Role of history of traumatic life experiences in current psychosomatic manifestations.

OBJECTIVES: Although the relationship between traumatic experiences (TEs) and psychosomatic manifestations (pain, somatization, somatosensory amplification [SSA], and alexithymia) has been widely described, very few studies have investigated how these variables correlate with each other and with a history of TEs. The aim of this study was to investigate whether and how current psychosomatic manifestations are correlated with major and minor adult- and childhood TEs. METHODS: One hundred and forty-six patients (91 with pain) from the Pisa Gift Institute for Integrative Medicine Psychosomatics Lab., Italy, were assessed for pain, history of TEs (divided into major and minor based on whether or not they meet the DSM-5 Criterion A for post-traumatic stress disorder), alexithymia, somatization, and SSA. RESULTS: TEs were positively correlated with age, the sensorial dimension and intensity of pain, somatization, psychopathology index, SSA, and alexithymia. Using the somatization score (controlled for age) as a covariate, the previous correlations between psychosomatic dimensions and TEs lost their statistical significance: SSA (total TEs: from r = 0.30, p = 0.000 to r = -0.04, p = 0.652); alexithymia (total TEs: from r = 0.28, p = 0.001 to r = 0.04, p = 0.663); sensorial dimension of pain (total TEs: from r = 0.30, p = 0.015 to r = 0.12, p = 0.373); and pain intensity (total TEs: from r = 0.38, p = 0.004 to r = -0.15, p = 0.317). Interestingly, the tendency to report more intense pain was mainly predicted by minor TEs in childhood (ß = 0.28; p = 0.030). CONCLUSIONS: The number of lifetime TEs is positively correlated with the sensorial dimension and intensity of pain but not its affective and cognitive dimensions. However, the former relationship depends on the presence of somatization. The intensity of pain is associated with minor rather than major TEs, especially when they occur in childhood.

Posttraumatic stress disorder in people with dementia: study protocol.

Background: Posttraumatic stress disorder (PTSD) is considered an independent risk factor for dementia. Despite the (clinical) evidence that PTSD is associated with neuropsychiatric symptoms in people with dementia, studies on its prevalence and clinical manifestation are limited, and their quality is affected by the lack of a structured method to diagnose PTSD in this population. The primary aim of the current study is to validate the 'TRAuma and DEmentia' interview as a diagnostic tool for PTSD in people with dementia and to test feasibility of EMDR treatment for people with PTSD and dementia.Methods: This prospective multi-centre study is divided into two parts. In study A, 90 participants with dementia will be included to test the criterion validity, inter-rater reliability and feasibility of the 'TRAuma and DEmentia' interview. In study B, 29 participants with dementia and PTSD will receive eye movement desensitisation and reprocessing therapy by a trained psychologist, and 29 participants with dementia and PTSD will be placed on the waiting list control group.Conclusion: This study aims to improve the diagnostic process of PTSD and to assess the effects of eye movement desensitisation and reprocessing treatment in people with dementia living in Dutch care facilities.Trial registration: NL70479.068.20 / METC 20-063 / OSF registration: https://doi.org/10.17605/OSF.IO/AKW4F.

This study protocol describes a two-part study on posttraumatic stress disorder in people with dementia in Dutch care facilities.The primary aim of the study is to validate the 'TRAuma and DEmentia' interview as a diagnostic tool for posttraumatic stress disorder in people with dementia.This study aims to test the feasibility of an evidence-based treatment for people with dementia and posttraumatic stress disorder in the form of eye movement desensitisation and reprocessing therapy.

The impact of substance use on posttraumatic stress disorder symptoms and treatment discontinuation.

This study examined the impact of ongoing substance use during posttraumatic stress disorder (PTSD) and substance use disorder (SUD) treatment on PTSD symptoms and treatment discontinuation. The study represents a secondary analysis of U.S. military veterans (N = 183) who participated in a randomized clinical trial for the treatment of both PTSD and SUD. Veterans mostly identified as Black (53.8%) or White (41.9%) and male (92.4%). Substance use, PTSD symptoms, and treatment discontinuation were measured at 4-week intervals throughout treatment. Predictors were the percentage of days with alcohol, cannabis, and other substance use (primarily cocaine and opioids) and the average number of alcoholic drinks per drinking day. Outcomes were PTSD symptoms and treatment discontinuation at concurrent and prospective assessments. Multilevel models accounted for the nested structure of the longitudinal data. Alcohol, cannabis, and other substance use did not predict PTSD symptoms or treatment discontinuation prospectively. Concurrently, we observed that as a participant's percentage of drinking days increased by 34.7% (i.e., 1 standard deviation), PTSD symptoms during the same period were 0.07 standard deviations higher (i.e., 1 point on the PCL), B = 0.03, p = .033. No other substances were related to PTSD symptoms concurrently. The findings demonstrate that PTSD symptoms improved regardless of substance use during exposure-based PTSD and SUD treatment, and treatment discontinuation was not associated with substance use. This study suggests that substance use during treatment cannot directly explain the poorer treatment outcomes observed in the literature on comorbid PTSD/SUD compared to PTSD-only populations.

