State of the Science of Cognitive Processing Therapy.

This state of the science review provides an overview of the history and findings of cognitive processing therapy (CPT), one of the most recommended treatments for posttraumatic stress disorder, acute stress disorder, and comorbid conditions. After an introduction to CPT and the randomized controlled trials that have been conducted, the effects of CPT on comorbid conditions are reviewed, as well as new combination treatments. Cognitive mediators of change are described. Different formats for CPT that have been developed are described, as well as patient, therapy, and therapist factors in outcome; applicability across diverse populations; efforts to disseminate CPT; and ongoing studies into the future.

Walking the line between fidelity and flexibility: A conceptual review of personalized approaches to manualized treatments for posttraumatic stress disorder.

The heterogeneity of the core symptoms of posttraumatic stress disorder (PTSD), high rates of comorbid mental and physical health conditions, and substantial impact of the disorder on functioning and well-being contribute to complex clinical presentations that can be challenging to treat. Despite these challenges, there are excellent manualized treatments for PTSD with significant empirical support. Although the success of frontline treatments for PTSD is evident, there remains room for improvement as indicated by suboptimal response and attrition rates. To address challenges to optimal therapy outcomes (COTOs), researchers have conducted numerous clinical trials designed to (a) enhance the core structure of treatment protocols to increase flexibility or (b) expand the protocols to address comorbid conditions that inhibit recovery. However, it is implausible to ever conduct the number of enhancement and expansion clinical trials necessary to test manual modifications for the universe of possible COTOs. This conceptual review describes the concept of a personalized model of therapy that leverages a case formulation approach to implementing an evidence-based treatment for PTSD. This personalized approach provides guidance for the clinician in assessing the patient's COTOs, monitoring them throughout treatment, and relying on the patient's idiosyncratic data to inform treatment decisions, including how and when to diverge from treatment when clinically indicated and ensuring a clear path to return to trauma-focused work when the COTO is stabilized. This personalized, case formulation approach to treating PTSD provides guidance for adopting a more flexible approach to treating clinically complex patients while ensuring fidelity to the protocol.

Using experience sampling methodology (ESM) to improve our understanding of day-to-day intrusion frequency and related distress in survivors of trauma.

BACKGROUND AND OBJECTIVES: Cognitive models of posttraumatic stress disorder (PTSD) suggest that appraisals of traumatic sequelae and subsequent distress drive the development and maintenance of PTSD. Posttraumatic research has relied heavily on macro-longitudinal designs, with weeks or months between assessments of trauma-related cognitions and symptoms. The present study uses experience sampling methodology (ESM) better understand the day-to-day experiences of trauma exposed individuals. METHODS: One-hundred trauma exposed adults reported their posttraumatic symptoms, interpretations, and behaviours four times a day over a 10-day ESM period. RESULTS: As anticipated, within-person fluctuations in negative appraisals of intrusions and maladaptive coping strategies (e.g., thought suppression) were significantly positively associated with intrusion frequency and related distress. In all cases, the associations for negative appraisals and maladaptive coping were stronger with intrusion related distress than intrusion frequency. LIMITATIONS: The observed contemporaneous associations only demonstrate that variables reliably fluctuated together and cannot indicate causality. CONCLUSIONS: The findings demonstrate that day-to-day fluctuations in trauma related perceptions and sequelae are significant and should be explored alongside broader individual differences to advance our understanding of the development, maintenance, and treatment of PTSD.

Exploring intrusions without awareness: A preliminary study of the characteristics and influences of meta-awareness failures.

