Implementation of a Primary Prevention Program for Posttraumatic Stress Disorder in a Cohort of Professional Soldiers (PREPAR): Protocol for a Randomized Controlled Trial.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a psychiatric disorder that can manifest after a traumatic event where the individual perceives a threat to his or her life or that of others. Its estimated prevalence in the European population is 0.7% to 1.9%. According to the "dose-response" model, individuals who are most exposed to traumatic events are most at risk of developing PTSD. Hence, it is unsurprising that studies have observed a higher prevalence among the military population, ranging from 10% to 18%, or even up to 45%. This project's overall goal is to evaluate the primary prevention actions that can strengthen the resilience of at-risk professionals, notably military personnel, in the short term, with the medium- to long-term aim of preventing the occurrence of PTSD and improving the patient's prognosis. OBJECTIVE: This study's objectives are (1) to design a primary prevention program for PTSD, tailored to the studied military population and compatible with operational constraints; and (2) to implement and validate the Primary Prevention of Posttraumatic Stress Disorder in Military Professionals (PREPARE) program in the short term with operational personnel belonging to the French Mountain Infantry Brigade. METHODS: This is a single-center, prospective, randomized, parallel-group controlled cohort study. The cohort is divided into 2 groups: the nonintervention group receives no training, and the intervention group follows a dedicated prevention program (structured into 8 workshops and 2 debriefing and practice reinforcement workshops). Each participant is evaluated 4 times (at inclusion, +4 months, +6 months, and +12 months). During each visit, participants complete several psychosocial questionnaires (which take 15-80 minutes to complete). Samples (a 30-mL blood sample and three 5-mL saliva samples) are collected on 3 occasions: at inclusion, +4 months, and +12 months. Emotional reactivity (electrocardiogram and electrodermal activity) is measured before, during, and after the classic and the emotional Stroop task. RESULTS: The project is currently ongoing, and results are expected to be published by the end of 2024. CONCLUSIONS: The study adopts an integrative approach to the processes that play a role in the risk of developing PTSD. Our biopsychosocial perspective makes it possible to target levers related to factors specific to the individual and socio-professional factors. The following dimensions are addressed: (1) biophysiology (by studying markers of the neurobiological stress response, wear and tear, and vulnerability phenomena and reinforcing the flexibility of the autonomic nervous system), (2) psychology (by facilitating and measuring the development of flexible coping strategies to deal with stress and evaluating the moderating role of the individual's sense of duty in the development of PTSD), and (3) social (by facilitating community strategies aimed at reducing stigmatization and supporting the use of care by professionals in difficulty, in the institutional context). TRIAL REGISTRATION: ClinicalTrials.gov NCT05094531; https://clinicaltrials.gov/study/NCT05094531. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/47175.

Position: A study protocol for the prevention of fall injuries in french special forces selection courses using a body-centered intervention.

INTRODUCTION: The Military Physical and Sports Training program was developed by the French Army in order to train, optimize, and maintain individual readiness. Although the health benefits of sport practice do not need to be demonstrated, such activities can cause acute musculoskeletal injuries that need to be addressed. The prevalence of lower limb injury is rather high in the French military population and, in particular, ranges from 15 to 45% during Special Forces selection courses. Thus, this project aims to investigate the efficiency of a body-centered program designed to enhance body awareness. The program seeks to train the mind to actively pay attention to body information, while the latter is viewed as a protective factor against fall injuries. We assume: (i) that postural control can be improved by enhancing the level of body awareness; and (ii) that greater postural awareness could be beneficial in reducing the risk of fall injuries. The body-centered prevention program is based on the Optimization of the Resources of the Armed Forces (ORAF) intervention, which focuses on mental preparation and recovery, and has been deployed in the French Army for many years. METHOD AND ANALYSES: The study focuses on five French Special Forces selection courses (400 soldiers/ participants). It is divided into two stages (year 1, year 2). The first year is dedicated to data collection from the control group (200 participants), while in the second year the ORAF intervention will be deployed. In both year, participants will be subjected to the same enrollment schedule (Fig 3). The main objective is to evaluate the effectiveness of the ORAF intervention in reducing the rate of fall injuries during military selection, based on a multidisciplinary method that captures demographic, biological, biometric, clinical, and para-clinical measures. TRIAL REGISTRATION: Registration number: IDRCB number 2021-A02108-33, Clinical Trial: NCT05451394.