Associations between mindfulness and mental health after collective trauma: results from a longitudinal, representative, probability-based survey.

BACKGROUND/OBJECTIVES: Trait mindfulness (TM) may protect against post-trauma mental health ailments and related impairment. Few studies have evaluated this association in the context of collective traumas using representative samples or longitudinal designs. DESIGN/METHOD: We explored relationships between TM and collective trauma-related outcomes in a prospective, representative, probability-based sample of 1846 U.S. Gulf Coast residents repeatedly exposed to catastrophic hurricanes, assessed twice during the COVID-19 outbreak (Wave 1: 5/14/20-5/27/20; Wave 2: 12/21/21-1/11/22). Generalized estimating equations examined longitudinal relationships between TM, COVID-19-related fear/worry, hurricane-related fear/worry, global distress, and functional impairment; ordinary least squares regression analyses examined the cross-sectional association between TM and COVID-19-related posttraumatic stress symptoms (PTSS) at Wave 1. Event-related stressor exposure was explored as a moderator. RESULTS: In covariate-adjusted models including pre-event mental health ailments and demographics, TM was negatively associated with COVID-19-related fear/worry, hurricane-related fear/worry, global distress, and functional impairment over time; in cross-sectional analyses, TM was negatively associated with COVID-19-related PTSS. TM moderated the relationship between COVID-19 secondary stressor exposure (e.g., lost job/wages) and both global distress and functional impairment over time. CONCLUSIONS: Results suggest TM may buffer adverse psychosocial outcomes following collective trauma, with some evidence TM may protect against negative effects of secondary stressor exposure.

Accuracy of the Depression, Anxiety and Stress Scale (DASS-21) for Screening on Comorbid Internalizing Disorders among Youth in Substance Use Disorder Treatment.

INTRODUCTION: Major depression, anxiety disorders, and post-traumatic stress disorder (PTSD) are among the most prevalent comorbid mental disorders in youth addiction treatment. Hence, screening for these internalizing disorders should be part of the standard routine at intake in substance use disorder treatment. We investigated the usefulness of the Depression, Anxiety and Stress Scale (DASS-21) as a screener for this purpose. METHODS: A nationally representative sample of 421 treatment-seeking youths aged 16-22 years with a primary cannabis, alcohol, cocaine, or amphetamine use disorder participated in the study. At intake, we administered the DASS-21 and the Mini International Neuropsychiatric Interview (MINI; Sheehan et al., 1998) based on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), as "gold standard," as part of a broader baseline assessment of the Youth in transition study [Moska et al. BMC Psychiatry. 2021;21(1):1-11]. RESULTS: At comparable sensitivity (0.80-0.84), based on the optimal cut-off value, specificity was higher for the DASS-21 total score detecting any DSM-5 internalizing disorder (0.62) than for the DASS subscales specifically detecting depression, anxiety, or PTSD (0.44, 0.49, and 0.51, respectively). Receiver operating characteristic curve analyses showed an area under the curve (AUC) value of 0.80 for the DASS total score to detect any internalizing disorder ("good discrimination"), compared with AUC values of 0.70-0.75 of the DASS depression and anxiety subscales to detect DSM-5 depression, anxiety, and PTSD ("fair discrimination"). The optimal DASS total score cut-off value of ≥44 for detecting any internalizing disorder resulted in 0.81 sensitivity, 0.62 specificity, 0.80 positive predictive value, and 0.64 negative predictive value. CONCLUSION: Given the high prevalence of comorbid internalizing disorders in youth addiction care, the need to address these comorbid disorders in treatment, and the favorable accuracy of the DASS to detect these disorders, we recommend to implement the DASS-21 as routine screener in youth addiction treatment in the Netherlands.

VHA Whole Health Services and Complementary and Integrative Health Therapies: a Gateway to Evidence-Based Mental Health Treatment.

