Trajectory of adjustment difficulties following disaster: 10-year longitudinal cohort study.

BACKGROUND: Although much is known about psychopathology such as post-traumatic stress disorder (PTSD) and depression following bushfire (also known as wildfire), little is known about prevalence, trajectory and impacts for those experiencing general adjustment difficulties following exposure to these now-common events. AIMS: This was an exploratory analysis of a large cohort study that examined the prevalence, trajectory and risk factors of probable adjustment disorder over a 10-year period following bushfire exposure. METHOD: The Beyond Bushfires study assessed individuals exposed to a large and deadly bushfire across three time points spanning 10 years. Self-report survey data from participants from areas with moderate and high levels of fire-affectedness were analysed: n = 802 participants at Wave 1 (3-4 years post-fires), n = 596 at Wave 2 (5 years post-fires) and n = 436 at Wave 3 (10 years post-fires). Surveys indexed fire-related experiences and post-fire stressors, and comprised the six-item Kessler Psychological Distress Scale (probable adjustment disorder index), four-item Posttraumatic Stress Disorder Checklist (probable fire-related PTSD) and nine-item Patient Health Questionnaire (probable major depressive episode). RESULTS: Prevalence of probable adjustment disorder was 16% (Wave 1), 15% (Wave 2) and 19% (Wave 3). Probable adjustment disorder at 3-4 years post-fires predicted a five-fold increase in risk for escalating to severe psychiatric disorder (i.e. probable fire-related PTSD/major depressive episode) at 10 years post-fires, and was associated with post-fire income and relationship stressors. CONCLUSIONS: Adjustment difficulties are prevalent post-disaster, many of which are maintained and exacerbated over time, resulting in increased risk for later disorder and adaptation difficulties. Psychosocial interventions supporting survivors with adjustment difficulties may prevent progression to more severe disorder.

Alexithymia and treatment response for prolonged exposure therapy: An evaluation of outcomes and mechanisms.

Alexithymia is the inability to identify and recognize emotions. The present study examined the impact of alexithymia on prolonged exposure (PE) therapy. Participants (n = 68) with PTSD underwent 10 PE sessions. Alexithymia was assessed via the Toronto Alexithymia Scale (TAS-20) and the emotional clarity and awareness subscales of the Difficulties in Emotion Regulation Scale. Treatment outcomes were assessed via the PTSD checklist and Clinician-Administered PTSD Scale for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition at posttreatment and 6-month follow-up. Those with high alexithymia were more likely to endorse experiencing a full PTSD diagnosis immediately posttreatment, χ²(1) = 12.53, p = .002, and at 6-month follow-up, χ²(1) = 11.21, p = .004. Alexithymia was associated with delayed treatment effects on avoidance, with a significant reduction in symptomology observed from pre- to follow-up, t(51) = 4.52, p < .001, and not from pre- to posttreatment. Although both the low and high alexithymia groups showed significant changes in negative changes in thinking and mood, F(2, 14) = 9.18, p = .001, d = 1.57 and F(2, 50) = 13.86, p = .001, d = 1.49, respectively, the high alexithymia group exhibited a marginally lesser magnitude of treatment effect. Although those with significantly greater difficulties with emotional clarity were more likely to drop out of PE treatment, emotional clarity and awareness did not moderate treatment response. Our results confirm the efficacy of PE but also highlight that those with alexithymia show a delayed treatment response and may be at greater risk of pathology after treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Lingering Impact of Resolved PTSD on Subsequent Functioning.