Steady electrocorticogram characteristics predict specific stress-induced behavioral phenotypes.

Introduction: Depending on the individual, exposure to an intense stressor may, or may not, lead to a stress-induced pathology. Predicting the physiopathological evolution in an individual is therefore an important challenge, at least for prevention. In this context, we developed an ethological model of simulated predator exposure in rats: we call this the multisensorial stress model (MSS). We hypothesized that: (i) MSS exposure can induce stress-induced phenotypes, and (ii) an electrocorticogram (ECoG) recorded before stress exposure can predict phenotypes observed after stress. Methods: Forty-five Sprague Dawley rats were equipped with ECoG telemetry and divided into two groups. The Stress group (n = 23) was exposed to an MSS that combined synthetic fox feces odor deposited on filter paper, synthetic blood odor, and 22 kHz rodent distress calls; the Sham group (n = 22) was not exposed to any sensorial stimulus. Fifteen days after initial exposure, the two groups were re-exposed to a context that included a filter paper soaked with water as a traumatic object (TO) reminder. During this re-exposure, freezing behavior and avoidance of the filter paper were measured. Results: Three behaviors were observed in the Stress group: 39% developed a fear memory phenotype (freezing, avoidance, and hyperreactivity); 26% developed avoidance and anhedonia; and 35% made a full recovery. We also identified pre-stress ECoG biomarkers that accurately predicted cluster membership. Decreased chronic 24 h frontal Low θ relative power was associated with resilience; increased frontal Low θ relative power was associated with fear memory; and decreased parietal ß2 frequency was associated with the avoidant-anhedonic phenotype. Discussion: These predictive biomarkers open the way to preventive medicine for stress-induced diseases.

Self-Reported Body Awareness: Validation of the Postural Awareness Scale and the Multidimensional Assessment of Interoceptive Awareness (Version 2) in a Non-clinical Adult French-Speaking Sample.

Body awareness refers to the individual ability to process signals originating from within the body, which provide a mapping of the body's internal landscape (interoception) and its relation with space and movement (proprioception). The present study aims to evaluate psychometric properties and validate in French two self-report measures of body awareness: the Postural Awareness Scale (PAS), and the last version of the Multidimensional Assessment of Interoceptive Awareness questionnaire (version 2, MAIA-2). We collected data in a non-clinical, adult sample (N = 308; 61% women, mean age 35 ± 12 years) using online survey, and a subset of the original sample (n = 122; 62% women, mean age 44 ± 11 years) also completed the retest control. Factor analyses and reliability analyses were conducted. Construct validity of the PAS and the MAIA-2 were examined by testing their association with each other, and with self-report measures of personality (Big Five Inventory), alexithymia (Toronto Alexithymia Scale) and dispositional trait mindfulness (Freiburg Mindfulness Inventory). Factor analyses of the PAS supported the same two-factor structure as previously published versions (in other languages). For the MAIA-2, factor analyses suggested that a six-factor structure, excluding Not-Worrying and Not-Distracting factors, could successfully account for a common general factor of self-reported interoception. We found satisfactory internal consistency, construct validity, and reliability over time for both the PAS and the MAIA-2. Altogether, our findings suggest that the French version of the PAS and the MAIA-2 are reliable self-report tools to assess both components of body awareness (proprioception and interoception dimension, respectively).

Acceptance Mindfulness-Trait as a Protective Factor for Post-Natal Depression: A Preliminary Research.

