Effect of Cultural Adaptation of a Smartphone-Based Self-Help Programme on Its Acceptability and Efficacy: Randomized Controlled Trial.

Background: Research on cultural adaptation of psychological interventions indicates that a higher level of adaptation is associated with a higher effect size of the intervention. However, direct comparisons of different levels of adaptations are scarce. Aims: This study used a smartphone-based self-help programme called Step-by-Step (Albanian: Hap-pas-Hapi) for the treatment of psychological distress among Albanian-speaking immigrants in Switzerland and Germany. Two levels of cultural adaptation (i.e., surface vs. deep structure adaptation) were compared. We hypothesised that the deep structure adaptation would enhance the acceptance and efficacy of the intervention. Method: We conducted a two-arm, single-blind randomised controlled trial. Inclusion criteria were good command of the Albanian language, age above 18, and elevated psychological distress (Kessler Psychological Distress Scale score above 15). Primary outcome measures were the total score of the Hopkins Symptom Checklist and the number of participants who completed at least three (out of five) sessions. Secondary outcomes were global functioning, well-being, post-traumatic stress, and self-defined problems. Results: Two-hundred-twenty-two participants were included, of which 18 (8%) completed the post-assessments. The number of participants who completed the third session was equal in both conditions, with N = 5 (5%) and N = 6 (6%) respectively. Discussion: Drop-out rates were high in both conditions, and no group difference was found regarding the acceptance of the intervention. The high drop-out rate stands in contrast with other trials testing Step-by-Step. Future research should examine cultural factors impacting recruitment strategies, as insights could help to reduce participant drop-out rates in clinical trials.

Exploring Characteristics of Preoccupation and Failure to Adapt Among Patients Suffering From Adjustment Disorder: A Qualitative Study.

Background: Adjustment Disorder (AjD) is a frequent diagnosis in psychological and psychiatric consultations. Recently, the ICD-11 has introduced preoccupation and failure to adapt as core symptoms of AjD. However, empirical research that explores the various possible manifestations of preoccupation and failure to adapt in AjD patients is sparse. Therefore, the study aimed to explore patients' experiences of the core symptoms of AjD in a qualitative study. Method: We recruited 16 patients suffering from ICD-11 AjD who filled in self-report questionnaires to assess sociodemographic information, adjustment disorder symptoms, anxiety and depression. Then, they participated in a semi-structured interview with a trained psychologist to explore the determinants and characteristics of their preoccupation and failure to adapt symptoms. Thematic analysis was applied to analyze the responses. Results: Six themes were identified in our analysis 1) Preoccupation triggers, 2) Preoccupations and negative emotions, 3) Strategies to stop preoccupation, 4) Consequences of preoccupation, 5) Manifestation of difficulties/failure to adapt and 6) Strategies to address difficulties/failure to adapt. Conclusion: We found partial congruence between our data and previous conceptualizations of AjD. Preoccupations seem to be time-consuming, center around stressors and their consequences, and be associated with negative emotions. Some preoccupations reported by the patients could also be labeled as ruminations or worries. The failure to adapt symptoms seemed to be broader than the exemplary symptoms highlighted in current measures of AjD.

Feasibility and Acceptability of a Mobile App for Prolonged Grief Disorder Symptoms.

Background: Mobile apps provide a unique platform for mental health assessment and monitoring. They can provide real time, accessible data on symptoms of mental disorders that may yield rich data for detailed clinical assessment and help individuals gain insight into their current mental state. We developed one of the first apps for tracking symptoms of prolonged grief disorder. Method: In this pilot feasibility study, we assess the feasibility and acceptability of a new mobile app mGAGE for use once a day for 3 weeks. 27 participants completed mental health assessments at t1 and t2. Results: Adherence to the app protocol was very high with 100% for the first two weeks of use. A surprising finding was the improvement of grief symptoms at t2. Debriefing interviews revealed general qualitative categories including positive feedback, negative feedback and specific recommendations. Overall, the app was found to be feasible for use for the first two weeks and acceptable for bereaved individuals. Conclusions: This app could provide valuable data for in depth clinical assessment, may support individuals to gain greater insight into their symptoms and may have a therapeutic effect in terms of improved grief symptoms. Implications for future studies including use in larger intervention studies are discussed.