This study investigated whether impairment persists after posttraumatic stress disorder (PTSD) has resolved. Traumatically injured patients (N = 1,035) were assessed during hospital admission and at 3 (85%) and 12 months (73%). Quality of life prior to traumatic injury was measured with the World Health Organization Quality of Life-BREF during hospitalization and at each subsequent assessment. PTSD was assessed using the Clinician-Administered PTSD Scale at 3 and 12 months. After controlling for preinjury functioning, current pain, and comorbid depression, patients whose PTSD symptoms had resolved by 12 months were more likely to have poorer quality of life in psychological (OR = 3.51), physical (OR = 10.17), social (OR = 4.54), and environmental (OR = 8.83) domains than those who never developed PTSD. These data provide initial evidence that PTSD can result in lingering effects on functional capacity even after remission of symptoms. Reprinted from Clin Psychol Sci 2016; 4:493-498, with permission from Sage. Copyright © 2016.

Posttraumatic Stress and Alexithymia: Symptom Associations.

ABSTRACT: There is a demonstrated association between alexithymia and posttraumatic stress disorder (PTSD). However, work has largely focused on male-dominant, high-risk occupation populations. We aimed to explore the relationship between posttraumatic stress (PTS) and alexithymia among 100 trauma-exposed female university students. Participants completed a Life Events Checklist, the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5), and the Toronto Alexithymia Scale (TAS-20). Multiple regressions were run to examine whether alexithymia was associated with each of the PCL-5 subscales. The TAS-20 total scores were associated with total PTS scores, ß = 0.47, t(99) = 5.22, p < 0.001. On a subscale level, Difficulty in Identifying Feelings (DIF) was positively associated (ß = 0.50 to 0.41) with all PCL-5 subscales except for Avoidance. Our results align with research showing that for women, the DIF subscale is most strongly associated with PTS, in contrast with the literature on male samples, showing strongest associations with the Difficulties in Describing Feelings subscale, suggesting sex differences in associations between PTS and alexithymia. Our study supports the universality of the associations between alexithymia and PTS.

Understanding the temporal dynamics of problem anger using sequence analysis.

Problem anger is a common, and potentially destructive mental health issue in trauma-affected populations, affecting up to 30% of veteran and military populations. Problem anger is associated with a range of psychosocial and functional difficulties and elevated risk of harm to self and others. Increasingly, ecological momentary assessment (EMA) is being used to understand the microlevel dynamics of emotions, and this information is valuable to inform treatment approaches. Using a data-driven approach, we used sequence analysis to determine whether heterogeneity exists amongst veterans with problem anger using EMA-recorded experiences of anger intensity. Veterans with problem anger (N = 60; Mage = 40.28) completed 10 days of EMA with four prompts per day. We identified four subtypes of veterans within the data, whose anger intensity dynamics differed significantly, and the subtypes mapped onto macrolevel indicators of anger and well-being. Taken together, these results highlight the importance of microlevel investigations of mood states in clinical populations, and in some instances, the novel use of sequence analysis may be appropriate. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emotion response disconcordance among trauma-exposed adults: the impact of alexithymia.

BACKGROUND: Emotion processing deficits have been identified as a critical transdiagnostic factor that facilitates distress after trauma exposure. Limited skills in identifying and labelling emotional states (i.e. alexithymia) may present on the more automated (less conscious) end of the spectrum of emotional awareness and clarity. Individuals with alexithymia tend to exhibit a disconcordance between subjective experience and autonomic activity (e.g. where high levels of subjective emotional intensity are associated with low physiological arousal), which may exacerbate distress. Although there is a robust link between alexithymia and trauma exposure, no work to date has explored whether alexithymia is associated with emotional response disconcordance among trauma-exposed adults. METHOD: Using a validated trauma script paradigm, the present study explored the impact of alexithymia on emotion response concordance [skin conductance (Galvanic Skin Response, GSR) and Total Mood Disturbance (TMD)] among 74 trauma-exposed adults recruited via a posttraumatic stress disorder (PTSD) treatment clinic and student research programme. RESULTS: Unlike posttraumatic symptom severity, age, sex, participant type and mood (which showed no effect on emotion response concordance), alexithymia was associated with heightened emotion response disconcordance between GSR and TMD [F(1, 37) = 8.93, p = 0.006], with low GSR being associated with high TMD. Observed effects of the trauma script were entirely accounted for by the interaction with alexithymia, such that those with alexithymia showed a negligible association between subjective and physiological states. CONCLUSION: This finding is paramount as it shows that a large proportion of trauma-exposed adults have a divergent emotion engagement profile.