(1) Background: the prevalence of postnatal depression (PND) reaches up to 20%. PND could be based on the interaction between a psychological vulnerability and chronic stress that pregnancy would activate. Vulnerability factors reflect a psychological profile mirroring mindfulness-trait (MT). A high level of MT is associated with an efficient regulation of both physiological and psychological stress, especially negative moods. Interestingly, mindfulness level can be improved by program based on mindfulness meditation. We hypothesize that MT is a protective factor for PND. We also postulate that negative moods increase during the pregnancy for women who develop a PND after delivery (2) Methods: we conducted a multicentric prospective longitudinal study including 85 women during their first trimester of their pregnancy and 72 from the childbirth to the baby's first birthday". At the inclusion, presence and acceptance of MT and various variables of personality and of psychological functioning were assessed. Mood evolution was monitored each month during the pregnancy and a delivery trauma risk was evaluated after delivery. PND detection was carried out at 48 h, 2, 6 and 12 months after the delivery with the Edinburgh Postnatal Depression Scale with a screening cut-off >11. (3) Results: high-acceptance MT is a protective factor for PND (OR: 0.79). Women without PND displayed less negative mood during pregnancy (p < 0.05 for Anxiety, Confusion and Anger). (4) Conclusions: these results suggest the value of deploying programs to enhance the level of mindfulness, especially in its acceptance dimension, before, during and after pregnancy, to reduce the risk of PND.

Heterogeneity of Psychological Profiles in French Army Units and Psychological Changes Between Pre- and Post-deployment: Two Pilot Studies.

INTRODUCTION: Over the past two decades, overseas deployments of the French Army have been characterized by the exposure of its service personnel to sustained, high levels of combat stress. There is a need to assess their mental health throughout the deployment cycle, identify risk factors associated with stress-related disorders, and characterize the factors that promote long-term well-being. METHODS: We conducted two pilot studies within four units of the French Army: a conventional combat unit, a counterterrorist unit, a combat service support unit, and a medical support unit. Study 1 (n = 65) analyzed the psychological functioning of service personnel with respect to their personality and stress management characteristics. Study 2 (n = 40) analyzed the impact of overseas deployment on stress-related psychological outcomes. RESULTS: Overall, results from study 1 showed that service personnel have a protective psychological functioning, which is particularly developed in the counterterrorist unit. In study 2, although no stress-related disorder symptoms were observed with the psychometric tools used, a certain degree of psychological dysfunction (social dysfunction and lower positive affect) was detected post-deployment. CONCLUSIONS: These two complementary studies are key elements in developing a better understanding of unmet, medico-military needs that lie on the pathway that links exposure to stressors to impaired health. Certain personnel enrolled in the French Army (notably, the counterterrorist unit) were found to have a high level of protective psychological functioning, largely due to the training they receive. Nevertheless, overall, overseas deployment was associated with poorer psychological functioning and the emergence of social dysfunction, especially in units responsible for the care of service personnel (medical support and combat service support units).

Chronic Stress protection for postnatal dEpREssioN prEvention (SERENE): a protocol for an exploratory study.

INTRODUCTION: The prevalence of postnatal depression (PND) is significant: reaching up to 20% in the general population. In mechanistic terms, the risk of PND lies in an interaction between a maternal psychophysiological vulnerability and a chronic environmental context of stress. On the one hand, repetition of stressor during pregnancy mimics a chronic stress model that is relevant to the study of the allostatic load and the adaptive mechanisms. On the other hand, vulnerability factors reflect a psychological profile mirroring mindfulness functioning (psychological quality that involves bringing one's complete and non-judgemental attention to the present experience on a moment-to-moment basis). This psychological resource is linked to protective and resilient psychic functioning. Thus, PND appears to be a relevant model for studying the mechanisms of chronic stress and vulnerability to psychopathologies.In this article, we present the protocol of an ongoing study (started in May 2017). METHODS AND ANALYSIS: The study is being carried out in five maternities and will involve 260 women. We aim to determine the predictive psychobiological factors for PND emergence and to provide a better insight into the mechanisms involved in chronic stress during pregnancy. We use a multidisciplinary approach that encompasses psychological resources and biophysiological and genetic profiles in order to detect relevant vulnerability biomarkers for chronic stress and the development of PND. To do so, each woman will be involved in the study from her first trimester of pregnancy until 12 months postdelivery. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Ile de France III Ethics Committee, France (2016-A00887-44). We aim to disseminate the findings through international conferences and international peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03088319; Pre-results.