BACKGROUND: Engagement in evidence-based psychotherapy (EBP) among veterans with behavioral health conditions is often low. The Veterans Health Administration (VHA) is implementing a "Whole Health (WH)" system of care, to identify veteran personal health goals, align care with those goals, and offer services designed to engage and empower veterans to achieve well-being. OBJECTIVE: To examine the relationship between veteran WH utilization and subsequent engagement in EBP. DESIGN: Retrospective analysis of VHA administrative records from 18 facilities implementing WH. SUBJECTS: Veterans (n = 265,364) with a diagnosis of depression, post-traumatic stress disorder (PTSD), and/or anxiety who had a mental healthcare encounter but no EBP use in fiscal year (FY) 2018. Among this cohort, 33,146 (12.5%) began using WH in FY2019. MAIN MEASURES: We examined use of an EBP for depression, anxiety, and/or PTSD within 1 year of the index date of WH use compared to use of an EBP anytime during FY2019 for veterans not identified as using WH. We used multiple logistic regression to examine the association between veteran WH use and EBP engagement. KEY RESULTS: Approximately 3.0% (n = 7,860) of the veterans in our overall cohort engaged in an EBP in the year following their index date. Controlling for key demographic, health, and utilization variables, WH users had 2.4 (95% CI: 2.2-2.5) times higher odds of engaging in an EBP the following year than those with no WH utilization. Associations between utilization of specific WH services (vs. no utilization of that service) and engagement in an EBP in the subsequent year ranged from 1.6 (95% CI: 1.0-2.6) to 3.5 (95% CI: 3.2-3.9) across the different types of WH services used. CONCLUSIONS: WH use was associated with increased engagement in EBPs among veterans with depression, anxiety, and/or PTSD. Future interventions intended to promote veteran engagement in EBPs may benefit from leveraging WH services and therapies.

Trauma-Informed Psychosocial Screening and Care Planning: A Patient-Centered Improvement Project in a Midwife Clinic.

INTRODUCTION: Traumatic stress is associated with increases in preterm birth, low birth weight, and other perinatal complications. Yet the identification of patients with traumatic stress and intervention for traumatic stress prevention or treatment remain low. Locally in this university hospital-based midwife clinic, a health records review found that trauma exposure was documented in 5% of patient records, and no records had a diagnosis of posttraumatic stress disorder (PTSD). This is lower than research-based population estimates of 25% to 50% for trauma exposure and 8% for PTSD during pregnancy. The clinic staff did not screen for posttraumatic stress, and exposure screening was limited to intimate personal violence. Staff had not been trained in trauma-informed care (TIC) as defined by the Substance Abuse and Mental Health Services Administration. The aim for this improvement project was to provide trauma screening and trauma-related care planning, collectively referred to as trauma-informed psychosocial care, to midwifery patients 85% of the time. PROCESS: Interventions were implemented over 4 plan-do-study-act (PDSA) cycles. These included staff training in TIC; written screening at the new prenatal, third trimester, and postpartum visits; verbal broad inquiry at every visit; and bidirectional trauma-specific care planning emphasizing patient and provider input into treatment choice. The clinic flow was changed to create privacy for patient-staff interaction at every visit. Field notes and data were analyzed every 2 weeks and iterative changes applied. OUTCOMES: Trauma disclosure increased from 5% to 30% and identification of PTSD from 0% to 7%. Bidirectional care plan documentation increased from 8% to 67%. Staff rated the workload as reasonable. DISCUSSION: Redesigning psychosocial screening to align with TIC principles increased the discovery of trauma to levels consistent with research-based population estimates. Gains were made in bidirectional care planning. This project illustrates practical methods of implementing TIC principles.

Protocol for a randomized controlled trial in Cambodian individuals with PTSD: Trauma-Informed Treatment Algorithms for Advancing Novel Outcomes (Project TITAN).

INTRODUCTION: Low- and middle-income countries shoulder a disproportionate burden of mental health disorders with limited resources to support the provision of care using culturally relevant, evidence-based interventions. This is particularly true in Cambodia where the population continues to confront traumatic consequences of the Khmer Rouge genocide that targeted educated people, including treatment providers. Trauma-Informed Treatment Algorithms for Advancing Novel Outcomes (Project TITAN) will examine proof of concept and preliminary efficacy of culturally tailored interventions for symptoms of post-traumatic stress (PTS) among Cambodian adults. METHODS: A stepped care randomized controlled trial enrolling people seeking mental health treatment and priority populations with high rates of trauma exposure, including female entertainment and sex workers and sexual and gender minorities. In total, 160 participants with symptoms of PTS are randomized to Stabilization Techniques or Behavioral Activation plus Stabilization Techniques, implemented within a culturally relevant framework. Individuals who do not demonstrate a reduction in symptoms of PTS after six treatment sessions receive Eye Movement Desensitization and Reprocessing therapy. PTS, depression, anxiety, and substance use are assessed at baseline and two and four months post-randomization. PLANNED ANALYSES: The percentage of individuals achieving reductions in symptoms of PTS after four months is the primary outcome. Secondary outcomes are depression, anxiety, and substance use over four months. Finally, machine learning analyses will be conducted to identify features at baseline and during treatment that predict outcomes. DISCUSSION: Findings will guide future development and implementation of interventions to improve mental health conditions among individuals in Cambodia and other resource-limited settings.