BACKGROUND AND OBJECTIVES: Research shows that people can lack meta-awareness (i.e., being explicitly aware) of their trauma-related thoughts, which impacts our understanding of re-experiencing symptoms, a key symptom type in posttraumatic stress disorder (PTSD), assessed through self-report. This preliminarily study explored differences between (meta-)aware and unaware intrusion characteristics to understand why some intrusions are not immediately apparent to individuals. METHODS: Trauma-exposed participants (N = 78) were recruited from online crowd-sourcing platforms to complete an online meta-awareness task. During a reading task, participants were intermittently probed to index the occurrence of unreported (i.e., unaware) trauma-related intrusions. Once participants indicated trauma-related intrusions were present, they then completed a questionnaire that indexed intrusion characteristics. RESULTS: Although unaware intrusions did occur in a subset of the sample, there were no fundamental differences between aware and unaware intrusions in terms of modality of experience (imagery vs. non-imagery), meaningfulness, accessibility, or other characteristics (e.g., vividness). LIMITATIONS: There was potential for lower participant engagement and attention due to the online delivery of the meta-awareness task, which may have minimized meta-awareness failure. Future research could consider using a continuous measure to index levels of meta-awareness. In addition, recruiting clinical samples (e.g., individuals with PTSD) who typically experience multiple daily intrusions would allow generalizability of the current findings to be tested. CONCLUSIONS: Our findings from this preliminary study suggest that unaware and aware intrusions show more commonality than not in their characteristics, with further research required to improve our understanding of the mechanisms leading to meta-awareness or lack of in PTSD.

Assessing the validity and responsiveness of a generic preference quality of life measure in the context of posttraumatic stress disorder.

PURPOSE: There is limited research exploring the usefulness of generic preference-based quality of life (GPQoL) measures used to facilitate economic evaluation in the context of posttraumatic stress disorder (PTSD). The aim of the current study was to explore the validity and responsiveness of a common GPQoL measure (Assessment of Quality of Life 8 Dimension [AQoL-8D]) in relation to a PTSD condition-specific outcome measure (Posttraumatic Stress Disorder Checklist for the DSM-5 [PCL-5]). METHOD: This aim was investigated in a sample of individuals (N = 147) who received trauma-focused cognitive-behavioural therapies for posttraumatic stress disorder. Convergent validity was investigated using spearman's correlations, and the level of agreement was investigated using Bland-Altman plots. Responsiveness was investigated by exploring the standardised response means (SRM) from pre-post-treatment across the two measures, which allow the comparison of the magnitude of change between the measures over time. RESULTS: Correlations between the AQoL-8D (dimensions, utility and summary total scores) and the PCL-5 total score ranged from small to large and agreement between the measures was considered moderate to good. While SRMs were large for the AQoL-8D and PCL-5 total scores, the SRM for the PCL-5 was nearly double that of the AQoL-8D. CONCLUSION: Our findings demonstrate that the AQoL-8D has good construct validity but present preliminary evidence that economic evaluations using only GPQoL measures may not fully capture the effectiveness of PTSD treatments.

Validation of the Psychosocial Assessment Tool 2.0 for paediatric burn patients.

OBJECTIVE: The Psychosocial Assessment Tool 2.0 (PAT-B) is an adaptation of an existing screening tool with the aim of the present study to examine its effectiveness and suitability to identify children and families at risk of emotional, behavioral, and social maladjustment following paediatric burns. METHODS: Sixty-eight children aged between 6 months - 16 years (M = 4.40) admitted into hospital following paediatric burns, and their primary caregivers, were recruited. The PAT-B comprises several dimensions including family structure and resources, social support, as well as caregiver and child psychological difficulties. Caregivers completed the PAT-B and several standardized measures for validation purposes (e.g., caregiver reports of family functioning, child emotional and behavioural problems, caregiver distress). Children old enough to complete measures reported on their psychological functioning (e.g., posttraumatic stress and depression). Measures were completed within 3 weeks of child admission and then again at 3 months after burn. RESULTS: The PAT-B demonstrated good construct validity, evidenced by moderate to strong correlations between the PAT-B Total and subscale scores and several criteria measures (family functioning, child behaviour and caregiver distress, child depressive symptoms, rs ranging from 0.33 -0.74). Preliminary support for criterion validity of the measure was observed when examined against the three tiers of the Paediatric Psychosocial Preventative Health Model. The proportion of families falling within these tiers of risk (Universal [low risk], 58.2%; Targeted, 31.3%; or Clinical range, 10.4%) was consistent with prior research. Sensitivity of the PAT-B to identify children and caregivers at high risk of psychological distress was 71% and 83%, respectively. CONCLUSION: The PAT-B appears to be a reliable and valid instrument for indexing psychosocial risk across families who have sustained a paediatric burn. However, further testing and replication using a larger sample size is recommended before the tool is integrated into routine clinical care.