Examining bi-directional links between loneliness, social connectedness and sleep from a trait and state perspective.

Greater loneliness as well as a lack of social connectedness have often been associated with poorer sleep. However, the temporal dynamics and direction of these associations remain unclear. Aim of the current study was to examine bi-directional associations between loneliness/social connectedness and sleep in 48 stress-exposed medical students during their first medical internship, considered a period of heightened stress. We obtained trait-level questionnaire data on loneliness and global sleep completed before and during the internship as well as state-level diary- and wearable-based data on daily changes in social connectedness and sleep collected twice over the period of seven consecutive days, once before and once during the internship. Bi-directional associations among greater loneliness and higher daytime dysfunction on trait-level were identified. In addition, several uni-directional associations between loneliness/social connectedness and sleep were found on trait- and state-level. In sum, findings of this study point at a bi-directional relation among loneliness/social connectedness and sleep, in which variables seem to reciprocally influence each other across longer-term periods as well as on a day-to-day basis.

Cultural psychological factors in posttraumatic symptom development and expression: a study protocol.

Introduction: Cultural factors were shown to be particularly relevant for the development and expression of posttraumatic stress. Recently, the concept of cultural scripts of trauma has been introduced, which proposes that trauma sequelae elements may be sequentially linked and specifically associated with cultural factors. Furthermore, a cascade model is proposed, including trauma exposure, demographic characteristics, cultural affiliation, and trauma-related value orientations as influencing factors of posttraumatic development. The purpose of this Network Project is to investigate cultural psychological factors that contribute to the expression of posttraumatic stress.Methods: The present Network Project implements a mixed methods approach and will be conducted in 5 different study sites, including Switzerland, Israel, Georgia, China, and East Africa. In sub-study I, the cultural scripts of traumatic stress inventories (CSTIs) will be developed. These scales provide a pool of trauma sequelae elements for each cultural group. For this purpose, focus groups with trauma survivors and trauma experts will be conducted and analysed using qualitative research methods. Sub-study II implements a validation analysis of the CSTIs and the empirical investigation of a cultural cascade model. This quantitative approach will include a larger sample of individuals who experienced traumatic life events.Discussion: This contribution is timely and enriches the knowledge of trauma and culture. Future publications of this Network Project will address trauma sequelae from a cultural perspective and provide diagnostic and psychotherapeutic implications.

This paper presents a Network Project that investigates cultural factors in posttraumatic sequelae.The Network Project encompasses an innovative research design with both qualitative and quantitative methods.New developments in the field of cultural clinical psychology are introduced, including cultural scripts of trauma and a cascade model of cultural factors in posttraumatic symptom expression.

[Evidence-based psychotherapy of posttraumatic stress syndrome-An update]. / Evidenzbasierte Psychotherapie posttraumatischer Belastungsstörungen ­ ein Update.

BACKGROUND: The aim of this article is to summarize the current state of research on the effectiveness of psychotherapeutic treatment of posttraumatic stress disorder (PTSD). METHODS: The results of current meta-analyses and trend-setting individual studies are summarized and the most important forms of intervention are explained. RESULTS: The psychotherapeutic treatment methods for PTSD are very effective, the effect sizes are large and superior to those of pharmacotherapy. Trauma exposure and cognitive restructuring are most effective. Trauma-focused procedures are generally superior to other forms of psychotherapy. A range of different cognitive behavioral procedures as well as eye movement desensitization and reprocessing are recommended. The most recent initial findings confirm a very good effectiveness for imagery rescripting methods as protective interventions without a formal confrontation with trauma. Individual therapy works better than group psychotherapy. In the group setting cognitive processing therapy has proven to be the best intervention. Trauma-focused treatment should also be used when comorbid conditions such as schizophrenia, bipolar disorder or addiction are present. DISCUSSION: Trauma-focused psychotherapy in an individual setting is the treatment of choice for PTSD. A large selection of effective methods and well-reviewed manuals are available. The German language S3 guidelines are currently being updated.

Cultural concepts of distress among Albanian young adults living in Switzerland - a qualitative study.