Utilization of Whole Health and Longitudinal Outcomes After Screening Positive for Possible Depression Documented in Veterans Health Administration's Electronic Health Record.

Objectives: Depression is common among Veterans. Veterans Health Administration (VHA) is transforming into a Whole Health system of care that includes holistic treatment planning, well-being programs, and health coaching. This evaluation explores the impact of Whole Health on improving symptoms of depression among Veterans who screen positive for possible depression diagnosis. Materials and Methods: We examined a cohort of Veterans who started using Whole Health after screening positive for possible depression (having a PHQ-2 score ≥3) at 18 VA Whole Health sites. We compared Whole Health users with non-Whole Health users on their follow-up PHQ-2 scores (9-36 months after baseline), using propensity score matching with multivariable regression to adjust for baseline differences. Results: Of the 13,559 Veterans screening positive for possible depression on the PHQ-2 and having a follow-up PHQ-2, 902 (7%) began using Whole Health after their initial positive PHQ-2. Whole Health users at baseline were more likely than non-Whole Health users to have posttraumatic stress disorder or acute stress (43% vs. 29%), anxiety (22% vs. 12%), ongoing opioid use (14% vs. 8%), recent severe pain scores (15% vs. 8%), or obesity (51% vs. 40%). Both groups improved at follow-up, with mean PHQ-2 scores decreasing from 4.49 to 1.77 in the Whole Health group and 4.46 to 1.46 in the conventional care group, with the Whole Health group significantly higher at follow-up. Also, the proportion continuing to screen positive at follow-up trended higher in the Whole Health group (26% and 21%, respectively). Conclusions: After screening positive for depression, Veterans with more mental and physical health conditions were more likely to subsequently use Whole Health services, suggesting that Whole Health is becoming a tool used in VHA to address the needs of complex patients. Nevertheless, the Whole Health group did not improve compared to the Conventional Care group. Results add to the growing body of literature that Whole Health services may play an important role among patients with complex symptom presentations by promoting self-management of symptoms and targeting "what matters most" to Veterans.

Post-traumatic stress disorder in doctors: Origins, approach and Eye Movement Desensitisation and Reprocessing therapy.

OBJECTIVES: Navigating a high-stakes clinical environment, medical doctors tend to consider trauma and adverse workplace events as 'part of their job'. This often leads to delays in help-seeking in doctors who develop acute traumatic stress symptoms (ATSS), post-traumatic stress disorder (PTSD) and their comorbidities. This article outlines the prevalence of acute traumatic stress and PTSD in this population and summarises the emerging evidence base for Eye Movement Desensitisation and Reprocessing (EMDR) early-intervention protocols of this population. CONCLUSION: Doctors have higher prevalence rates of ATSS and PTSD than the general public. Eye Movement Desensitisation and Reprocessing therapy's early-intervention protocols for recent, prolonged and ongoing traumatic stress have the potential to be a widely acceptable, timely and cost-effective intervention for doctors and other healthcare workers (HCWs), as highlighted in the emerging evidence base, which has grown considerably in response to the impact of the COVID pandemic on HCWs' mental health. These evidence-based interventions could potentially be routinely offered to doctors and other HCWs within 1 month of an adverse workplace experience to reduce ATSS, PTSD and other comorbidities.

Predictors of Treatment Completion among Women Receiving Integrated Treatment for Comorbid Posttraumatic Stress and Substance Use Disorders.

