Treatment Of Posttraumatic Stress Disorder Research Articles

Examining Ethnoracial Differences in Retention in Evidence-Based Treatments for Posttraumatic Stress Disorder Secondary to Military Sexual Trauma.

Improving and expanding mental health treatment for Veterans who have experienced military sexual trauma (MST) is currently a top priority in Veterans Healthcare Administration. Many of these Veterans develop posttraumatic stress disorder (PTSD), and there is increasing recognition that diversity is a core treatment consideration for Veterans who have experienced trauma. As such, more information is needed concerning the relationship between trauma-focused treatment attrition and ethnoracial identity in Veterans who have experienced MST. This article presents two studies exploring dropout from a Midwestern Department of Veterans Affairs (VA) PTSD clinic in samples of Veterans who experienced MST. These studies aim to reduce this knowledge gap by contrasting Black and White Veterans' retention in trauma-focused care. In Study 1 (n = 141), we examined ethnoracial differences in dropout in a cohort of treatment-seeking Veterans who experienced MST and engaged in cognitive processing therapy (CPT) in a VA specialty PTSD clinic. In Study 2 (n = 109), we explored the same questions related to treatment attrition in a separate cohort of treatment-seeking Veterans who experienced MST and engaged in prolonged exposure (PE) in a VA specialty PTSD clinic. Results from both studies did not indicate ethnoracial differences in attrition rate (for both total sessions and an 8-week minimally adequate care [MAC] window) across evidence-based PTSD treatment. However, it remains important to consider the impact of racial and cultural factors on retention. Future research should aim to recruit a larger racially and ethnically diverse sample to explore possible varying retention outcomes of CPT and PE for MST-related PTSD.

PSTD Treatment of Joint Forces Operation Combatants: A Case Study.

The participation of military personnel in operations like the Anti-Terrorist Operation (ATO)/Joint Forces Operations (JFO) can lead to significant psychological trauma, potentially resulting in posttraumatic stress disorder (PTSD). Understanding the effectiveness of psychotherapy in treating PTSD among ATO/JFO participants is crucial given its profound impact on personal relationships, life scenarios, and overall well-being. This study evaluates how acceptance and commitment therapy can alleviate PTSD symptoms and enhance well-being in Ukrainian military personnel with combat-related PTSD. The main research method was a psychological experiment, and the case study method was used as an auxiliary research method. The study revealed the following: combatants in the ATO/JFO who have been diagnosed with PTSD should be classified as persons with disabilities due to certain limitations in their life activities, namely, the inability to control their behavior, and difficulties in work and communication. This study proves that cognitive-behavioral psychotherapy has a clear advantage in overcoming PTSD in the military, as it allows transforming psychological trauma into posttraumatic growth. Attachment and acceptance therapy, a form of behavioral therapy, has emerged as one of the most effective treatments for PTSD. It focuses on diagnosing and addressing the psychological consequences of war by analyzing the connections among cognition, affect, and behavior. Given the protracted nature of PTSD, the practical significance of the study is to develop effective psychotherapeutic interventions for the expected recovery of ATO/JFO participants affected by combat operations.

Symphony of Success: Leader-Practitioner Reciprocity during Evidence-Based Practice Implementation

This study aimed to explore the reciprocal relationships between implementation leadership and practitioner implementation citizenship behavior during the implementation of evidence-based practices (EBPs). Data were collected at two timepoints with a time lag of six months during a national implementation of evidence-based treatment for post-traumatic stress disorder in Norwegian mental health clinics. Data from 72 leaders and 346 practitioners were analyzed with a two-wave cross-lagged panel model, accounting for the nested structure and adjusting for demographic variables. Significant positive autoregressive effects for both implementation leadership and implementation citizenship behavior indicated some stability in ratings across time. Significant cross-lagged effects in both directions indicated that practitioners who experienced greater implementation leadership from their leaders demonstrated greater implementation citizenship behavior six months later, and vice versa. Findings hence supported both the social exchange hypothesis and the followership hypothesis, suggesting reciprocal associations between the constructs. The findings underscore the mutually influential relationship between leaders’ behavior and practitioners’ engagement in citizenship behavior during EBP implementation. The study emphasizes the importance of interventions focusing on leadership behaviors that encourage practitioner engagement and mutually beneficial behavior patterns, highlighting the reciprocal and vital roles that both leaders and practitioners play in successful EBP implementation.