Objectives: Existing research recognizes the critical role that social, sociodemographic, and acculturative processes play in increasing vulnerability for experiencing psychological distress among second-generation migrants. However, to date, far too little attention has been given to the study of psychological distress in this social group. The main objective of this study is to examine cultural identities, as well as expressions and causes of psychological distress among second-generation Albanian-speaking migrants in Switzerland. Methods: Semi-structured qualitative interviews were conducted with 13 Albanian-speaking participants between 19 and 35 years of age using the interview of the Barts Explanatory Model Inventory. Data were analyzed by qualitative content analysis using MAXQDA-2018 software. Findings: Study participants showed bicultural identities, which caused value conflicts and a feeling of being "caught" between Swiss and Albanian culture. Some participants experienced the fear of disappointing their parents. Others find it difficult to deal with conflicting norms and values. Parentification was another important cause within their cultural concept of distress. At the same time, (implicit) social support, i.e., spending time with the family and the community, was an important coping mechanism. Conclusion: Second-generation immigrants are exposed to specific risk factors for psychological distress. A better understanding of these risk factors and their coping mechanisms is essential for providing them with meaningful support services, both in prevention and psychotherapy.

Assessing complex PTSD and PTSD: validation of the German version of the International Trauma Interview (ITI).

Background: With the introduction of the ICD-11 into clinical practice, the reliable distinction between Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) becomes paramount. The semi-structured clinician-administered International Trauma Interview (ITI) aims to close this gap in clinical and research settings.Objective: This study investigated the psychometric properties of the German version of the ITI among trauma-exposed clinical samples from Switzerland and Germany.Method: Participants were 143 civilian and 100 military participants, aged M = 40.3 years, of whom 53.5% were male. Indicators of reliability and validity (latent structure, internal reliability, inter-rater agreement, convergent and discriminant validity) were evaluated. Confirmatory factor analysis (CFA) and partial correlation analysis were conducted separately for civilian and military participants.Results: Prevalence of PTSD was 30% (civilian) and 33% (military) and prevalence of CPTSD was 53% (civilians) and 21% (military). Satisfactory internal consistency and inter-rater agreement were found. In the military sample, a parsimonious first-order six-factor model was preferred over a second-order two-factor CFA model of ITI PTSD and Disturbances in Self-Organization (DSO). Model fit was excellent among military participants but no solution was supported among civilian participants. Overall, convergent validity was supported by positive correlations of ITI PTSD and DSO with DSM-5 PTSD. Discriminant validity for PTSD symptoms was confirmed among civilians but low in the military sample.Conclusions: The German ITI has shown potential as a clinician-administered diagnostic tool for assessing ICD-11 PTSD and CPTSD in primary care. However, further exploration of its latent structure and discriminant validity are indicated.

This study validated the German International Trauma Interview (ITI), a semi-structured clinician-administered diagnostic interview for ICD-11 Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder.Internal reliability, inter-rater agreement, latent structure, and convergent validity were explored in trauma-exposed clinical and military samples from five different in- and outpatient centres in Germany and German-speaking Switzerland.The findings supported the German ITI's reliability, inter-rater agreement, convergent validity and usefulness from a patient perspective. Future research should explore its factor structure and discriminant validity, for which differences between the samples were found.

A new approach to cultural scripts of trauma sequelae assessment: The sample case of Switzerland.

BACKGROUND: The novel concept of cultural scripts of trauma sequelae captures culture-specific expressions of posttraumatic distress (e.g., cognitive, emotional, interpersonal, psychosomatic changes) and their temporal associations. Cultural scripts of trauma sequelae complement pan-cultural (etic) diagnoses, such as posttraumatic stress disorder (PTSD) and Complex PTSD, as well as the cultural syndromes concept. OBJECTIVE: This study aimed to develop the cultural scripts of trauma inventory (CSTI) for German-speaking Switzerland and to explore temporal associations of script elements. METHOD: Five semi-structured focus groups were conducted with psychotraumatologists (n = 8) and Swiss trauma survivors (n = 7). The interview schedule included open questions about different domains of potential posttraumatic changes (emotions, cognitions, worldviews, interpersonal relationships, body-related experiences, behavior, and growth). Data were analyzed using qualitative content analysis. RESULTS: The Swiss CSTI includes 57 emic elements that represent salient trauma sequelae (30 conformed with a theoretically derived item pool, 27 were newly phrased). Temporal script associations were visualized in a network, whereby self-deprecation, the urge to function and overcompensate, and the urge to hide and endure suffering had the highest number of connections. CONCLUSION: While many posttraumatic changes identified in the present work seem to mirror pan-cultural phenomena represented in the Complex PTSD concept (e.g., self-deprecation), others (e.g., urge to function and perform, urge to hide and endure suffering) may be prominently related to Swiss culture with its value orientations. Knowledge about cultural scripts of trauma sequelae may provide a culture-specific framework that can help to understand individual experiences of distress and enable mental health practitioners to administer culturally sensitive interventions. Pending further validation, the Swiss CSTI bears the potential to advance culture-sensitive assessment of trauma sequelae.