Systematic Review and Meta-Analysis of Stepped Care Psychological Prevention and Treatment Approaches for Posttraumatic Stress Disorder.

Stepped care approaches have been developed to increase treatment accessibility for individuals with posttraumatic stress disorder (PTSD). However, despite guidelines recommending stepped care, it is currently unclear how the approach compares to other treatments for PTSD in terms of symptom reduction, cost, and client-rated acceptability. We conducted a systematic review and meta-analysis of randomized controlled and open trials evaluating stepped care prevention (i.e., targeting those with recent trauma exposure at risk of developing PTSD) and treatment approaches for adults and adolescents/children with PTSD. Eight prevention and four treatment studies were included. There was considerable variation in the sample types, stepped approaches, and control conditions. Most studies found no significant differences between stepped care (both prevention and treatment) and control (active and usual care) in terms of PTSD severity, loss of PTSD diagnosis, depression severity, and quality of life at the final follow-up. There was some evidence to suggest that stepped care was more cost-effective, and as acceptable or more acceptable compared to controls. Interpretations were tempered by high statistical heterogeneity, risk of bias, and lack of recommended evidence-based treatments. Stepped care can make PTSD treatment more accessible; however, more high-quality research is needed comparing stepped care to active controls.

Client Versus Clinicians' Standards of Clinically Meaningful Change and the Effects of Treatment Expectations on Therapeutic Outcomes in Individuals With Posttraumatic Stress Disorder.

There is limited research on the concordance between client perceptions and clinician standards of the degree of symptom change required to achieve meaningful therapeutic improvement. This was investigated in an adult sample (N = 147) who received trauma-focused cognitive-behavioral therapies for posttraumatic stress disorder (PTSD). We examined whether clients' benchmarks of change were related to actual outcomes and the relationship between client expectations and their treatment outcomes. Clients completed measures indexing the level of symptom reduction required (in their view) to reflect a benefit or recovery from treatment and treatment expectations. Actual PTSD severity was indexed pre- and posttreatment via self-report and clinician-administered interview. Results demonstrated that the amount of change clients said they required to experience a benefit or recovery was significantly larger than typical clinical research standards. Nonetheless, the majority of client benchmarks of change (79.7-81.8%) were consistent with clinical research standards of what constitutes benefit or recovery. Client benchmarks were generally positively correlated with their actual outcomes. Clients' belief that treatment would be successful was associated with greater reductions in PTSD symptoms. These findings provide preliminary evidence that the standards used to determine clinically significant change are somewhat consistent with clients' own perceptions of required symptom change.

Predicting response to Cognitive Processing Therapy for PTSD: A machine-learning approach.

Cognitive Processing Therapy (CPT) is an effective treatment for posttraumatic stress disorder (PTSD); however, not every client achieves optimal outcomes. Data were pooled from four randomized trials in which female interpersonal trauma survivors completed CPT (N = 179). Random forests of classification trees were used to investigate the role of both baseline (e.g., demographics, trauma history, comorbid disorders) and session PTSD and depressive symptom scores on predicting trajectory and outcome. Of particular focus was whether those on track for poor outcome (e.g., non-response, partial treatment response) could be identified early in therapy. Results demonstrated inconsistent findings for discrimination between delayed responders (no early change but full response after 12 weeks of therapy) and those who either showed a partial response to treatment or did not respond at all; level of discrimination depended on the assessment point under study and the chosen comparison group. Those defined as clear and early responders, however, could be reliably differentiated from the other groups by session 4. Although it is possible to identify clients who will recover from PTSD by the middle of the CPT protocol, further work is needed to accurately identify those who will ultimately not recover from PTSD during a course of CPT.