Ambulatory assessment to predict problem anger in trauma-affected adults: Study protocol.

BACKGROUND: Problem anger is common after experiencing a traumatic event. Current evidence-driven treatment options are limited, and problem anger negatively affects an individual's capacity to engage with traditional psychological treatments. Smartphone interventions hold significant potential in mental health because of their ability to deliver low-intensity, precision support for individuals at the time and place they need it most. While wearable technology has the capacity to augment smartphone-delivered interventions, there is a dearth of evidence relating to several key areas, including feasibility of compliance in mental health populations; validity of in vivo anger assessment; ability to predict future mood states; and delivery of timely and appropriate interventions. METHODS: This protocol describes a cohort study that leverages 10 days of ambulatory assessment in the form of ecological momentary assessment and a wearable. Approximately 100 adults with problem anger will complete four-hourly in vivo mobile application-delivered micro-surveys on anger intensity, frequency, and verbal and physical aggression, as well as other self-reported mental health and wellbeing measures. Concurrently, a commercial wearable device will continuously record indicators of physiological arousal. The aims are to test the feasibility and acceptability of ambulatory assessment in a trauma-affected population, and determine whether a continuously measured physiological indicator of stress predicts self-reported anger intensity. DISCUSSION: This study will contribute new data around the ability of physiological indicators to predict mood state in individuals with psychopathology. This will have important implications for the design of smartphone-delivered interventions for trauma-affected individuals, as well as for the digital mental health field more broadly.

A predictive coding account of value-based learning in PTSD: Implications for precision treatments.

While there are a number of recommended first-line interventions for posttraumatic stress disorder (PTSD), treatment efficacy has been less than ideal. Generally, PTSD treatment models explain symptom manifestation via associative learning, treating the individual as a passive organism - acted upon - rather than self as agent. At their core, predictive coding (PC) models introduce the fundamental role of self-conceptualisation and hierarchical processing of one's sensory context in safety learning. This theoretical article outlines how predictive coding models of emotion offer a parsimonious framework to explain PTSD treatment response within a value-based decision-making framework. Our model integrates the predictive coding elements of the perceived: self, world and self-in the world and how they impact upon one or more discrete stages of value-based decision-making: (1) mental representation; (2) emotional valuation; (3) action selection and (4) outcome valuation. We discuss treatment and research implications stemming from our hypotheses.

Problem anger in veterans and military personnel: Prevalence, predictors, and associated harms of suicide and violence.

BACKGROUND: Problem anger is increasingly identified as an important issue, and may be associated with suicidality and violence. This study investigates the relationship between problem anger, suicidality, and violence amongst veterans and military personnel. METHODS: Cross-sectional survey data from n = 12,806 military personnel and veterans were subject to analyses. These considered the weighted prevalence of problem anger, while further analyses of veterans (n = 4326) considered risk factors and co-occurrence with other psychiatric conditions. Path analyses examined inter-relationships involving anger, violence and suicidality. RESULTS: There were 30.7% of veterans and 16.4% of military personnel that reported past month problem anger, while 14.9% of veterans and 7.4% of military personnel reported physical violence. There were higher levels of suicidality among veterans (30.3%), than military personnel (14.3%). Logistic regression models indicated that PTSD was the strongest risk factor for problem anger (PCL-5, OR = 21.68), while there were small but substantial increases in anger rates associated with depression (OR = 15.62) and alcohol dependence (OR = 6.55). Path models indicated that problem anger had an influence on suicide attempts, occurring primarily through suicidal ideation, and an influence on violence. Influences of problem anger on suicidal ideation and violence remained significant when controlling for co-occurring mental health problems. CONCLUSIONS: Problem anger, violence, and suicidality are common and inter-related issues among military personnel and veterans. Problem anger is a unique correlate of suicidality, supporting the need for anger to be included as part of violence and suicide risk assessment, and clinician training.