Challenges Associated With the Civilian Reintegration of Soldiers With Chronic PTSD: A New Approach Integrating Psychological Resources and Values in Action Reappropriation.

Background: In light of the psychological changes in an individual suffering from chronic Posttraumatic Stress Disorder (PTSD), questions are being raised in order to understand and facilitate recovery and a return to work. This is particularly challenging for soldiers suffering from chronic PTSD, who are often young individuals suffering from moral conflicts. A French military rehabilitation program proposes the broadening of the relationships between recovery and reintegration by incorporating approaches from the field of positive psychology for soldiers with chronic PTSD. The aim of the study was to evaluate (i) the psychological resources which remain sustainable for these trauma exposed soldiers according to their PTSD symptoms, (ii) the dynamics of resource reappropriation after the military rehabilitation program, which focuses on values in action (VIA) as character strengths, and (iii) how these resources and their reappropriation facilitate civilian professional reintegration. Method: We conducted a prospective study with 56 trauma exposed soldiers with a clinical diagnosis of chronic PTSD. PTSD severity and psychological resources (optimism, mindfulness, well-being, motivation, self-esteem, and VIA) were assessed before and after the rehabilitation program. After the identification of resource profiles, we analyzed the impact of the program on resource levels and successful reintegration into a civilian job. Results: 3 profiles were identified based on the psychological resources of the soldiers. Profiles 1, 2, and 3 differed in terms of clinical severity (PCL5). Profile 1 exhibited both the highest level of resources and the lowest clinical severity of PTSD but did not modify its resources after the intervention program when compared to profile 3. Profile 3 was characterized by the lowest level of resources, the highest clinical severity of PTSD and the highest reappropriation in all VIAs. This profile was associated with the highest rate of reintegration success 1 year after the intervention. Conclusions: This paper aims to broaden the relationship between recovery and reintegration by incorporating approaches from the field of positive psychology for soldiers with PTSD. VIA appears to be an important factor for reintegration. Our results highlight the importance of taking into account the existing needs of the patient and the optimization of the modalities of individual, collective, and institutional rehabilitation for patients suffering from PTSD in order to better understand the dynamics of the recovery process of a chronically afflicted individual.

Lesions to the ventral, but not the dorsal, medial prefrontal cortex enhance latent inhibition.

The acquisition of a conditioned response to a stimulus when it is paired with a reinforcer is retarded if the stimulus has previously been repeatedly pre-exposed in the absence of the reinforcer. This effect, called latent inhibition, has previously been found to be insensitive to lesions of the medial prefrontal cortex (mPFC) in rats. Using an on-baseline conditioned emotional response procedure, which is especially sensitive to small variations in the absolute magnitude of latent inhibition, we found increased latent inhibition following excitotoxic lesions of the mPFC (Experiment 1) or the ventral mPFC alone (Experiment 2) as compared with sham-operated control rats. Lesions restricted to the dorsal mPFC, however, were without effect (Experiment 2). These results are consistent with those of experiments employing another type of interference procedure, extinction. Together, these findings suggest that when different contingencies between a stimulus and a reinforcer are established in separate learning phases, lesions to the ventral mPFC result in increased interference between first-learned and second-learned contingencies. As a consequence, retrieval of the second-learned contingency is impaired, and performance is dominated by the first-learned contingency. These findings are discussed in light of the use of latent inhibition to model cognitive deficits in schizophrenia.

Optional-shift behaviour in rats: a novel procedure for assessing attentional processes in discrimination learning.

A novel, optional-shift procedure was used to assess changes in the attention paid to stimuli that occur over the course of discrimination learning. In Phase 1, rats were trained on a conditional instrumental discrimination using audiovisual stimulus compounds; one stimulus dimension (auditory or visual) was relevant to the solution of the discrimination, the other was irrelevant. In Phase 2, all animals received three sessions of training with novel audiovisual compounds where both dimensions were equally diagnostic. Results from probe test trials indicated that, during Phase 2, animals learnt most about cues belonging to the stimulus dimension that was relevant during Phase 1. These results suggest that over the course of discrimination learning there was an increase in the amount of attention paid to relevant stimuli and/or a decrease in the attention paid to irrelevant stimuli.