How meaning in life and vitality are associated with posttrauma outcomes: A systematic review.

When confronted with a traumatic event, people may suffer from adverse posttraumatic outcomes, such as posttraumatic stress disorder (PTSD) or complex PTSD (CPTSD). Positive psychology research has shown that meaning in life and vitality are potentially correlated protective factors against negative developments following trauma exposure that can lead to PTSD or CPTSD. This systematic review aimed to synthesize global empirical research findings, emphasizing the impact of meaning in life and vitality on both PTSD and CPTSD. A search of empirical studies was performed within the Embase, Scopus, and Web of Science core collection databases, as well as PsycInfo, using the PRISMA checklist. A total of 29 studies were included after a systematic exclusion process. The collective findings from 22 studies examining meaning in life and five studies focusing on vitality revealed a consistent negative association with symptoms of PTSD. No study that explored the associations among meaning in life, vitality, and CPTSD was found. In contrast to vitality, meaning in life has been extensively studied in relation to traumatic stress worldwide, and few discrepancies in results were found. This systematic review identified the need to intensify scientific efforts in capitalizing on meaning in life as a possible target for psychological interventions, especially for trauma survivors globally, and to consider vitality as a protective factor that needs more empirical attention in relation to posttraumatic stress. Furthermore, there is a need for studies that encompass diverse target samples and employ longitudinal study design to examine the associations between protective factors and CPTSD.

[Toward Cultural Scripts of Trauma Sequelae]. / Auf dem Weg zu kulturellen Skripten von Traumafolgen.

BACKGROUND: The concept of cultural scripts has proven to be very useful for describing depression-like psychological complaints in different cultural regions of the world. The article presents the galaxy model and its implementation in the model of cultural scripts theoretically for the first time and connects these with cultural psychological value research. A new, extensive series of research projects aims to investigate post-trauma -related psychological complaints in various regions of the world. METHODS: The work in two countries/regions began with focus groups in which elements of cultural scripts were collected by traumatized clients and/or by (therapeutic) experts. For this purpose, a theory-based framework of possible post-traumatic script elements was provided. In Switzerland, focus groups were conducted with patients and experts. Focus groups were conducted with genocide survivors and other trauma victims in Rwanda and three East African countries. The evaluation was semi-quantitative. RESULTS: In Switzerland, around 50 symptoms and changes were mentioned as script elements (e. g. still having to function). Approximately 100 symptoms and changes were mentioned as script elements in East Africa (e. g. loss of dignity). The first temporal connections (i. e. strong scripts) were found for the Swiss scripts (e. g. self-devaluation - urge to function). In the East African study, cultural value orientations underlying the script groupings were also assessed (e. g. community reputation). DISCUSSION: The illustrative results presented here demonstrate the galaxy model and the suitability of the cultural script concept for recording the effects of trauma. There are differences and similarities in the two world regions examined so far. Further steps at the two study sites will be the temporal connections and the relationships to value orientations. The studies will be started at the other study sites in the following years.

User-centered development of an internet-based CBT intervention for the treatment of loneliness in older individuals.