Attention-control training as an early intervention for veterans leaving the military: A pilot randomized controlled trial.

Transitioning out of the military can be a time of change and challenge. Research indicates that altered threat monitoring in military populations may contribute to the development of psychopathology in veterans, and interventions that adjust threat monitoring in personnel leaving the military may be beneficial. Australian Defence Force personnel (N = 59) transitioning from the military were randomized to receive four weekly sessions of either attention-control training or a placebo attention training. The primary outcome was symptoms of posttraumatic stress disorder (PTSD), as measured using the PTSD Checklist for DSM-5 (PCL-5) at posttreatment. Following training, participants who received attention-control training reported significantly lower levels of PTSD symptoms, Hedges' g = 0.86, 95% CI [0.37, 1.36], p = .004, and significantly improved work and social functioning, Hedges' g = 0.93, 95% CI [0.46, 1.39], p = .001, relative to those in the placebo condition. Moreover, no participants who received attention-control training worsened with regard to PTSD symptoms, whereas 23.8% of those who received the placebo attention training experienced an increase in PTSD symptoms. The preliminary findings from this pilot study add to a small body of evidence supporting attention-control training as a viable indicated early intervention approach for PTSD that is worthy of further research.

Cross-lagged analyses of anger and PTSD symptoms among veterans in treatment.

OBJECTIVE: Anger is a salient feature of posttraumatic mental health which is linked to posttraumatic stress disorder (PTSD) and may have implications for treatment. However, the nature of associations involving anger and PTSD remains unclear. The aim of the present study was to examine bidirectional influences involving anger and International Classification of Diseases (ICD)-11 PTSD symptom clusters over time among treatment-seeking veterans. METHOD: Current or ex-serving members (n = 742; 92.4% male) who participated in an accredited outpatient PTSD treatment program were administered measures of PTSD symptoms (PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th edition [PCL-5]) and anger (Dimensions of Anger Reactions Scale-5 [DAR-5]) at treatment intake, discharge, and three-month follow-up. Bidirectional influences were assessed using cross-lagged panel analyses. RESULTS: The majority of participants (78%) exhibited significant anger problems at intake. Cross-lagged analyses showed anger was associated with relative increases in PTSD symptoms of intrusive reexperiencing and avoidance at posttreatment, whereas no reverse effects of any PTSD symptoms on anger were observed. Anger continued to influence changes in heightened sense of threat and avoidance symptoms at three-months posttreatment. CONCLUSIONS: Anger influences change in specific PTSD symptoms over time among military veterans in treatment and may interfere with treatments for PTSD. Veterans who present to clinical services with anger problems may benefit from anger interventions prior to commencing trauma-focused treatment. The findings have additional implications for conceptual models of the relationship between anger and PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Understanding the mental health impacts of COVID-19 through a trauma lens.

This special issue of the European Journal of Psychotraumatology (EJPT) presents the first studies published by EJPT on COVID-19. We present 26 qualitative and quantitative studies assessing the prevalence of trauma-related symptoms and psychopathology within specific vulnerable populations such as health-care workers, students, children, and managers, or more broadly at a country level with a diverse set of outcomes including post-traumatic stress, moral injury, grief and post-traumatic growth. Intervention studies focus on whether telehealth delivery of mental health therapy in the pandemic environment was useful and effective. It is clear that the pandemic has brought with it a rise in trauma exposure and consequently impacted on trauma-related mental health. While for many individuals, COVID-19-related events met criteria for a DSM-5 Criterion A event, challenges remain in disentangling trauma exposure from stress, anxiety, and other phenomena. It is important to determine the contexts in which a trauma lens makes a useful contribution to understanding the mental health impacts of COVID-19 and the ways in which this may facilitate recovery. The papers included in this Special Issue provide an important and much-needed evidence-based foundation for developing trauma-informed understanding and responses to the pandemic.

