review.

Background/Objectives: Research has shown a high prevalence of co-occurring trauma-related disorders and cocaine use disorder (CUD). However, there remains a need for preclinical studies to determine how traumatic event exposure influences vulnerability to CUD development and relapse. In this study, we assessed the impact of traumatic event exposure using a threat conditioning (TC) paradigm, which models traumatic event exposure through associative threat learning on cocaine-seeking behavior in adult male and female rats. Methods: Adult male and female rats were exposed to a single TC session. After TC, the rats underwent cocaine self-administration (SA), extinction training, cue-primed reinstatement, and cocaine-primed reinstatement testing. A parallel cohort was subjected to a sucrose SA cohort to assess whether TC altered non-drug reward seeking in the form of sucrose SA. Results: In the cocaine cohort, stressed male rats exhibited greater cue- and cocaine-primed reinstatement relative to non-stressed males, whereas no reinstatement differences emerged in female rats. In the sucrose cohort, stressed females displayed increased sucrose pellet delivery during self-administration compared to non-stressed females, but no differences were observed during sucrose reinstatement in either male or female rats. Conclusions: These findings indicate that trauma exposure prior to cocaine use influences cocaine relapse-related behavior, as well as non-drug reward reinforcement earning, in a sex-specific manner. Overall, these results highlight the value of associative stress models such as TC for studying trauma–addiction comorbidity and the need to investigate the neurobiological mechanisms driving these sex-specific outcomes.

Background Trauma has a profound impact on both psychological and physiological functioning, with sleep disturbances—particularly nightmares—emerging as one of the most commonly reported symptoms. These sleep disruptions often co-occur with cognitive difficulties, affecting memory and attention. Purpose The present study aimed to explore the relationship between trauma history, nightmare frequency and their effects on cognitive functions such as memory and concentration among young adults aged 18–30. Methods A sample of 22 participants was surveyed using a structured questionnaire designed to assess trauma exposure, sleep quality, nightmare frequency and self-reported cognitive performance. Data were analysed to identify associations between trauma experiences, sleep disturbances and cognitive outcomes. Results Individuals with a history of trauma reported more frequent nightmares and poorer sleep quality. A notable association was observed between frequent nightmares and cognitive difficulties, particularly memory lapses and problems with concentration. Participants experiencing regular nightmares also reported higher levels of daytime impairment, indicating a link between nocturnal distress and reduced cognitive efficiency. Conclusion The findings highlight the significance of recognising nightmares not only as a symptom of trauma but also as a contributing factor to cognitive challenges. Integrating sleep-focused interventions into trauma-informed care may enhance cognitive well-being and overall functioning among affected individuals. This study adds to the growing evidence underscoring the interconnectedness of trauma, sleep and cognitive health.

ABSTRACT Objectives Experiential avoidance is the unwillingness to come into contact with aversive internal experiences. Trauma exposure is associated with greater experiential avoidance and insomnia symptoms. Experiential avoidance may perpetuate insomnia symptoms in patients with posttraumatic stress disorder (PTSD). We examined the relationship between experiential avoidance and insomnia symptoms among veterans with PTSD (based on the Clinician-Administered PTSD Scale for DSM-5). Method The sample included 93 veterans (M = 54.7 years; 86.0% male) who attributed their sleep disturbance onset to experiences of trauma on the CAPS-5. Experiential avoidance, insomnia, sleep disturbance, daytime sleepiness, and daytime consequences were measured with the Brief Experiential Avoidance Questionnaire (BEAQ), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and International Classification of Sleep Disorders (ICSD) items. We conducted multiple linear regressions with age, sex, and BEAQ as the independent variables and sleep variables as the dependent variables. Results There were significant positive associations between the BEAQ and the ISI, PSQI daily disturbance factor, ESS, and ICSD daytime consequences. Conclusions Greater experiential avoidance was associated with worse insomnia symptoms and consequences, particularly daytime dysfunction. Experiential avoidance may be an overlooked, but relevant treatment target for patients with comorbid insomnia and PTSD.