Are Individuals Always Aware of Their Trauma-Related Intrusive Thoughts? A Study of Meta-Awareness.

Individuals are not always aware of their mental content. We tested whether lack of awareness occurs in those who have experienced trauma, with and without posttraumatic stress disorder (PTSD). We also examined the role of proposed cognitive mechanisms (working memory and inhibition) in explaining unnoticed intrusions. Individuals with PTSD (n = 44), and varying levels of symptoms (high posttraumatic stress [PTS]: n = 24; low PTS: n = 37) reported on intrusive thoughts throughout a reading task. Intermittently, participants responded to probes about whether their thoughts were trauma related. Participants were "caught" engaging in unreported trauma-related thoughts (unnoticed intrusions) for between 24 and 27% of the probes in the PTSD and high PTS groups, compared with 15% of occasions in the low PTS group. For trauma-related intrusions only, participants lacked meta-awareness for almost 40% of probes in the PTSD group, which was significantly less than that observed in the other groups (∼60%). Contrary to predictions, working memory and response inhibition did not predict unnoticed intrusions. The results suggest that individuals who have experienced significant trauma can lack awareness about the frequency of their trauma-related thoughts. Further research is warranted to identify the mechanisms underpinning the occurrence of unnoticed intrusions.

The role of belief in memory amplification for trauma events.

BACKGROUND AND OBJECTIVES: Trauma survivors often report trauma events inconsistently over time. Many studies, for example, have found that people report having experienced trauma events that they initially failed to report or remember, a phenomenon called "memory amplification." Other studies have found the opposite: people report experiencing fewer events over time. Nahleen, Nixon, and Takarangi (2019) asked participants at two time-points, with a six-month delay, whether they had experienced 19 sexual assault events on a yes/no scale. Participants reported fewer events over time, that is, memory for sexual assault did not amplify overall. In the current study, we assessed whether inconsistency in reports of trauma exposure over time may be attributed to changes in participants' belief that certain events were experienced. METHODS: We replicated Nahleen et al. (2019), but rather than respond to a yes/no trauma exposure scale, participants were required to rate the likelihood that each trauma event occurred on an 8-point scale (1 = definitely did not happen; 8 = definitely did happen). RESULTS: We found that participants believed that they were less likely to have experienced the sexual assault events at follow-up compared to initial assessment. LIMITATIONS: We could not corroborate trauma experiences or determine causality with our design. Further, not all of our findings were consistent with Nahleen et al. (2019). CONCLUSIONS: Sexual assault memories did not amplify over time, perhaps because, compared to other types of trauma, the idea of experiencing additional sexual assault events that were not actually experienced is less believable.

The Emerging Literature on Exposure-Based Writing Therapies for Subthreshold and Clinical Posttraumatic Stress Disorder: A Response to Thompson-Hollands et al.'s (2020) Commentary on Dawson et al. (2020).

Thompson-Hollands et al.'s (2020) commentary on our systematic review of exposure-based writing therapies for subthreshold and clinical posttraumatic stress symptoms (Dawson et al., 2020) emphasizes important questions about the impact of heterogeneity in drawing inferences from evidence reviews. In this reply, we discuss (a) our rationale for undertaking a systematic review that was broad rather than narrow in scope and (b) provide clarifications on how heterogeneity was considered in the meta-analyses that were conducted. We also strongly agree with Thompson-Hollands et al.'s recommendation that future research should focus on better understanding the mechanisms by which exposure-based writing therapies help reduce posttraumatic stress symptoms.

Exposure-Based Writing Therapies for Subthreshold and Clinical Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis.