The association between posttraumatic stress disorder symptom severity and distress tolerance in traumatic stress treatment.

Distress tolerance, or the perceived ability to tolerate negative emotional states, is often associated with posttraumatic stress disorder (PTSD) such that higher distress tolerance is generally associated with less severe PTSD symptom levels. As distress tolerance is often considered a risk and maintenance factor in distress disorders, examining the association between changes in distress tolerance and changes in PTSD symptoms may have clinical relevance. The present study examined the associations between PTSD symptom severity and distress tolerance across three assessment points over 12 weeks among 212 patients receiving outpatient psychotherapy services. Using random-intercept cross-lagged panel modeling (RI-CLPM), concurrent and prospective associations between PTSD and distress tolerance were examined. PTSD symptoms at Time 1 and Time 2 significantly predicted distress tolerance at Time 2, β = -.296, and Time 3, β = -.395, respectively. Distress tolerance did not predict subsequent PTSD symptom severity. Exploratory analyses examined distress tolerance and four PTSD symptom clusters over time. Patterns of results differed across clusters, though it was consistent that only PTSD symptom clusters predicted subsequent distress tolerance and not vice versa. The results support the interrelationship of changes in psychopathology and emotional distress tolerance and indicate that distress tolerance may be an important factor in symptom remission during PTSD treatment.

Protective and vulnerability personality traits associated with PTSD diagnosis after preterm delivery.

Giving birth prematurely is a traumatic event that has many consequences for the mother but also for her baby and their family. Studies have shown that about a quarter of these mothers will suffer from post-traumatic stress disorder (PTSD) as a result. This study aims to identify internal personality factors associated with the development of PTSD in mothers who gave birth before 33 weeks. The results revealed significant correlations between two personality dimensions (neuroticism and extraversion) and the likeliness of developing PTSD in mothers who gave birth prematurely. Neuroticism is positively liked with the disorder while extraversion is negatively correlated with it. Studies should now focus on early detection of PTSD and better interventions for these mothers.

Reductions in PTSD severity precede reductions in pain intensity among veterans receiving intensive treatment.

Chronic pain often co-occurs with posttraumatic stress disorder (PTSD). The mutual maintenance hypothesis proposes that there may be shared underlying mechanisms of symptoms of pain exacerbating PTSD, and vice versa. The association between PTSD and pain intensity remains understudied. To elucidate the relationship, the present study examined the temporality of changes in PTSD severity and pain intensity in veterans undergoing intensive PTSD treatment. Data from 332 veterans undergoing intensive 2-week cognitive processing therapy- (CPT-) based treatment (ITP) with adjunctive components (i.e., mindfulness, art therapy). Random intercepts cross-lagged panel models (RI-CLPMs) were used to examine within-subjects relationships between pain intensity and PTSD severity over the course of the program. Veterans experienced large PTSD severity reductions (Essg = 1.20; p < .001) and small pain severity reductions (Essg = 0.21; p < .001) over the course of treatment, despite pain not being a treatment target. RI-CLPMs revealed that PTSD severity significantly predicted subsequent pain severity. Results indicate the absence of a bidirectional relationship in that changes in pain intensity did not predict later PTSD severity improvement during the ITP. Time trends for both PTSD severity and pain intensity were generally consistent with respect to baseline demographic characteristics. Our findings support the mutual maintenance regarding the association between PTSD and pain intensity. Future research should investigate temporal associations in other evidence-based PTSD treatments and formats and evaluate the long-term impacts of PTSD treatment on pain intensity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Serum cortisol and neuroticism for post-traumatic stress disorder over 2 years in patients with physical injuries.