Este número especial de la Revista Europea de Psicotraumatología(European Journal of Psychotraumatology­EJPT) presenta los primeros estudios publicados por EJPT sobre COVID-19. Presentamos 26 estudios cualitativos y cuantitativos que evalúan la prevalencia de los síntomas y la psicopatología relacionados con el trauma en poblaciones vulnerables específicas, como trabajadores de la salud, estudiantes, niños y niñas, administradores o, en general, a nivel de país con un conjunto diverso de resultados que incluyen el estrés postraumático, el daño moral, el dolour, y el crecimiento postraumático. Los estudios de intervenciones se centran en si la prestación de telesalud de terapia de salud mental en el entorno pandémico fue útil y eficaz.Está claro que la pandemia ha traído consigo un aumento en la exposición al trauma y, en consecuencia, ha tenido un impacto en la salud mental relacionada con el trauma. Si bien para muchas personas los eventos relacionados con el COVID-19 cumplieron los criterios para un evento del Criterio A del DSM-5, persisten los desafíos para desenredar la exposición al trauma del estrés, la ansiedad, y otros fenómenos. Es importante determinar los contextos en los que un lente de trauma hace una contribución útil para comprender los impactos de COVID-19 en la salud mental y las formas en que esto puede facilitar la recuperación. Los artículos incluidos en este Número Especial brindan una base importante y muy necesaria, basada en la evidencia, para desarrollar una comprensión y respuestas a la pandemia informadas sobre el trauma.

Prevalence and treatment implications of ICD-11 complex PTSD in Australian treatment-seeking current and ex-serving military members.

Background: Despite growing support for the distinction between posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as separate diagnoses within the ICD-11 psychiatric taxonomy, the prevalence and treatment implications of CPTSD among current and ex-serving military members have not been established. Objective: The study aims were to a) establish the prevalence of provisional ICD-11 CPTSD diagnosis relative to PTSD in an Australian sample of treatment-seeking current and ex-serving military members, and b) examine the implications of CPTSD diagnosis for intake profile and treatment response. Methods: The study analysed data collected routinely from Australian-accredited treatment programmes for military-related PTSD. Participants were 480 current and ex-serving military members in this programmes who received a provisional ICD-11 diagnosis of PTSD or CPTSD at intake using proxy measures. Measures of PTSD symptoms, disturbances in self-organisation, psychological distress, mental health and social relationships were considered at treatment intake, discharge, and 3-month follow-up. Results: Among participants with a provisional ICD-11 diagnosis, 78.2% were classified as having CPTSD, while 21.8% were classified as having PTSD. When compared to ICD-11 PTSD, participants with CPTSD reported greater symptom severity and psychological distress at intake, and lower scores on relationship and mental health dimensions of the quality of life measure. These relative differences persisted at each post-treatment assessment. Decreases in PTSD symptoms between intake and discharge were similar across PTSD (d RM  = -0.81) and CPTSD (d RM  = -0.76) groups, and there were no significant post-treatment differences between groups when controlling for initial scores. Conclusions: CPTSD is common among treatment-seeking current and ex-serving military members, and is associated with initially higher levels of psychiatric severity, which persist over time. Participants with CPTSD were equally responsive to PTSD treatment; however, the tendency for those with CPTSD to remain highly symptomatic post-treatment suggests additional treatment components should be considered.