We undertook a systematic review to assess the efficacy of exposure-based writing therapies (WTs) for trauma-exposed adults with subthreshold or clinical levels of posttraumatic stress disorder. Four databases (PsycINFO, Medline, Wiley Online, PILOTS) were searched for randomized controlled trials (RCTs) of exposure-based WTs. A total of 13 RCTs that reported on results from 17 WT versus control comparisons were included. The primary outcomes were posttraumatic stress symptom severity at posttreatment and/or clinical response. An overall unclear or high risk of bias was identified in 84.6% of studies. In comparison to both waitlist k = 3, Hedges' g = -0.97, 95% CI [-1.20, -0.73], and placebo writing conditions, k = 9, Hedges' g = -0.48, 95% CI [-0.87, -0.08], WTs were more beneficial to participants. There was no evidence of a difference between WTs that were longer in duration compared to other psychotherapy, k = 2; pooled OR = 1.42; 95% CI [0.83, 2.43]. These findings indicate that exposure-based WTs are effective when compared to waitlist and placebo writing control conditions. The evidence needs to be considered in the context of the modest number of studies conducted to date, the high methodological heterogeneity between the studies, and the high or unclear risk of bias across many studies. Further research is needed to increase the evidence base regarding the efficacy of WTs for posttraumatic stress. Future research should also measure the mediators and predictors of outcomes to further develop protocols and understand which variants of WTs work for different populations or individuals.

Comorbid posttraumatic stress disorder and major depressive disorder: The usefulness of a sequential treatment approach within a randomised design.

Cognitive Processing Therapy (CPT) and Behavioural Activation Therapy (BA) were used to treat individuals with comorbid posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Fifty-two individuals (48 women, 4 men) were randomized to CPT alone (n = 18), CPT then BA for MDD (n = 17), or BA then CPT (n = 17). Presenting trauma was primarily interpersonal (87 %). Participants were assessed at pre-, posttreatment, and 6-month follow-up. PTSD and MDD symptoms were the main outcome of interest; trauma cognitions, rumination, and emotional numbing were secondary outcomes. All groups showed sizeable reductions in PTSD and depression (effect sizes at follow-up ranging between 1.02-2.54). A pattern of findings indicated CPT/BA showed better outcomes in terms of larger effect sizes and loss of diagnoses relative to CPT alone and BA/CPT. At follow-up greater numbers of the CPT/BA group were estimated to have achieved good end-state for remission of both PTSD and depression (49 %, CI95 [.26, .73]) relative to CPT alone (18 %, CI95 [.03, .38]) and BA/CPT (11 %, CI95 [.01, .29]). Although tempered by the modest sample size, the findings suggest that individuals with comorbid PTSD and MDD may benefit from having PTSD targeted first before remaining MDD symptoms are addressed.

Development of an international data repository and research resource: the Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive.

Background: Studies that identify children after acute trauma and prospectively track risk/protective factors and trauma responses over time are resource-intensive; small sample sizes often limit power and generalizability. The Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive was created to facilitate more robust integrative cross-study data analyses. Objectives: To (a) describe creation of this research resource, including harmonization of key variables; (b) describe key study- and participant-level variables; and (c) examine retention to follow-up across studies. Methods: For the first 30 studies in the Archive, we described study-level (design factors, retention rates) and participant-level (demographic, event, traumatic stress) variables. We used Chi square or ANOVA to examine study- and participant-level variables potentially associated with retention. Results: These 30 prospective studies (N per study = 50 to 568; overall N = 5499) conducted by 15 research teams in 5 countries enrolled children exposed to injury (46%), disaster (24%), violence (13%), traffic accidents (10%), or other acute events. Participants were school-age or adolescent (97%), 60% were male, and approximately half were of minority ethnicity. Using harmonized data from 22 measures, 24% reported significant traumatic stress ≥1 month post-event. Other commonly assessed outcomes included depression (19 studies), internalizing/externalizing symptoms (19), and parent mental health (19). Studies involved 2 to 5 research assessments; 80% of participants were retained for ≥2 assessments. At the study level, greater retention was associated with more planned assessments. At the participant level, adolescents, minority youth, and those of lower socioeconomic status had lower retention rates. Conclusion: This project demonstrates the feasibility and value of bringing together traumatic stress research data and making it available for re-use. As an ongoing research resource, the Archive can promote 'FAIR' data practices and facilitate integrated analyses to advance understanding of child traumatic stress.