ABSTRACT Despite the formal end of the conflict, healthcare workers (HCWs) in Afghanistan continue to face chronic exposure to trauma, placing them at heightened risk for psychological distress and post-traumatic stress disorder (PTSD) symptoms. This study aimed to identify key psychological predictors of PTSD severity in this population, and to examine whether resilience, self-compassion, and perceived social support mediate or moderate the relationship between trauma exposure and post-traumatic symptoms. Fifty-four HCWs working at the Emergency NGO Surgical Center for War Victims in Kabul and Lashkar-Gah, Afghanistan, completed an online survey assessing trauma exposure, PTSD symptoms, anxiety, depression, resilience, self-compassion, and perceived social support. Multiple regression analyses and mediation analyses via Structural Equation Modeling (SEM) were conducted to examine predictors and mediation effects. Higher levels of depression, anxiety, and trauma load were significantly associated with greater PTSD severity, while higher resilience was linked to lower symptom severity. Among all variables, depressive symptoms emerged as the strongest predictor. SEM supported this finding, revealing that depression significantly mediated the relationship between trauma load and PTSD symptoms. No significant mediating effects were found for anxiety, resilience, perceived social support, or self-compassion. These findings highlight the central role of depression in the development and maintenance of PTSD symptoms among HCWs exposed to chronic instability trauma. The results underscore the need for trauma-informed, culturally sensitive interventions that include early detection and treatment of depressive symptoms to mitigate the psychological burden on humanitarian staff in conflict settings.

Abstract Previous research has shown that exposure to traumatic history, such as visits to Holocaust memorials or death camps, can have detrimental effects on people’s psychological well-being. There is relatively little research showing how these negative consequences could be mitigated. Based on previous studies in which humor is an effective way to cope with stress and difficult situations, we tested how humor in memes can help cope with exposure to traumatizing historical content. An online experiment ( N = 197) was conducted in which we showed participants a video of the Auschwitz-Birkenau Museum and then tested their reactions depending on which memes they viewed (Holocaust-related vs. everyday life-related vs. no memes). The study found that individuals who effectively use humor as a coping mechanism and who view memes related to traumatic historical contents (such as Holocaust-related memes) experience a more positive mood after exposure to traumatic stimulus than those who watch everyday memes or no memes. Results suggest that humor may be an effective form of reducing the negative consequences of confrontations with traumatic historical contents.

ABSTRACT Background: North Korean defectors (NKDs), a predominantly trauma-exposed population, are at high risk for somatic symptoms. Unrecognized and untreated somatic symptoms can profoundly affect health and psychosocial functioning. Therefore, it is crucial to understand and address somatic symptoms in the NKD population. Objective: This study aimed to assess the prevalence of somatic symptoms and to identify and quantify their correlates among trauma-exposed NKDs. Method: Cross-sectional survey data of 438 trauma-exposed NKDs in South Korea were analyzed. Participants completed a survey assessing somatic symptoms, sociodemographic, trauma-related (repatriation experience, trauma exposure, probable post-traumatic stress disorder [PTSD] and disturbances in self-organization [DSO]), health-related (physical activity), and social (loneliness and perceived discrimination) characteristics. Results: Overall, 42 of the 438 NKDs reported moderate-to-severe somatic symptoms. Multiple linear regression and relative importance analyses revealed that higher levels of loneliness (β = 0.27, p < .001; 25.2% relative variance explained [RVE]) was the strongest correlates of somatic symptoms, followed by older age (β = 0.24, p < .001; 17.2% RVE), probable PTSD (β = 0.14, p = .001; 14.6%), greater perceived discrimination (β = 0.15, p = .001; 14.5%), and probable DSO (β = 0.10, p = .026; 13.0% RVE). Conclusions: This study provides evidence of the high severity of somatic symptoms among NKDs. Further research is needed to develop and test culturally appropriate interventions to address loneliness and perceived discrimination of NKDs, especially those with comorbid PTSD and DSO symptoms, to help mitigate somatic symptoms.