This study aimed to explore the relationships between serum cortisol levels, personality traits, and the development of Post-Traumatic Stress Disorder (PTSD) over 2 years among individuals with physical injuries. Participants were consecutively recruited from a trauma center and followed prospectively for 2 years. At baseline, serum cortisol levels were measured, and personality traits were categorized into five dimensions (Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness), using the Big Five Inventory-10. The diagnosis of PTSD during follow-up (at 3, 6, 12, and 24 months post-injury) was determined using the Clinician-Administered PTSD Scale for DSM-5. Binary and multinomial logistic regression analyses were conducted to examine the interactions between cortisol levels, personality traits, and PTSD development. Among 923 patients analyzed, 112 (12.1%) were diagnosed with PTSD at some point during the study period, with prevalence rates decreasing from 8.8% at 3 months to 3.7% at 24 months post-injury. Direct associations between cortisol levels or personality traits and PTSD were not observed. However, a significant interaction between lower cortisol levels and higher Neuroticism in relation to PTSD risk was identified, especially during the early follow-up periods (3 to 6 months), but this association waned from the 12-month follow-up onward. Our findings reveal Neuroticism-dependent associations between serum cortisol levels and PTSD development, exhibiting temporal variations. These results suggest that PTSD development may be influenced by a complex, time-sensitive interplay of biological and psychosocial factors, underscoring the importance of considering individual differences in stress reactivity and personality in PTSD research and treatment.

A Meta-Analysis of Interpersonal and Psychodynamic Psychotherapies for Posttraumatic Stress Disorder.

Established trauma-focused cognitive-behavioral therapies for posttraumatic stress disorder (PTSD) have remission rates of approximately 30%-40%. Alternatively, interpersonal psychotherapy (IPT) and psychodynamic psychotherapy (PDT) focus on disrupted attachment, mentalization, and social connection in PTSD and may help some patients. The authors conducted a meta-analysis on these interpersonal and affect-oriented approaches to treating PTSD. Building on a prior meta-analysis, the authors searched for randomized controlled trials (RCTs) comparing IPT or PDT with other established PTSD treatments or control conditions for adults diagnosed as having PTSD. Random-effects meta-analyses were conducted to assess outcome effect sizes and dropout rates. RCTs were rated via the Randomized Controlled Trial Psychotherapy Quality Rating Scale. Ten RCTs (eight of IPT) comparing IPT or PDT with control (k=7) or active treatment (k=4) conditions were identified, nine of which were of adequate quality. IPT (k=5) and PDT (k=2), when analyzed together, were superior to control conditions overall (g=-1.14, p=0.011 [as was IPT alone: g=-0.88, p=0.034]) and to waitlist (g=-1.49) and treatment-as-usual (g=-0.70) groups. Effect sizes, however, may have been inflated by outliers or publication bias. IPT (k=3) and PDT (k=1), when analyzed together, were equally efficacious compared with other active PTSD treatments (primarily exposure-based psychotherapies), as was IPT alone, and had lower dropout rates (relative risk=0.63, p=0.049 for IPT and PDT analyzed together; relative risk=0.61, p=0.098 for IPT alone). Affect-focused therapies hold promise in the treatment of PTSD. IPT has demonstrated efficacy in multiple trials, whereas the evidence base for PDT is sparse.

The efficacy of psychological interventions for posttraumatic stress disorder symptoms in incarcerated forensic populations: A meta-analysis of randomized controlled trials.

Given the high prevalence of posttraumatic stress disorder (PTSD) symptoms in incarcerated forensic populations, this meta-analysis estimated the efficacy of interventions in this field and explored predictors of intervention outcomes. Twelve randomized controlled trials of psychological interventions for PTSD symptoms in incarcerated forensic populations were included. A combined Hedges's g effect size was synthesized, quality assessments and risk of bias analyses were performed, and publication bias was assessed. Gender and type of control group were explored as predictors. Thirteen comparisons from 12 studies were included in the main analysis. A small to medium combined effect size (g = 0.43, p = .005) was found at posttreatment. The type of control group (p = .156) and gender (p = .953) did not predict outcomes. When we analyzed the available follow-up data (k = 5), the effect was nonsignificant (g = 0.36, p = .123). Study quality was poor and risk of bias high, and studies of first-line PTSD treatments were not found in the literature. A few studies suggest that PTSD treatment may improve symptoms in incarcerated forensic populations, at least temporarily. Follow-up data are still too scarce to draw conclusions about long-term outcomes. Findings of this study indicate that methodologically rigorous outcome research in these populations is needed, with a specific focus on first-line PTSD treatments, long-term efficacy, measurement of recidivism, as well as addressing comorbid conditions given the common complex clinical and social needs in this population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Role of ventral tegmental area dopamine neurons in fear memory retention in post-traumatic stress disorder model rats