Antecedentes: Los estudios que identifican niños luego de la exposición a trauma agudo y realizan un seguimiento prospectivo para identificar factores protectores o de riesgo, y respuestas al trauma en el tiempo requieren una gran cantidad de recursos; el tamaño pequeño de las muestras frecuentemente limita su poder y generalización. El Banco de Información de los Estudios Prospectivos sobre Trauma Agudo y Recuperación en el Niño (PACT/R por sus siglas en inglés) se creó para facilitar un análisis de datos más robusto e integrativo entre los estudios.Objetivos: a) Describir la creación de este recurso de investigación, incluyendo la armonización de variables clave; b) describir las variables clave a nivel de estudios y de participantes; y c) evaluar la permanencia del seguimiento en los estudios.Métodos: Describimos las variables 'nivel de estudio' (diseño, factores, tasas de permanencia) y 'nivel de participantes' (demografía, evento, estrés traumático) en los 30 primeros estudios del Banco. Empleamos Chi cuadrado o ANOVA para evaluar los niveles de estudio y de participante potencialmente asociados con la permanencia.Resultados: Estos 30 estudios prospectivos (N por estudio = 50 a 568; total N = 5499) realizados por 15 grupos de investigación en 5 países reclutaron niños expuestos a lesión (46%), desastre (24), violencia (13%), accidentes de tránsito (10%) u otros eventos agudos. Los participantes estaban en edad escolar o en la adolescencia (97%), 60% eran varones y, aproximadamente la mitad pertenecían a una minoría étnica. Empleando la armonización de datos para 22 mediciones, el 24% reportó estrés traumático significativo mayor o igual a un mes luego del evento. Otros desenlaces comúnmente evaluados incluyeron a la depresión (19 estudios), síntomas internalizantes y externalizantes (19), y salud mental de los padres (19). Los estudios incluyeron entre 2 y 5 evaluaciones de investigación; 80% de los participantes fueron mantenidos para dos o más evaluaciones. En el nivel de estudio, una mayor permanencia se asoció a un mayor número de evaluaciones planificadas. En el nivel de participantes, los adolescentes, los jóvenes pertenecientes a minorías, y aquellos en niveles socioeconómicos más bajos presentaron menores tasas de permanencia.Conclusión: Este proyecto demuestra la viabilidad y el valour de integrar la información sobre la investigación en estrés traumático y hacerla disponible para ser reutilizada. Como recurso de investigación en curso, el Banco puede promover el uso de prácticas de información 'FAIR' y facilitar el análisis integrado para generar progreso en la comprensión del estrés traumático infantil.

Posttraumatic anger: a confirmatory factor analysis of the Dimensions of Anger Reactions Scale-5 (DAR-5) - French adaptation.

Background: Research has shown that posttraumatic anger is common after a traumatic experience, represents a risk factor for post-trauma psychopathology, and can be screened for using the Dimensions of Anger Reactions Scale-5 (DAR-5), a concise five-item measure. However, a French version of the DAR-5 is not yet available. Objective: We aimed to provide a French adaptation (DAR-5-F) and to replicate, in a French community sample, the psychometric properties of the original DAR-5. Method: After translation using transcultural psychometric principles, the DAR-5-F was presented to 822 fluent French speakers alongside validated scales of anger (State-Trait Anger Expression Inventory-2), anxiety and depression (Hospital Anxiety and Depression Scale), alcohol misuse (Alcohol Use Disorders Identification Test-Consumption), and trauma exposure (Life Events Checklist-5). Results: Confirmatory factor analyses confirmed that DAR-5-F scores fit a single-factor model as described with the English version of the scale. The scale showed noteworthy internal consistency and robust convergent validity with trait anger. The screening DAR-5-F cut-off of ≥12 successfully differentiated high from low scores of STAXI-2, anxiety, depression, and traumatic exposure. Conclusions: The DAR-5 is a robust, psychometrically strong brief scale of anger useful for post-trauma screening, with the DAR-5-F now available for use in French-speaking populations. Future research that examines relationships between the DAR-5-F and variables such as trauma severity and posttraumatic stress symptoms will further improve our understanding of these phenomena.