Background: Retention in treatment for individuals with comorbid posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is an area of concern in treatment outcome studies. The current study explores key variables related to retention in a group of women with comorbid PTSD and SUD enrolled in community SUD treatment randomized to eight weekly sessions of a trauma adapted mindfulness-based relapse prevention (TA-MBRP) or an integrated coping skills (ICS) group intervention. Methods: Two unadjusted and adjusted logistic discrete failure time (DFT) models were fit to examine associations between participants and the time (in weeks) to treatment completion status. Key covariates of interest, including time-varying PTSD Symptom Scale-Self Report (PSS) total score, time-varying Five Factors Mindfulness Questionnaire (FFMQ) total score, group assignment, baseline endorsements of substance use and demographics such as age, race and employment status were fit into the model. Results: In the adjusted PSS model, increased levels of PTSD symptom severity (PSS) scores at week 5 and 7 (PSS OR: 1:06: OR 1.13, respectively) were associated with higher odds of non-completion. In the FFMQ model, increased levels of FFMQ scores at week 6 (OR: 0:92) were associated with lower odds of non-completion. In both models, assignment to the ICS control group and unemployment were associated with lower odds of completion and baseline use of cocaine and sedatives were associated with higher odds of completion. Conclusion: Monitoring PTSD symptom severity and measures of mindfulness can inform providers on strategies to enhance retention early in treatment for individuals with comorbid PTSD/SUD.ClinicalTrials.gov # NCT02755103.

Exploring the health and well-being of a national sample of U.K. treatment-seeking veterans.

OBJECTIVE: Military veterans experience a higher prevalence of mental health difficulties compared with the general population. Research has highlighted veterans who experience mental health difficulties have poorer treatment outcomes. Understanding veteran needs may help improve veteran mental health services and treatment outcomes. The aim of this study was to explore the complexity of health and well-being needs among a national clinical sample of veterans. METHOD: In total, 989 veterans from a U.K. veterans mental health charity were invited to complete a questionnaire about their sociodemographic characteristics, military experiences, physical and mental health, and well-being. RESULTS: Of the invitees, 428 veterans (43.3%) completed the questionnaire. Common mental disorders, such as anxiety and depression, were the most frequently reported mental health difficulty (80.7%), followed by loneliness (79.1%) and perceived low social support (72.2%). Rates of PTSD were also high (68.7% any PTSD), with most participants experiencing complex PTSD (CPTSD; 62.5%) compared with PTSD (6.2%). Veterans with co-occurring CPTSD symptoms have poorer health due to a higher number of comorbidities, for instance between CPTSD and moral injury. CONCLUSIONS: Comorbidity appeared to be the norm rather than the exception within treatment-seeking veterans. As such, it seems important for veteran mental health services to take a holistic approach when supporting veterans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Prevalence and sociocultural correlates of post-traumatic stress disorder and complex PTSD among Chinese community health service users in Hong Kong.

OBJECTIVES: Complex post-traumatic stress disorder (CPTSD) is a newly recognized trauma disorder in ICD-11. Little is known about the prevalence and correlates of CPTSD in primary care settings. Its cultural aspects also remained minimally explored. This study investigated the prevalence and sociocultural correlates of PTSD and complex PTSD among Chinese community health service users in Hong Kong. METHODS: This study investigated ICD-11 PTSD and CPTSD in a sample of adults (N = 376) who had recently received services from Registered Chinese Medicine Practitioners in Hong Kong. Traditional Chinese medicine service is part of primary care services in Chinese societies. Participants completed self-report measures of CPTSD, trauma exposure, perceived family support, perceived caregiver's Chinese traditionality/modernity, participation (social activities and occupational productivity), depression and pain. RESULTS: The past-month prevalence of ICD-11 PTSD and CPTSD was 5.6% and 18.4%, respectively, in our sample. Chi-square tests and one-way ANOVAs revealed that participants with CPTSD were younger and reported more trauma, lower family support, lower levels of social participation and productivity, more depressive symptoms and pain, and more social welfare and mental health service usages than those without PTSD. We found that perceived caregiver's Chinese modernity (e.g. egalitarianism) was negatively correlated with CPTSD symptoms. Apart from age, non-betrayal trauma had the strongest association with classical PTSD symptoms, while betrayal trauma and perceived family support had the strongest association with disturbances in self-organization symptoms. CONCLUSION: This study provides the first data regarding the prevalence and correlates of ICD-11 PTSD and CPTSD among community health service users in Hong Kong. PTSD and CPTSD are common but often unrecognized mental health problems which are associated with more impairments and more service needs.

Pathways to post-traumatic growth and post-traumatic stress following the Canterbury earthquakes in a cohort of 40-year-olds.