Ventral tegmental area (VTA) dopamine (DA) neurons have been found to substantially associate with post-traumatic stress disorder (PTSD) pathology, however, whether and how these DA neurons affect fear memory management in PTSD individuals remains largely unknown. In this study, we utilized auditory conditioned foot-shock to evaluate the fear memory retrieval and retention characteristics in a single prolonged stress-induced PTSD rat model. We employed chemogenetic technology to specifically activate VTA DA neurons to examine the freezing behaviors responding to the conditioned stimuli. In vivo extracellular electrophysiological analyses were used to identify VTA DA neuronal firing alterations due to the chemogenetic activation. The results demonstrated that PTSD model rats showed comparable fear memory retrieval (Day 2 after the conditioned foot-shock), but significant enhancements in fear memory retention (Day 8 after the conditioned foot-shock), compared to normal control rats. Chemogenetic activation of VTA DA neurons markedly diminished the retention of fear memory in PTSD model rats, which appeared concomitantly with increases in the firing activities of the DA neurons. These findings revealed that PTSD induced the persistence of fear memory, which could be attenuated by activation of VTA DA neurons. It is presumed that VTA dopaminergic signals may serve as a prospective option for PTSD treatment.

Exploration of stress reactivity and fear conditioning on intrusive memory frequency in a conditioned-intrusion paradigm

Background and objectivesThe conditioned-intrusion paradigm was designed to provide insight into the relationship between fear conditioning and intrusive memory formation, which is relevant to understanding posttraumatic stress disorder symptoms and treatment. However, boundary conditions of this new paradigm have not been explored and it is currently not known whether findings from this work are valid in a clinical context. MethodsIn the current study, we explored the relationship between stress reactivity to trauma film clips, usual exposure to violent media, renewal of fear conditioning using skin conductance as well as subjective ratings, and the effect of shock versus film clip during conditioning on the frequency of intrusive memories. An adapted fear conditioning paradigm using trauma clips as unconditional stimuli was used, and participants subsequently reported intrusive memories of the trauma clips. ResultsSkin conductance responses to conditioned stimuli paired with shocks and film clips were significantly higher than conditioned stimuli paired with film clips alone. Subjective stress reactivity, previous exposure to violent media, and film valence rating were associated with the frequency of intrusive memories. No aspects of fear conditioning were associated with intrusive memories, and factor analysis suggested the fear conditioning and stress related to film clip viewing were mostly separate constructs. Similarly, content and triggers of intrusive memories were usually film-clip related rather than conditional stimulus related. LimitationsWe did not observe strong conditioning effects of the unconditional stimuli to conditional stimuli, which were shapes rather than high frequency stimuli such as faces. ConclusionsThese findings provide potential boundary conditions for this paradigm and suggest multiple ways in which the validity of the paradigm can be tested in the future.

Acute Neurobehavioral and Glial Responses to Explosion Gas Inhalation in Rats.