Hurricane Helene made landfall in the United States as a Category 4 hurricane on September 26, 2024. Its impacts spanned nearly 500 miles and six states; most notably, it devastated economically disadvantaged Appalachian communities hundreds of miles inland who were unprepared to deal with the storm. Previous research provides some insights into contextual and individual risk factors commonly associated with posttraumatic stress symptoms (PTSS) and disorder (PTSD) following disasters, however each disaster is unique and so are its impacts. Accordingly, the present study sought to characterize the traumatic impact of Hurricane Helene, including associations with PTSS/PTSD, in a sample of 544 individuals exposed to Hurricane Helene (Mage = 46.1, 85.9% White). Participants completed self-report surveys of hurricane exposure, PTSS, lifetime trauma exposure, and peritraumatic and posttraumatic PTSD risk factors between 4-8 weeks poststorm and a series of linear and logistic regressions were computed. Consistent with local reporting, Appalachian participants in our sample endured more severe traumatic impacts of the storm compared to those in non-Appalachian communities. Approximately 26% of the full sample screened positive for probable PTSD, including 38.3% of directly impacted Appalachian participants. Consistently across the full sample and among directly impacted Appalachian participants, economic factors, having one's home damaged or destroyed, and loss of access to safe water were associated with PTSS and/or PTSD. Peritraumatic fear was particularly salient for directly impacted Appalachian participants. Findings offer insight into the survivors of Hurricane Helene most impacted by the storm, informing mental health intervention efforts. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Background The October 7, 2023 attacks in Israel and the ensuing Iron Swords War triggered a widespread mental health crisis. In this context, online cognitive behavioral therapy (CBT) has emerged as an accessible and convenient option. Objective To characterize individuals who sought out online CBT during the war, with regard to their sociodemographic characteristics, wartime exposures, and self-reported psychological distress and to evaluate the associations between sub-populations characteristic and psychological distress severity. Methods Data were analyzed from electronic medical records of civilians who contacted Sheba BEYOND’s virtual CBT clinic between November 2023 and August 2024. Sociodemographic characteristics, psychiatric history, and wartime exposures were available for 520 adults, 199 of whom also completed standardized psychological questionnaires (including PDS-5, GAD-7, PHQ-9) which were used to measure sever psychological symptoms of PTSD, anxiety and depression. Results Individuals seeking online services during the war represented a diverse population in terms of their socio-demographic background (e.g., age range; level of educational, employment status, and place of residence) and war-related experiences. High rates of psychological symptoms were observed: 62.3% of respondents scored ≥36 on the PDS-5, 43.2% met criteria for severe anxiety (GAD-7 score ≥15), and 20.1% met criteria for severe depression (PHQ-9 score ≥20). The multivariable model indicated that displaced individuals were at a significantly elevated risk for PTSD (OR = 6.33; 95% CI 1.74–23.05), for anxiety symptoms (OR = 4.67; 95% CI 1.76–12.41), and for depressive symptoms (OR = 2.97; 95% CI 1.05–8.36). In addition, history of interpersonal trauma was associated with increase the risk of severe PTSD, anxiety, and depressive symptoms. Discussion The high level of psychological distress observed in this study highlight the importance of accessible wartime mental health care. By reaching populations across diverse sociodemographic backgrounds and varying levels of trauma exposure, online interventions demonstrate the potential feasibility and accessibility necessary to provide mental health support during time of crisis. The identification of both high symptom severity rates and subpopulation at higher risk provides valuable information for future preparedness for such services during emergencies.

Military veterans in later adulthood are at increased risk for chronic posttraumatic stress disorder (PTSD), often characterized by cumulative trauma exposure, high levels of psychiatric and medical comorbidity, and prolonged symptom persistence. Although several evidence-based psychotherapies for PTSD are available, their effectiveness and clinical characteristics when implemented with older, non-active military veterans remain insufficiently synthesized. This integrative review aimed to examine psychotherapeutic interventions for PTSD in this population, focusing on intervention types, clinical outcomes, treatment acceptability, and strength of evidence. Following Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols guidelines, a comprehensive search was conducted in March 2024 across five electronic databases. Quantitative, qualitative, mixed-methods studies, and case studies published in English or Portuguese were eligible for inclusion. Of the 1,073 records identified, 23 studies met the inclusion criteria. Trauma-focused interventions were the most frequently studied, including prolonged exposure (PE), cognitive processing therapy (CPT), and exposure-based variants. Among studies with sufficient statistical reporting, trauma-focused therapies demonstrated the most consistent reductions in PTSD symptoms, with moderate to large effect sizes reported for PE, CPT, and multimodal motion-assisted memory desensitization and reconsolidation (3MDR). In contrast, relaxation-based and psychoeducational interventions were associated with smaller, inconsistent, or non-significant effects. Overall, findings support trauma-focused psychotherapies as the most robustly supported interventions for reducing PTSD symptoms in older, non-active military veterans. However, substantial heterogeneity in study design, outcome measurement, statistical reporting, and methodological quality limits comparability across studies and precludes quantitative synthesis, underscoring the need for more rigorous and standardized research to inform clinical decision-making in this aging veteran population.