OBJECTIVE: To report on post-traumatic growth and post-traumatic stress following the Canterbury earthquakes and to quantify the relationships between exposure to the earthquakes, post-traumatic growth and post-traumatic stress. METHOD: The Christchurch Health and Development Study is a longitudinal birth cohort study of New Zealanders aged 40 years at the time of latest assessment in 2017. A total of 455 participants were exposed to the Canterbury earthquakes and assessed in 2012 and 2017. Post-traumatic growth was measured in 2017 using the Post-traumatic Growth Inventory. Earthquake-related post-traumatic stress was measured in 2012 using post-traumatic stress disorder items from the Diagnostic Interview Schedule. Post-traumatic growth and post-traumatic stress were modelled using measures of earthquake impact and subjective measures of earthquake consequences (peri-traumatic stress and disruption distress). RESULTS: There was an indirect relationship between earthquake impact and post-traumatic growth. This was mediated via disruption distress. There was also an indirect relationship between earthquake impact and post-traumatic stress. This was mediated via peri-traumatic stress and disruption distress. Post-traumatic growth and post-traumatic stress were not significantly related. CONCLUSIONS: Measurement of post-traumatic growth and post-traumatic stress is required for a holistic understanding of disaster consequences. Subjective assessment of distress following disasters is required to predict their psychological effects.

"Buffering traumatic reactions to COVID-19: Mindfulness moderates the relationship between the severity of the pandemic and posttraumatic stress symptoms": Correction.

Reports an error in "Buffering traumatic reactions to COVID-19: Mindfulness moderates the relationship between the severity of the pandemic and posttraumatic stress symptoms" by Xiaoyan Liu, Xue Wen, Qian Zhang and Wei Xu (Psychological Trauma: Theory, Research, Practice, and Policy, Advanced Online Publication, Mar 21, 2022, np). In the original article, the first affiliation was incorrectly listed as "Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing Normal University" and was corrected to read "Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University." All versions of this article have been corrected. (The following abstract of the original article appeared in record 2022-45143-001). OBJECTIVE: As an international public health emergency panic, Corona Virus Disease-19 (COVID-19) has caused substantial impacts on economic and daily life. The public were at high risk of mental health problems and posttraumatic stress symptoms (PTSS). This study aimed to evaluate the association between objective/subjective severity of COVID-19 pandemic and PTSS, and explore the moderating role of mindfulness. METHOD: Using longitudinal and 7-day ecological momentary assessment (EMA) designs, we gathered data from 109 college students who were home-quarantined to examined study hypotheses. In the EMA phase, participants completed questionnaires measuring subjective severity, mindfulness and PTSS three times per day. Objective severity was indicated using the daily new confirmed cases. Then participants completed a follow-up measure of PTSS 2 months later, when the epidemic initially became stable. RESULTS: The results of structural equation modeling showed that state mindfulness moderated the relationship between subjectivity severity of COVID-19 and PTSS. Specifically, the association between subjective severity of COVID-19 and PTSS was positive at the low level of state mindfulness, and negative at the high level of state mindfulness. Trait mindfulness did not moderate the relationship between objectivity severity of COVID-19 and PTSS. CONCLUSION: Mindfulness-based interventions can be used as preventive mental health education to the daily lives of the general public, and to deal with unpredictable crisis events. Implications of this study are drawn for theory, practice, and research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Buffering traumatic reactions to COVID-19: Mindfulness moderates the relationship between the severity of the pandemic and posttraumatic stress symptoms.

[Correction Notice: An Erratum for this article was reported online in Psychological Trauma: Theory, Research, Practice, and Policy on Sep 15 2022 (see record 2023-01896-001). In the original article, the first affiliation was incorrectly listed as "Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing Normal University" and was corrected to read "Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University." All versions of this article have been corrected.] Objective: As an international public health emergency panic, Corona Virus Disease-19 (COVID-19) has caused substantial impacts on economic and daily life. The public were at high risk of mental health problems and posttraumatic stress symptoms (PTSS). This study aimed to evaluate the association between objective/subjective severity of COVID-19 pandemic and PTSS, and explore the moderating role of mindfulness. METHOD: Using longitudinal and 7-day ecological momentary assessment (EMA) designs, we gathered data from 109 college students who were home-quarantined to examined study hypotheses. In the EMA phase, participants completed questionnaires measuring subjective severity, mindfulness and PTSS three times per day. Objective severity was indicated using the daily new confirmed cases. Then participants completed a follow-up measure of PTSS 2 months later, when the epidemic initially became stable. RESULTS: The results of structural equation modeling showed that state mindfulness moderated the relationship between subjectivity severity of COVID-19 and PTSS. Specifically, the association between subjective severity of COVID-19 and PTSS was positive at the low level of state mindfulness, and negative at the high level of state mindfulness. Trait mindfulness did not moderate the relationship between objectivity severity of COVID-19 and PTSS. CONCLUSION: Mindfulness-based interventions can be used as preventive mental health education to the daily lives of the general public, and to deal with unpredictable crisis events. Implications of this study are drawn for theory, practice, and research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Virtually-delivered Sudarshan Kriya Yoga (SKY) for Canadian veterans with PTSD: A study protocol for a nation-wide effectiveness and implementation evaluation.