Antecedentes: La investigación ha demostrado que la ira postraumática es común después de una experiencia traumática, representa un factor de riesgo para psicopatología post trauma, y puede ser tamizada usando las dimensiones de la Escala de Reacciones de Ira-5 (DAR-5 por sus siglas en inglés), una medida concisa de 5 items. Sin embargo, una versión francesa del DAR-5 no está aún disponible.Objetivo: Nuestro objetivo fue proveer una adaptación francesa (DAR-5-F) y replicar, en una muestra de la comunidad francesa, las propiedades psicométricas de la DAR-5 original.Método: Después de una traducción usando principios psicométricos transculturales, la DAR-5-F se presentó a 822 francoparlantes fluidos junto a escalas validadas de ira (Inventario de Expresión de Ira estado-rasgo, STAXI-2), ansiedad y depresión (Escala de Ansiedad y Depresión Hospitalaria, HAD), abuso de alcohol (Test de Identificación de Trastornos por consumo de alcohol, AUDIT- Consumo), y exposición a trauma (Lista de Chequeo de Eventos Vitales, LEC-5).Resultados: El análisis factorial confirmatorio confirmó que el puntaje de DAR-5 F calza con un modelo de factor único como se describió en la versión inglesa de la escala. La escala mostró una consistencia interna notable y una validez convergente robusta con la ira-rasgo. El punto de corte del tamizaje de DAR-5 F igual o mayor a 12 diferenció exitosamente los puntajes altos de los bajos de STAXI-2, ansiedad, depresión, y exposición traumática.Conclusiones: La DAR-5 es una escala de ira breve robusta, psicométricamente fuerte útil para el tamizaje post trauma, con la DAR-5 F ahora disponible para su uso en población francoparlante. Investigaciones futuras que examinen la relación entre la DAR-5 F y variables tales como severidad del trauma y síntomas de estrés postraumático mejorarán aún más nuestra comprensión de este fenómeno.

Dysfunctional posttraumatic cognitions, posttraumatic stress and depression in children and adolescents exposed to trauma: a network analysis.

BACKGROUND: The latest version of the International Classification of Diseases (ICD-11) proposes a posttraumatic stress disorder (PTSD) diagnosis reduced to its core symptoms within the symptom clusters re-experiencing, avoidance and hyperarousal. Since children and adolescents often show a variety of internalizing and externalizing symptoms in the aftermath of traumatic events, the question arises whether such a conceptualization of the PTSD diagnosis is supported in children and adolescents. Furthermore, although dysfunctional posttraumatic cognitions (PTCs) appear to play an important role in the development and persistence of PTSD in children and adolescents, their function within diagnostic frameworks requires clarification. METHODS: We compiled a large international data set of 2,313 children and adolescents aged 6 to 18 years exposed to trauma and calculated a network model including dysfunctional PTCs, PTSD core symptoms and depression symptoms. Central items and relations between constructs were investigated. RESULTS: The PTSD re-experiencing symptoms strong or overwhelming emotions and strong physical sensations and the depression symptom difficulty concentrating emerged as most central. Items from the same construct were more strongly connected with each other than with items from the other constructs. Dysfunctional PTCs were not more strongly connected to core PTSD symptoms than to depression symptoms. CONCLUSIONS: Our findings provide support that a PTSD diagnosis reduced to its core symptoms could help to disentangle PTSD, depression and dysfunctional PTCs. Using longitudinal data and complementing between-subject with within-subject analyses might provide further insight into the relationship between dysfunctional PTCs, PTSD and depression.

The effect of a brief online self-compassion versus cognitive restructuring intervention on trait social anxiety.