Antecedentes: A pesar del creciente apoyo para la distinción entre trastorno de estrés postraumático (TEPT) y trastorno de estrés postraumático complejo (TEPTC) como diagnósticos separados dentro de la taxonomía psiquiátrica de la CIE-11, la prevalencia y las implicaciones en el tratamiento del TEPTC dentro de miembros militares activos o en retiro no han sido establecidas.Objetivo: Los objetivos del estudio fueron a) establecer la prevalencia de TEPTC provisional según CIE-11 en relación al TEPT en una muestra australiana de miembros militares activos o en retiro en busca de tratamiento, y b) examinar las implicaciones del diagnóstico de TEPTC para el perfil de ingreso y respuesta a tratamiento.Método: El estudio analizó datos recolectados de forma rutinaria por programas de tratamiento australianos acreditados para TEPT relacionado a militares. Los participantes fueron 480 miembros activos o en retiro ingresados a este programa bajo el diagnóstico provisional de TEPT o TEPTC según CIE-11 a través de indicadores indirectos. Al ingreso, egreso y a los 3 meses de seguimiento, se consideraron mediciones de los síntomas de TEPT, alteraciones en la organización del Yo, estrés psicológico, salud mental y relaciones sociales.Resultados: Dentro de los participantes con un diagnóstico provisional según CIE-11, el 78,2% fue clasificado como portador de TEPTC, mientras que un 21,8% fue clasificado como portador de TEPT. Al ser comparados con TEPT según CIE-11, los participantes con TEPTC reportaron al ingreso una mayor severidad en la sintomatología y en el estrés psicológico, y menores puntajes en las dimensiones de medida de calidad de vida de salud mental y relaciones sociales. Estas diferencias relativas persistieron en cada seguimiento posterior al tratamiento. Las disminuciones en los síntomas de TEPT entre el ingreso y el egreso fueron similares entre los grupos con TEPT (d RM = -0.81) y TEPTC (d RM = -0.76), y no hubo diferencias significativas post-tratamiento entre los grupos al controlarlos según los puntajes iniciales. Conclusiones: El TEPTC es común dentro de miembros militares activos o en retiro en busca de tratamiento, y está asociado a mayores niveles de severidad psiquiátrica inicial, la cual persiste a lo largo del tiempo. Los participantes con TEPTC respondieron igualmente al tratamiento del TEPT; sin embargo, la tendencia de aquéllos con TEPTC de permanecer altamente sintomáticos tras el tratamiento sugiere componentes de tratamiento adicionales que deberían ser considerados.

Rapid Design and Delivery of an Experience-Based Co-designed Mobile App to Support the Mental Health Needs of Health Care Workers Affected by the COVID-19 Pandemic: Impact Evaluation Protocol.

BACKGROUND: The COVID-19 pandemic has highlighted the importance of health care workers' mental health and well-being for the successful function of the health care system. Few targeted digital tools exist to support the mental health of hospital-based health care workers, and none of them appear to have been led and co-designed by health care workers. OBJECTIVE: RMHive is being led and developed by health care workers using experience-based co-design (EBCD) processes as a mobile app to support the mental health challenges posed by the COVID-19 pandemic to health care workers. We present a protocol for the impact evaluation for the rapid design and delivery of the RMHive mobile app. METHODS: The impact evaluation will adopt a mixed methods design. Qualitative data from photo interviews undertaken with up to 30 health care workers and semistructured interviews conducted with up to 30 governance stakeholders will be integrated with qualitative and quantitative user analytics data and user-generated demographic and mental health data entered into the app. Analyses will address three evaluation questions related to engagement with the mobile app, implementation and integration of the app, and the impact of the app on individual mental health outcomes. The design and development will be described using the Mobile Health Evidence Reporting and Assessment guidelines. Implementation of the app will be evaluated using normalization process theory to analyze qualitative data from interviews combined with text and video analysis from the semistructured interviews. Mental health impacts will be assessed using the total score of the 4-item Patient Health Questionnaire (PHQ4) and subscale scores for the 2-item Patient Health Questionnaire for depression and the 2-item Generalized Anxiety Scale for anxiety. The PHQ4 will be completed at baseline and at 14 and 28 days. RESULTS: The anticipated average use period of the app is 30 days. The rapid design will occur over four months using EBCD to collect qualitative data and develop app content. The impact evaluation will monitor outcome data for up to 12 weeks following hospital-wide release of the minimal viable product release. The study received funding and ethics approvals in June 2020. Outcome data is expected to be available in March 2021, and the impact evaluation is expected to be published mid-2021. CONCLUSIONS: The impact evaluation will examine the rapid design, development, and implementation of the RMHive app and its impact on mental health outcomes for health care workers. Findings from the impact evaluation will provide guidance for the integration of EBCD in rapid design and implementation processes. The evaluation will also inform future development and rollout of the app to support the mental health needs of hospital-based health care workers more widely. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26168.