Emotion regulation plays a role in the development of posttraumatic stress symptoms (PTSS). Most research in this area has focused on how people regulate their emotions, a process called self-emotion regulation (self-ER). Self-ER strategies are well-established predictors of PTSS. However, people also regulate their emotions with the help of others, a process called social emotion regulation (social ER). Relative to self-ER, social ER is understudied, and its associations with PTSS and self-ER are unclear. Therefore, we used network analysis to examine the associations among self-ER, social ER, and PTSS. Adults with a history of direct trauma exposure (N = 1,061) reported their use of four social ER strategies (soothing, social modeling, perspective taking, and enhancing positive affect), two self-ER strategies (cognitive reappraisal and expressive suppression), and PTSS. We identified ER nodes that had the largest bridge expected influence (EI) centrality with PTSS. Expressive suppression, a self-ER strategy, had the strongest bridge EI centrality in the network, followed by soothing and social modeling, both of which are social ER strategies. Although longitudinal research is needed to establish the direction of effects, these findings underscore the importance of evaluating the roles of both self and social ER in the development and maintenance of PTSS.

Transgender and nonbinary individuals (TNBI) face disproportionate exposure to identity-based discrimination and violence, yet limited research has examined how discrimination prospectively influences trauma adaptation. This longitudinal study examined predictors of posttraumatic stress disorder (PTSD) symptom adaptation among TNBI (N = 75, Mage = 30.6 years, 48.0% White, 44.0% nonbinary, 77.3% met PTSD criteria) with past-year DSM-5 Criterion A trauma exposure who completed structured diagnostic interviews and daily diary assessments at baseline and 3-, 6-, and 12-month follow-ups. Mixed linear modeling was used to estimate PTSD adaptation as a function of trauma characteristics and gender minority stress/resilience. A small, significant PTSD symptom reduction was observed over time, B = -0.44, p <.001. Average PTSD symptoms over time were significantly higher for participants with greater gender nonaffirmation exposure, B = 0.43, p =.039, and those who met the criteria for a mood disorder, B = 10.70, p <.001, at baseline. Participants whose "worst" trauma exposure entailed interpersonal violence, B = 9.26, p =.009; were revictimized, B = 7.83, p =.006; and experienced higher exposure to daily discrimination during the follow-up period, B = 0.52, p <.001, demonstrated significantly higher average PTSD symptom severity over time. Unexpectedly, identity pride was associated with significantly higher PTSD symptoms over time, B = 0.36, p =.031, whereas community connectedness was marginally associated with lower symptoms, B = -0.57, p =.054. Findings underscore the roles of identity affirmation, discrimination, and revictimization in shaping TNBI trauma adaptation.

The trauma film paradigm (TFP) is a widely used analog assessment for studying reactivity to trauma exposure. Psychometrically established in the laboratory, the TFP has not been validated in a virtual format, which could broaden the application of this methodology. In a fully controlled, randomized experimental design, the virtual TFP was compared to the in-lab TFP, as well as virtual and in-lab neutral film paradigms among female undergraduate students (N = 92, n = 23 per condition). It was hypothesized that the virtual and in-lab TFPs would be comparable, and both would elicit more negative emotion and greater intrusion frequency, than the virtual and in-lab neutral film paradigms. Using a 4 × 6 mixed between- and within-subject analysis of variance, a significant interaction was found between condition and time on emotion changes. Both the virtual and in-lab TFP elicited more negative emotion than the virtual and in-lab neutral film paradigms across all time points. A negative binomial regression showed significantly greater postfilm involuntary memory intrusions in the TFP conditions, and virtual and in-person conditions did not differ. Findings supported the utility of the virtual TFP methodology as an experimental method, which should extend the reach and accessibility of this paradigm. (PsycInfo Database Record (c) 2026 APA, all rights reserved).