Background: Loneliness is a widespread phenomenon associated with a number of negative health outcomes. Older individuals may constitute one important target group with a need for effective interventions. However, despite evidence showing that addressing maladaptive social cognition (e.g., via cognitive behavioral therapy [CBT]) is the most effective intervention strategy for reducing loneliness, most existing programs aimed at older individuals do not use that method. Further, in terms of mental health service use, older individuals have been found to be an extremely undertreated population. When developing interventions, active involvement of end users in the development process is essential to increase later uptake. Objective: The aim of the present study was to develop an internet-based CBT intervention for loneliness in older individuals (i.e., aged ≥65 years) applying a user-centered design. The present report provides an in-depth description of the development process. Methods: Two phases of qualitative data collection were conducted in parallel with intervention development using a sample of N = 12 participants including both potential end users (i.e., older adults) as well as experts (i.e., psychotherapists). Measures included semi-structured interviews and usability testing. Results: In Phase 1 interviews, participants indicated that they were predominantly positive about the idea of an internet-based program for loneliness targeting older individuals. Individualization and interactivity were named as crucial features. In Phase 2, usability testing of a prototype program provided important insights into technical barriers to intervention use. Further, participants reported that they were missing content on philosophy/theology and the role of descendants/relatives. Valuable insights from Phase 1 and Phase 2 were incorporated into the intervention program resulting in a 7-module internet-based self-help CBT intervention. Discussion: Findings of this study highlight the significance of including relevant stakeholders in the development process of an intervention. Additionally, results emphasize the high acceptance of internet-based interventions in this population, but also underline the need for considering age-specific aspects when developing treatments.

Predictors and (in-)stability of ICD-11 complex posttraumatic stress disorder in older adults: findings from a longitudinal study in Switzerland.

Objective: There is a lack of research on complex post-traumatic stress disorder (CPTSD) in older individuals, with little known about the temporal course of CPTSD. Therefore, this study assessed and compared the demographic characteristics, adverse childhood experiences (ACE), and well-being of Swiss older adults with and without probable CPTSD. The (in-)stability of probable CPTSD was also examined in relation to the predictive value of various emotion-related factors.Methods: A longitudinal study was conducted in Switzerland with N = 213 participants (Mage = 69.98 years, SD = 10.61; 45.5% female). Data was collected via face-to-face assessments at baseline and follow-up, 21 months apart. The German version of the International Trauma Questionnaire was used to screen for (C)PTSD. Standardized instruments were used to assess ACE as well as the predictors anger, embitterment, emotion regulation, and meaning in life.Results: From the total sample, n = 16 participants (7.5%) were identified as having probable CPTSD, with only five of these (31.25%) having probable CPTSD at both baseline and follow-up. Individuals with and without probable CPTSD differed significantly regarding age and employment status. Significant predictors of probable CPTSD were anger (ß = 0.16), embitterment (ß = 0.06), cognitive reappraisal (ß = -0.41), and the presence of meaning in life (ß = -0.10).Conclusions: Probable CPTSD appears to be relatively unstable over the course of a 21-month period in older individuals. The links between CPTSD and emotion-related predictors highlight potential targets for intervention.

KEY FINDINGS: Older adults with and without probable CPTSD differ in terms of age, employment status, adverse childhood experiences, psychiatric comorbidities, well-being, and life satisfaction.Temporal (in-)stability: In older adults, probable CPTSD appears to be unstable over a 21-month period with around one-third of the participants showing a stable course.Treatment targets: The identified significant predictors anger, embitterment, cognitive reappraisal, and the presence of meaning in life beliefs are potential treatment targets.

Half a Century of Research on Posttraumatic Stress Disorder: A Scientometric Analysis.

We conducted a scientometric analysis to outline clinical research on posttraumatic stress disorder (PTSD). Our primary objective was to perform a broad-ranging scientometric analysis to evaluate key themes and trends over the past decades. Our secondary objective was to measure research network performance. We conducted a systematic search in the Web of Science Core Collection up to 15 August 2022 for publications on PTSD. We identified 42,170 publications published between 1945 and 2022. We used CiteSpace to retrieve the co-cited reference network (1978-2022) that presented significant modularity and mean silhouette scores, indicating highly credible clusters (Q = 0.915, S = 0.795). Four major trends of research were identified: 'war veterans and refugees', 'treatment of PTSD/neuroimaging', 'evidence syntheses', and 'somatic symptoms of PTSD'. The largest cluster of research concerned evidence synthesis for genetic predisposition and environmental exposures leading to PTSD occurrence. Research on war-related trauma has shifted from battlefield-related in-person exposure trauma to drone operator trauma and is being out published by civilian-related trauma research, such as the 'COVID-19' pandemic impact, 'postpartum', and 'grief disorder'. The focus on the most recent trends in the research revealed a burst in the 'treatment of PTSD' with the development of Mhealth, virtual reality, and psychedelic drugs. The collaboration networks reveal a central place for the USA research network, and although relatively isolated, a recent surge of publications from China was found. Compared to other psychiatric disorders, we found a lack of high-quality randomized controlled trials for pharmacological and nonpharmacological treatments. These results can inform funding agencies and future research.