A Pilot Study of the Efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Treating Posttraumatic Psychopathology: A Randomized Controlled Trial.

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is an intervention that targets common mechanisms that maintain symptoms across multiple disorders. The UP has been shown to be effective across many disorders, including generalized anxiety disorder, major depressive episode (MDE), and panic disorder, that commonly codevelop following trauma exposure. The present study represented the first randomized controlled trial of the UP in the treatment of trauma-related psychopathology, including posttraumatic stress disorder (PTSD), depression, and anxiety symptoms. Adults (N = 43) who developed posttraumatic psychopathology that included PTSD, MDE, or an anxiety disorder after sustaining a severe injury were randomly assigned to receive 10-14 weekly, 60-min sessions of UP (n = 22) or usual care (n = 21). The primary treatment outcome was PTSD symptom severity, with secondary outcomes of depression and anxiety symptom severity and loss of diagnosis for any trauma-related psychiatric disorder. Assessments were conducted at intake, posttreatment, and 6-month follow-up. Posttreatment, participants who received the UP showed significantly larger reductions in PTSD, Hedges' g = 1.27; anxiety, Hedges' g = 1.20; and depression symptom severity, Hedges' g = 1.40, compared to those receiving usual care. These treatment effects were maintained at 6-month follow-up for PTSD, anxiety, and depressive symptom severity. Statistically significant posttreatment loss of PTSD, MDE, and agoraphobia diagnoses was observed for participants who received the UP but not usual care. This study provides preliminary evidence that the UP may be an effective non-trauma-focused treatment for PTSD and other trauma-related psychopathology.

Efficacy of Psychoactive Drugs for the Treatment of Posttraumatic Stress Disorder: A Systematic Review of MDMA, Ketamine, LSD and Psilocybin.

The aim of this systematic review was to examine the efficacy of MDMA, ketamine, LSD, and psilocybin for the treatment of posttraumatic stress disorder (PTSD). A search of four databases for English language, peer-reviewed literature published from inception to 18th October 2019 yielded 2,959 records, 34 of which were screened on full-text. Observational studies and RCTs which tested the efficacy of MDMA, ketamine, LSD, or psilocybin for reducing PTSD symptoms in adults, and reported changes to PTSD diagnosis or symptomatology, were included. Nine trials (five ketamine and four MDMA) met inclusion criteria. Trials were rated on a quality and bias checklist and GRADE was used to rank the evidence. The evidence for ketamine as a stand-alone treatment for comorbid PTSD and depression was ranked "very low", and the evidence for ketamine in combination with psychotherapy as a PTSD treatment was ranked "low". The evidence for MDMA in combination with psychotherapy as a PTSD treatment was ranked "moderate".

Strategies for Delivering Mental Health Services in Response to Global Climate Change: A Narrative Review.

This narrative review examined strategies for preparedness and response to mental health impacts of three forms of climate change from a services perspective: (1) acute and extreme weather events such as hurricanes, floods, and wildfires, (2) sub-acute or long-term events such as droughts and heatwaves; and (3) the prospect of long-term and permanent changes, including higher temperatures, rising sea levels, and an uninhabitable physical environment. Strategies for acute events included development and implementation of programs and practices for monitoring and treating mental health problems and strengthening individual and community resilience, training of community health workers to deliver services, and conducting inventories of available resources and assessments of at-risk populations. Additional strategies for sub-acute changes included advocacy for mitigation policies and programs and adaptation of guidelines and interventions to address the secondary impacts of sub-acute events, such as threats to livelihood, health and well-being, population displacement, environmental degradation, and civil conflict. Strategies for long-lasting changes included the implementation of evidence-based risk communication interventions that address the existing and potential threat of climate change, promoting the mental health benefits of environmental conservation, and promoting psychological growth and resilience.