BACKGROUND: Post-traumatic stress disorder (PTSD) remains a significant treatment challenge among Canadian veterans. Currently accessible pharmacological and non-pharmacological interventions for PTSD often do not lead to resolution of PTSD as a categorical diagnosis and have significant non-response rates. Sudarshan Kriya Yoga (SKY), a complementary and integrative health (CIH) intervention, can improve symptoms of PTSD. In response to the COVID-19 pandemic, this intervention has pivoted to virtual delivery and may be reaching new sets of participants who face multiple barriers to care. OBJECTIVE: To evaluate the implementation and effectiveness of virtually delivered Sudarshan Kriya Yoga (SKY) on decreasing PTSD symptom severity, symptoms of depression, anxiety, and pain, and improving quality of life in Canadian veterans affected by PTSD. METHODS AND ANALYSIS: Using a mixed-methods approach guided by the RE-AIM framework, we will conduct a hybrid type II effectiveness and implementation study of virtually delivered Sudarshan Kriya Yoga (SKY) for Canadian veterans. Effectiveness will be evaluated by comparing virtually delivered SKY to a waitlist control in a single-blinded (investigator and data analyst) randomized controlled trial (RCT). Change in PTSD symptoms (PCL-5) is the primary outcome and quality of life (SF-36), symptoms of depression (PHQ-9), anxiety (GAD-7), and pain (BPI) are secondary outcomes. The SKY intervention will be conducted over a 6-week period with assessments at baseline, 6-weeks, 12-weeks, and 30 weeks. The reach, effectiveness, adoption, implementation, and maintenance of the intervention will be evaluated through one-on-one semi-structured interviews with RCT participants, SKY instructors, health professionals, and administrators that work with veterans. DISCUSSION: This is the first investigation of the virtual delivery of SKY for PTSD in veterans and aims to determine if the intervention is effective and implementable at scale.

The perceived impact of birth trauma witnessed by maternity health professionals: A systematic review.

OBJECTIVES: Maternity health professionals (MHPs) caring for women may witness or be involved in traumatic births. This can be associated with MHPs experiencing secondary traumatic stress (STS) or probable post-traumatic stress disorder (PTSD), which may impact MHPs emotionally and physically. The aims of this review were therefore to determine: (i) the prevalence of STS and PTSD in maternity health professionals; and (ii) the impact of witnessing birth trauma on maternity health professionals. METHODS: A mixed-methods systematic review was carried out by conducting literature searches on CINAHL, MEDLINE, PsychARTICLES, PsychINFO and PsychTESTS databases. Searches were conducted from the inception of databases up to February 2022 using search terms on MHPs and birth trauma combined. Methodological quality and bias were assessed. Data were synthesised using thematic synthesis. RESULTS: A total of 18 studies were included in the review. Sample size ranged from 9 to 2,165 (total N = 8,630). Participants included midwives, nurses and obstetricians aged 18-77 years. Many MHPs had witnessed a traumatic birth event (45% - 96.9%) with the prevalence of STS ranging from 12.6%-38.7% and the proportion of participants meeting diagnostic criteria for PTSD ranging from 3.1%-46%. MHPs reported positive and negative effects associated with witnessing traumatic birth events. Synthesis of quantitative and qualitative papers identified five themes: Negative emotions and symptoms; Responsibility and regret; Impact on practice and care; Challenging professional identity; and Team support being essential. DISCUSSION: Witnessing traumatic birth events is associated with profound emotional and physical impacts on MHPs, signifying the importance of acknowledging and addressing this in the maternity workforce. It is important to raise awareness of the impact of birth trauma on MHPs. Effective education and training guidelines, a supervisory network, ways to change practice and policy, and support and treatment should be provided to assist and improve the outcomes and work-life of MHPs' who witness traumatic births.

Formal mindfulness practice predicts reductions in PTSD symptom severity following a mindfulness-based intervention for women with co-occurring PTSD and substance use disorder.