Military personnel, firefighters, and fire survivors exhibit a higher prevalence of mental health conditions such as depression and post-traumatic stress disorder (PTSD) compared to the general population. While numerous studies have examined the neurological impacts of physical trauma and psychological stress, research on acute neurobehavioral effects of gas inhalation from explosions or fires is limited. This study investigates the early-stage neurobehavioral and neuronal consequences of acute explosion gas inhalation in Sprague-Dawley rats. Rats were exposed to simulated explosive gas and subsequently assessed using behavioral tests and neurobiological analyses. The high-dose exposure group demonstrated significant depression-like behaviors, including reduced mobility and exploration. However, neuronal damage was not evident in histological analyses. Immunofluorescence revealed increased density of radial glia and oligodendrocytes in specific brain regions, suggesting hypoxia and axon damage induced by gas inhalation as a potential mechanism for the observed neurobehavioral changes. These findings underscore the acute impact of explosion gas inhalation on mental health, highlighting the habenula and dentate gyrus of hippocampus as the possible target regions. The findings are expected to support early diagnosis and treatment strategies for brain injuries caused by explosion gas, offering insights into early intervention for depression and PTSD in affected populations.

Neurobiology and Treatment of Posttraumatic Stress Disorder.

The recent worldwide surge of warfare and hostilities exposes increasingly large numbers of individuals to traumatic events, placing them at risk of developing posttraumatic stress disorder (PTSD) and challenging both clinicians and service delivery systems. This overview summarizes and updates the core knowledge of the genetic, molecular, and neural circuit features of the neurobiology of PTSD and advances in evidence-based psychotherapy, pharmacotherapy, neuromodulation, and digital treatments. While the complexity of the neurobiology and the biological and clinical heterogeneity of PTSD have challenged clinicians and researchers, there is an emerging consensus concerning the underlying mechanisms and approaches to diagnosis, treatment, and prevention of PTSD. This update addresses PTSD diagnosis, prevalence, course, risk factors, neurobiological mechanisms, current standard of care, and innovations in next-generation treatment and prevention strategies. It provides a comprehensive summary and concludes with areas of research for integrating advances in the neurobiology of the disorder with novel treatment and prevention targets.

Are equine-assisted services beneficial for military veterans with post-traumatic stress disorder? A systematic review and meta-analysis

BackgroundEquine-assisted services (EAS) involves the use of horses within therapy, learning or horsemanship sessions and has been used with military veterans suffering from post-traumatic stress disorder (PTSD). This study systematically reviewed existing research on the use of EAS in the treatment of PTSD in military veterans and evaluated its effectiveness.MethodsA systematic review was performed, in May 2023, with searches and data extraction carried out from three separate databases (PubMed, JSTOR and Science Direct) related to testing the effect of EAS on PTSD outcomes in veterans. A risk of bias assessment of included studies was conducted and meta-analysis of outcomes performed when two or more studies reported the same outcomes. Other effects of EAS on veterans’ health were also discussed.ResultsA total of 13 studies were identified based on our inclusion and exclusion criteria with 11 originating from the US and the remaining two from Australia and Israel. There were 344 participants amongst all of the studies with a mean age of 47 years and a male:female ratio of 19:6. Eight out of the 13 studies reported PTSD scores, as measured by either PTSD Checklist for DSM-5 (PCL-5) or PCL-Veteran/-Military versions (PCL-V/-M), and results suggested a reduction in PTSD score after EAS treatment of 22.6%. A meta-analysis confirmed that EAS favored a significantly lower PTSD score after treatment, with a mean difference of 12.46, 95% CI [9.03,15.88], p < 0.00001. However, only one study had low risk of bias whilst all the rest of the studies had some concerns to high risk of bias.ConclusionsEAS appeared to have a positive influence on PTSD symptoms in military veterans, significantly reducing PTSD severity scores. Other benefits of EAS may be peer support, social integration, learning new skills and bonding. However, the results of this systematic review must be interpreted with caution as almost all of the studies were of low quality. Therefore, further rigorous research is required with larger participants to be able to draw conclusions about the benefits of EAS on PTSD severity.