We compared two brief online interventions of 2-week duration for individuals with elevated levels of social anxiety. Participants were randomized to self-compassion or cognitive restructuring conditions (N = 119) and assessed across five assessment points, including a 5-week follow-up. Mediators and moderators of outcome were also examined. Both interventions led to significant decreases in social anxiety (d's ranged from 0.26 to 0.58), which were maintained and improved at follow-up (d's from baseline ranged from 0.53 to 0.80). Of those who were above social anxiety cut-off at baseline (>75%), approximately 20% of participants in each group showed reliable and clinically significant changes in symptoms. No differences between the treatment conditions were found for social anxiety outcomes. Similarly, there were no measures that differentially mediated the effect of treatment condition on social anxiety. Furthermore, we did not find support for a theory-driven mediational model in which self-compassion reduced social anxiety through activation of the soothing system. Contrary to predictions and theory, neither self-criticism nor fear of self-compassion moderated the effect of the interventions. Although preliminary, the findings suggest that self-compassion techniques warrant further study as an additional means of reducing social anxiety.

Developing an integrated intervention to address intimate partner violence and psychological distress in Congolese refugee women in Tanzania.

BACKGROUND: Multi-sectoral, integrated interventions have long been recommended for addressing mental health and its social determinants (e.g., gender-based violence) in settings of ongoing adversity. We developed an integrated health and protection intervention to reduce psychological distress and intimate partner violence (IPV), and tested its delivery by lay facilitators in a low-resource refugee setting. METHODS: Formative research to develop the intervention consisted of a structured desk review, consultation with experts and local stakeholders (refugee incentive workers, representatives of humanitarian agencies, and clinical experts), and qualitative interviews (40 free list interviews with refugees, 15 key informant interviews). Given existing efforts by humanitarian agencies to prevent gender-based violence in this particular refugee camp, including with (potential) perpetrators, we focused on a complementary effort to develop an integrated intervention with potential to reduce IPV and associated mental health impacts with female IPV survivors. We enrolled Congolese refugee women with elevated psychological distress and past-year histories of IPV (n = 60) who received the intervention delivered by trained and supervised lay refugee facilitators. Relevance, feasibility and acceptability of the intervention were evaluated through quantitative and qualitative interviews with participants. We assessed instrument test-retest reliability (n = 24), inter-rater reliability (n = 5 interviews), internal consistency, and construct validity (n = 60). RESULTS: We designed an 8-session intervention, termed Nguvu ('strength'), incorporating brief Cognitive Processing Therapy (focused on helping clients obtaining skills to overcome negative thoughts and self-perceptions and gain control over the impact these have on their lives) and Advocacy Counseling (focused on increasing autonomy, empowerment and strengthening linkages to community supports). On average, participants attended two-thirds of the sessions. In qualitative interviews, participants recommended adaptations to specific intervention components and provided recommendations regarding coordination, retention, safety concerns and intervention participation incentives. Analysis of the performance of outcome instruments overall revealed acceptable reliability and validity. CONCLUSIONS: We found it feasible to develop and implement an integrated, multi-sectoral mental health and IPV intervention in a refugee camp setting. Implementation challenges were identified and may be informative for future implementation and evaluation of multi-sectoral strategies for populations facing ongoing adversity. TRIAL REGISTRATION: ISRCTN65771265, June 27, 2016.

Current PTSD symptomatology distorts memory for past symptoms.

Clinicians often rely on clients' retrospective reports of past symptoms to diagnose and treat Posttraumatic Stress Disorder (PTSD). However, there is limited research investigating memory for past PTSD symptoms. We asked sexual assault survivors to report their PTSD symptoms and then recall them 6 months later. Overall, symptom recall was consistent with initial reports. However, after dividing participants into PTSD-positive and negative groups, we found that people who were PTSD-negative at follow-up underestimated past PTSD symptom severity while people who were PTSD-positive overestimated past symptoms. For example, 2.8% of PTSD-negative participants versus 15.9% of PTSD-positive participants recalled experiencing 20+ more points on the PCL-5 at follow-up than at initial assessment. Further, people who adjusted over time greatly underestimated past symptoms unlike those who remained PTSD-positive. Our findings have important theoretical and clinical implications because they show that current symptom severity may influence the memory reconstruction of prior levels of adjustment.