Examining accurate diagnosis of complex PTSD in ICD-11.

BACKGROUND: Complex posttraumatic stress disorder (complex PTSD), the most frequently suggested new category for inclusion by mental health professionals, has been included in the Eleventh Revision of the World Health Organization's International Classification of Diseases (ICD-11). Research has yet to explore whether clinicians' recognition of the distinct complex PTSD symptoms predicts giving the correct diagnosis. The present study sought to determine if international mental health professionals were able to accurately diagnose complex PTSD and identify the shared PTSD features and three essential diagnostic features, specific to complex PTSD. METHODS: Participants were randomly assigned to view two vignettes and tasked with providing a diagnosis (or indicating that no diagnosis was warranted). Participants then answered a series of questions regarding the presence or absence of each of the essential diagnostic features specific to the diagnosis they provided. RESULTS: Clinicians who recognized the presence or absence of complex PTSD specific features were more likely to arrive at the correct diagnostic conclusion. Complex PTSD specific features were significant predictors while the shared PTSD features were not, indicating that attending to each of the specific symptoms was necessary for diagnostic accuracy of complex PTSD. LIMITATIONS: The use of written case vignettes including only adult patients and a non-representative sample of mental health professionals may limit the generalizability of the results. CONCLUSIONS: Findings support mental health professionals' ability to accurately identify specific features of complex PTSD. Future work should assess whether mental health providers can effectively identify symptoms of complex PTSD in a clinical setting.

[Psychotherapy for elderly patients]. / Psychische Störungen im Alter und ihre psychotherapeutische Behandlung.

A particular feature of the demographic change is the growing proportion of elderly and very elderly people. In Western countries, this is largely due to improved medical care for age-associated diseases. There is still comparatively little knowledge about mental health disorders in old age, their age-typical clinical presentation and specific psychotherapeutic treatment.

Elements of cultural scripts of trauma sequelae among trauma victims in East Africa.

Background: As a new, unifying approach to mapping the cultural expressions of trauma sequelae, cultural scripts of trauma sequelae are empirically investigated here for the first time in a primarily qualitative study. Elements of Cultural Scripts of Trauma (CST) include the typical symptoms and appraisals of changes of those who have experienced traumatic events. These elements refer to the value orientations in the given culture. Aims: To identify post-traumatic cultural scripts' elements and their groupings, as expressed by trauma survivors from the East African population, and to explore the cultural values that serve as a reference to such scripts' elements. Methods: Semi-structured, in-depth interviews were conducted in nine focus groups of trauma survivors and trauma experts. Grounded theory was the basis for the content analysis, and MAXQDA was used for coding and grouping. Semi-quantitative analyses of the frequency of groupings followed. Results: The study extracted 270 elements of the cultural scripts of trauma. Three stages of cultural scripts' elements were identified including unspeakable, heart wounds and painful scars and growth. The reported elements are only those in the three last stages and they are grouped into six categories, such as cognitive appraisals, worldview, interpersonal relationships, body-related, positive changes and changes in family interest and management, while the elements of the first stages are not codable as the survivors do not yet get the words of their expressions. The cultural values that served as a reference consisted of holding the sadness, Christianity, community reputation, solidarity, social connectedness, social cynicism, and reproductiveness, among others. Discussion: This comprehensive study with participants from several countries in East Africa collected a large number of elements of cultural scripts of trauma for this regional area. Notably, these elements were based mostly on man-made traumas, such as the genocide against the Tutsis in Rwanda. Further steps in the CST investigation are subject to future studies, such as a more systematic investigation of the relationship with cultural values and the temporal relationships within the scripts.

The role of daily adjustment disorder, depression and anxiety symptoms for the physical activity of cardiac patients.