Do psychological treatments for PTSD in children and young people reduce trauma-related appraisals? A systematic review and meta-analysis

Research is increasingly highlighting the role of negative trauma-related appraisals in child and adolescent post-traumatic stress disorder (PTSD). The cognitive model of PTSD claims that an essential mechanism of treatment is a reduction in these appraisals. The current systematic review with meta-analysis investigated the extent to which psychological treatments for PTSD reduce negative trauma-related appraisals in children and adolescents. Four databases (PsycINFO, Medline Complete, CINAHL Complete and PTSDpubs) were searched on the 11–12th December 2022. The Risk of Bias 2 (ROB-2) tool was used to assess for risk of bias. Thirteen studies were included in this review, comprising 937 child and adolescent participants. Using a random effects model to perform the meta-analysis, a medium pooled effect size for the effect of current treatments on trauma-related appraisals was found (g = −.67, 95% CI [-.86, −.48]). There was only a moderate level of heterogeneity between studies (I2 = 44.4%), increasing the confidence with which these findings can be interpreted. These results indicate that psychological treatments for child and adolescent PTSD significantly reduce negative trauma-related appraisals. However, it is important to note that no trial included in the review was categorised as having low risk of bias.

Targeted memory reactivation to augment treatment in post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a psychiatric disorder with traumatic memories at its core. Post-treatment sleep may offer a unique time window to increase therapeutic efficacy through consolidation of therapeutically modified traumatic memories. Targeted memory reactivation (TMR) enhances memory consolidation by presenting reminder cues (e.g., sounds associated with a memory) during sleep. Here, we applied TMR in PTSD patients to strengthen therapeutic memories during sleep after one treatment session with eye movement desensitization and reprocessing (EMDR). PTSD patients received either slow oscillation (SO) phase-targeted TMR, using modeling-based closed-loop neurostimulation (M-CLNS) with EMDR clicks as a reactivation cue (n= 17), or sham stimulation (n= 16). Effects of TMR on sleep were assessed through high-density polysomnography. Effects on treatment outcome were assessed through subjective, autonomic, and fMRI responses to script-driven imagery (SDI) of the targeted traumatic memory and overall PTSD symptom level. Compared to sham stimulation, TMR led to stimulus-locked increases in SO and spindle dynamics, which correlated positively with PTSD symptom reduction in the TMR group. Given the role of SOs and spindles in memory consolidation, these findings suggest that TMR may have strengthened the consolidation of the EMDR-treatment memory. Clinically, TMR vs. sham stimulation resulted in a larger reduction of avoidance level during SDI. TMR did not disturb sleep or trigger nightmares. Together, these data provide first proof of principle that TMR may be a safe and viable future treatment augmentation strategy for PTSD. The required follow-up studies may implement multi-night TMR or TMR during REM sleep to further establish the clinical effect of TMR for traumatic memories.

Feasibility, Safety, and Acceptability of Cognitive Processing Therapy for PTSD Following a Recent Suicide Attempt: A Case Study

While cognitive processing therapy (CPT) has been found to be highly effective in the treatment of posttraumatic stress disorder (PTSD) and comorbid suicidal ideation, it is unknown how soon after a suicide attempt this treatment may be safe and effective. This case study investigates the effectiveness of weekly, telehealth-delivered CPT for a client with PTSD following a suicide attempt on the anniversary of a traumatic event. Results indicate a clinically meaningful reduction in PTSD symptoms and loss of PTSD diagnosis, as measured by the PTSD Checklist for DSM-5 (PCL-5), and a lack of further suicidal ideation or attempts. These results were maintained at long-term follow-ups at 1-, 3-, and 12-month periods. Qualitative data from the client further supported the effectiveness and acceptability of treatment. This case study suggests the potential of CPT as a valuable intervention for individuals with PTSD recovering from suicide attempts and highlights the importance of further research in this area. In support of this, the case study also suggests the use of nuanced suicide risk assessments, such as the fluid vulnerability theory (FVT), to respond to fluctuations in suicide risk in high-risk clients.

Psilocybin Facilitates Fear Extinction: Importance of Dose, Context, and Serotonin Receptors.