Differential neural predictors of treatment response for fear and dysphoric features of posttraumatic stress disorder.

BACKGROUND: Although trauma-focused cognitive behavioral therapy (TF-CBT) is the frontline treatment for posttraumatic stress disorder (PTSD), at least one-third of patients are treatment nonresponders. This study aimed to identify neural markers of treatment response, specifically the prediction of remission of specific PTSD symptoms. METHODS: This study assessed PTSD treatment-seeking patients (n = 40) before TF-CBT during functional magnetic brain resonance imaging (fMRI) when they processed fearful, sad, happy, and neutral faces. Patients underwent nine sessions of TF-CBT and were independently assessed on the Clinician-Administered PTSD Scale (CAPS) following treatment. Treatment responders and nonresponders were compared with healthy controls (n = 40). The severity of PTSD was assessed with the CAPS. fMRI responses were calculated for each emotion face compared to neutral contrast, which were correlated with reduction in PTSD severity from pretreatment to posttreatment. Treatment response was categorized by at least 50% reduction in the severity of PTSD. RESULTS: The activation of left insula during the processing of both sad and fearful faces was associated with a greater reduction of fear but not with dysphoric symptoms after treatment. Connectivity of the left insula to the pregenual anterior cingulate cortex was associated with poorer response to treatment. Responders and controllers had similar levels of activation and connectivity and were different from nonresponders. CONCLUSIONS: Positive response to TF-CBT is predicted during emotion processing by normal levels of recruitment of neural networks implicated in emotional information. These findings suggest that distinct neural networks are predictive of PTSD fear and dysphoric symptom reduction following TF-CBT.

Factors Associated With Response to Adapted Cognitive Behavioral Therapy for Anxiety and Depression Following Traumatic Brain Injury.

BACKGROUND: Given the high frequency and significance of anxiety and depression following traumatic brain injury (TBI), there is a need to evaluate the efficacy of psychological interventions and to understand factors influencing response to such interventions. The present study investigated factors associated with positive response to cognitive behavioral therapy adapted for cognitive impairments (CBT-ABI) for individuals with anxiety and depression following TBI, including demographic and injury-related factors, pretreatment levels of anxiety and depression, working alliance, and change expectancy as predictors. METHODS: Participants were 45 individuals enrolled in an active treatment condition within a randomized controlled trial, examining the efficacy of a 9-session CBT-ABI program for anxiety and depression following TBI. These participants completed all CBT sessions. RESULTS: Mixed-effects regressions controlling for baseline anxiety and depression indicated that for anxiety, older age at injury, as well as higher level of baseline anxiety, was associated with greater symptom reduction. For depression, longer time since injury and higher expectancy for change, as well as higher baseline level of depression, were significantly associated with a greater reduction in depression symptoms. CONCLUSIONS: This study paves the way for more detailed studies of the therapeutic processes involved in alleviating anxiety and depression following TBI.

Adjustment Disorder: Current Developments and Future Directions.

Despite its high prevalence in clinical and consultant liaison psychiatry populations, adjustment disorder research has traditionally been hindered by its lack of clear diagnostic criteria. However, with the greater diagnostic clarity provided in the Diagnostic and Statistical Manual of Mental Disorders - fifth edition (DSM-5) and the International Statistical Classification of Diseases and Related Health Problems, 11th edition (ICD-11), adjustment disorder has been increasingly recognised as an area of research interest. This paper evaluates the commonalities and differences between the ICD-11 and DSM-5 concepts of adjustment disorder and reviews the current state of knowledge regarding its symptom profile, course, assessment, and treatment. In doing so, it identifies the gaps in our understanding of adjustment disorder and discusses future directions for research.