BACKGROUND: Physical activity (PA) is crucial in the treatment of cardiac disease. There is a high prevalence of stress-response and affective disorders among cardiac patients, which might be negatively associated with their PA. This study aimed at investigating daily differential associations of International Classification of Diseases (ICD)-11 adjustment disorder, depression and anxiety symptoms with PA and sedentary behaviour (SB) during and right after inpatient cardiac rehabilitation. METHODS: The sample included N = 129 inpatients in cardiac rehabilitation, Mage = 62.2, s.d.age = 11.3, 84.5% male, n = 2845 days. Adjustment disorder, depression and anxiety symptoms were measured daily during the last 7 days of rehabilitation and for 3 weeks after discharge. Moderate-to-vigorous PA (MVPA), light PA (LPA) and SB were measured with an accelerometer. Bayesian lagged multilevel regressions including all three symptoms to obtain their unique effects were conducted. RESULTS: On days with higher adjustment disorder symptoms than usual, patients engaged in less MVPA, and more SB. Patients with overall higher depression symptoms engaged in less MVPA, less LPA and more SB. On days with higher depression symptoms than usual, there was less MVPA and LPA, and more SB. Patients with higher anxiety symptoms engaged in more LPA and less SB. CONCLUSIONS: Results highlight the necessity to screen for and treat adjustment disorder and depression symptoms during cardiac rehabilitation.

How to deal with the past? How collective and historical trauma psychologically reverberates in Eastern Europe.

Traumatic stress studies have recently addressed the issue of 'historical trauma' that well explain the impact of collective or totalitarian trauma. The example of former communist Eastern Europe shows that there are many individual and socio-psychological consequences that still have effects today. This paper summarizes concepts and findings on 'historical traumas' that describe such long-lasting effects. The focus is on the side of the victims and their family descendants and thus also on the moral heirs of the dissidents, e.g., the Russian NGO Memorial. Analogous to developments in psychotraumatology, increasing knowledge in this area can explain psychosocial pathologies but also help develop effective remedies. This includes the development of a culture of remembrance, socio-therapeutic interventions and increased sensitivity towards those patients and clients who have such a personal legacy.

Somatic symptom distress and ICD-11 prolonged grief in a large intercultural sample.

Background: Grief is a multi-faceted experience including emotional, social, and physical reactions. Research in ICD-11 prolonged grief disorder (PGD) in different cultural contexts has revealed different or potentially missing grief symptoms that may be relevant.Objective: This study thus aimed to explore the prevalence of somatic symptom distress and its associations with grief and negative affect in a culturally diverse sample of bereaved individuals with symptoms of PGD.Methods: Based on cross-sectional survey data from the Measurement and Assessment of Grief (MAGIC) project, this study included 1337 participants (mean age 23.79 yrs, 76.1% female) from three regions (USA: 62.3%, Turkey/Iran: 24.2%, Cyprus/Greece: 13.5%), who experienced a loss of a significant other. Associations between somatic symptom distress (Somatic Symptom Scale, SSS-8), symptoms of PGD (International Prolonged Grief Disorder Scale, IPGDS-33), anxiety (Generalized Anxiety Disorder Questionnaire, GAD-7), depression (Patient Health Questionnaire, PHQ-9) as well as demographic and loss related characteristics were investigated. Three hundred and thirteen participants (23.4%) scored above the proposed cut-off for clinically severe PGD.Results: 'High' or 'very high' levels of somatic symptom distress were more frequent in a possible PGD group (58.2%), than in a non-PGD group (22.4%), p < .001, as divided per cut-off in the IPGDS. In a multiple regression analysis, PGD symptoms were significantly but weakly associated with somatic symptom distress (ß = 0.08, p < .001) beyond demographics, loss-related variables, and negative affect. Negative affect (anxiety and depression) mediated the relationship of PGD symptoms with somatic symptom distress and the indirect effect explained 58% of the variance.Conclusions: High levels of somatic symptom distress can be observed in a substantial proportion of bereaved across cultures. Our findings suggest that PGD is related to somatic symptom distress partly and indirectly through facets of negative affect.

30.8% of bereaved adults showed 'high' or 'very high' levels of somatic symptom distress.Anxiety and depression partially mediate relationship of PGD symptoms with somatic symptom distress.Findings encourage practitioners to consider somatic symptom distress in psychotherapeutic treatment of PGD.