A variety of classic psychedelics and MDMA have been shown to enhance fear extinction in rodent models. This has translational significance because a standard treatment for post-traumatic stress disorder (PTSD) is prolonged exposure therapy. However, few studies have investigated psilocybin's potential effect on fear learning paradigms. More specifically, the extents to which dose, timing of administration, and serotonin receptors may influence psilocybin's effect on fear extinction are not understood. In this study, we used a delay fear conditioning paradigm to determine the effects of psilocybin on fear extinction, extinction retention, and fear renewal in male and female mice. Psilocybin robustly enhances fear extinction when given acutely prior to testing for all doses tested. Psilocybin also exerts long-term effects to elevate extinction retention and suppress fear renewal in a novel context, although these changes were sensitive to dose. Analysis of sex differences showed that females may respond to a narrower range of doses than males. Administration of psilocybin prior to fear learning or immediately after extinction yielded no change in behavior, indicating that concurrent extinction experience is necessary for the drug's effects. Cotreatment with a 5-HT2A receptor antagonist blocked psilocybin's effects for extinction, extinction retention, and fear renewal, whereas 5-HT1A receptor antagonism attenuated only the effect on fear renewal. Collectively, these results highlight dose, context, and serotonin receptors as crucial factors in psilocybin's ability to facilitate fear extinction. The study provides preclinical evidence to support investigating psilocybin as a pharmacological adjunct for extinction-based therapy for PTSD.

Advances in Repetitive Transcranial Magnetic Stimulation for the Treatment of Post-traumatic Stress Disorder.

Post-traumatic stress disorder (PTSD) is a psychiatric disorder that develops and persists after an individual experiences a major traumatic or life-threatening event. While pharmacological treatment and psychological interventions can alleviate some symptoms, pharmacotherapy is time-consuming with low patient compliance, and psychological interventions are costly. Repetitive Transcranial Magnetic Stimulation (rTMS) is a safe and effective technique for treating PTSD, with advantages such as high compliance, low cost, and simplicity of implementation. It can even simultaneously improve depressive symptoms in some patients. Current research indicates that high-frequency rTMS shows better therapeutic effects compared to low-frequency rTMS, with no significant difference in the likelihood of adverse reactions between the two. Theta Burst Stimulation (TBS) exhibits similar efficacy to high-frequency rTMS, with shorter duration and significant improvement in depressive symptoms. However, it carries a slightly higher risk of adverse reactions compared to traditional high-frequency rTMS. Combining rTMS with psychological therapy appears to be more effective in improving PTSD symptoms, with early onset of effects and longer duration, albeit at higher cost and requiring individualized patient control. The most common adverse effect of treatment is headache, which can be improved by stopping treatment or using analgesics. Despite these encouraging data, several aspects remain unknown. Given the highly heterogeneous nature of PTSD, defining unique treatment methods for this patient population is quite challenging. There are also considerable differences between trials regarding stimulation parameters, therapeutic effects, and the role of combined psychological therapy, which future research needs to address.

An evaluation of the associations among posttraumatic stress disorder, depression, and complicated grief in active duty military personnel with traumatic loss.

Between 44% and 87% of active duty service members and veterans who deployed following the September 11, 2001, terrorist attacks know someone who was killed or seriously injured in combat. Considering the high frequency and known impact of traumatic loss, it is important to understand if and how traumatic loss may impede posttraumatic stress disorder (PTSD) treatment progress in military personnel. Additionally, experiencing a traumatic loss elevates the risk of developing prolonged grief disorder (PGD), which is associated with higher levels of PTSD symptoms, more functional impairment, and more lifetime suicide attempts among military personnel. Given what is known about the association between PGD and PTSD in treatment-seeking service members and veterans, it is also important to understand whether grief-related symptom severity negatively impacts PTSD treatment response. The current study examined associations among traumatic loss, complicated grief, depressive symptoms, and PTSD treatment response among military personnel (N = 127) who participated in variable-length cognitive processing therapy (CPT). There was no direct, F(2, 125) = 0.77, p =.465, or indirect, β =.02, p =.677, association between a traumatic loss index event and PTSD treatment response compared with other trauma types. Prior assessments of depressive symptom severity were directly related to PTSD at later assessments across two models, ps <.001-p =.021 Participants with a traumatic loss index trauma demonstrated significant reductions in complicated grief, depressive symptoms, and PTSD following CPT, ps <.001, ds = -0.61--0.83. Implications, study limitations, and suggestions for future research are presented.