BACKGROUND: Women with co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) experience systemic barriers that place them in danger of poorer treatment outcomes. Some mindfulness-based interventions (MBIs) have demonstrated efficacy in reducing PTSD and SUD symptoms. Mindfulness practice is a core component of MBIs, thought to elicit and maintain positive behavioral change; however, no research to our knowledge has assessed the role of mindfulness practice on sustained treatment gains among women with co-occurring PTSD-SUD. Such research is necessary to better inform MBIs for dually diagnosed women. METHODS: This secondary analysis assessed whether post-intervention formal and informal mindfulness practice predicted reductions in PTSD symptoms and substance craving 6 months following an 8-session mindfulness-based relapse prevention intervention for women diagnosed with co-occurring PTSD-SUD (N = 23). Data were derived from a pilot randomized controlled trial evaluating the feasibility and preliminary efficacy of a trauma-integrated mindfulness-based relapse prevention program for women with co-occurring PTSD-SUD. RESULTS: Greater duration of formal mindfulness practice (i.e., minutes per practice) predicted reduced total PTSD symptoms ([Formula: see text] = - .670, p < .00), trauma-related avoidance ([Formula: see text] = - .564, p = .01), arousal and reactivity ([Formula: see text] = - .530, p = .02), and negative cognitions and mood ([Formula: see text] = - .780, p < .01) six months following treatment. Informal practice did not predict any outcomes. CONCLUSIONS: This research highlights the potential role of formal mindfulness practice in sustaining reductions in PTSD symptoms over time among women with co-occurring PTSD-SUD. Further study of strategies to promote ongoing formal mindfulness practice in this population following a MBI are warranted. Trial registration The parent trial was registered with ClinicalTrials.gov (Identifier: NCT03505749).

Personal characteristics of World War Two survivor offspring related to the presence of indirect intrusions.

Background: A substantial proportion of clinical World War Two survivor offspring reports intrusions about war events they did not experience themselves. Objective: To help identify factors that contribute to the development of such indirect intrusions (i.e. intrusions about non-self-experienced traumatic events), we examined the personal characteristics of survivor offspring that were related to the presence of indirect intrusions. To explore the specificity of these relationships, we compared characteristics related to the presence of indirect and direct intrusions (i.e. intrusions about self-experienced traumatic events). Methods: Participants (N = 98) were post-war offspring of World War Two survivors in treatment in one of two clinics specialized in mental health services for war victims. We assessed the presence of indirect and direct intrusions as well as the following personal characteristics: gender, education level, trait dissociation, affect intensity, attentional control, mental imagery, fantasy proneness, and current psychopathology. Results: Reports of indirect intrusions were more frequent in individuals high in fantasy proneness, trait dissociation, and current psychopathology. Reports of direct intrusions were more frequent in women, individuals scoring high on trait dissociation, affect intensity, and current psychopathology. Fantasy proneness was a unique correlate of indirect intrusions. Conclusions: These findings are consistent with the idea that intrusions are the result of (re)constructive processes affected by several factors including personal characteristics. HIGHLIGHTS: Offspring of World War Two survivors often experience indirect intrusions.We examined personal characteristics related to indirect and direct intrusions.Fantasy proneness was the best predictor of indirect intrusions.Gender was the best predictor of direct intrusions.

Antecedentes: Una proporción sustancial de los descendientes sobrevivientes clínicos de la Segunda Guerra Mundial reportan intrusiones sobre eventos de guerra que no experimentaron ellos mismos.Objetivo: Para ayudar a identificar los factores que contribuyen al desarrollo de tales intrusiones indirectas (es decir, intrusiones sobre eventos traumáticos no-auto-experimentados) examinamos las características personales de los hijos sobrevivientes que estaban relacionadas con la presencia de intrusiones indirectas. Para explorar la especificidad de estas relaciones, comparamos las características relacionadas con la presencia de intrusiones indirectas y directas (es decir, intrusiones sobre eventos traumáticos auto-experimentados).Métodos: Los participantes (N = 98) fueron hijos de sobrevivientes de la Segunda Guerra Mundial que estaban en tratamiento en alguna de las dos clínicas especializadas en servicios de salud mental para víctimas de guerra. Se evaluó la presencia de intrusiones indirectas y directas, así como las siguientes características personales: sexo, nivel educativo, disociación de rasgos, intensidad afectiva, control atencional, imaginería mental, propensión a la fantasía y psicopatología actual.Resultados: Los informes de intrusiones indirectas fueron más frecuentes en individuos con alta propensión a la fantasía, disociación de rasgos y psicopatología actual. Los informes de intrusiones directas fueron más frecuentes en mujeres, individuos con puntajes altos en disociación de rasgos, intensidad afectiva y psicopatología actual. La propensión a la fantasía fue un correlato único de las intrusiones indirectas.Conclusiones: Estos hallazgos son consistentes con la idea de que las intrusiones son el resultado de procesos (re)constructivos afectados por varios factores, incluidas las características personales.