Social Functioning in Individuals Affected by Childhood Maltreatment: Establishing a Research Agenda to Inform Interventions.

Childhood maltreatment (CM) is linked to impairments in various domains of social functioning. Here, we argue that it is critical to identify factors that underlie impaired social functioning as well as processes that mediate the beneficial health effects of positive relationships in individuals exposed to CM. Key research recommendations are presented, focusing on: (1) identifying attachment-related alterations in specific inter- and intrapersonal processes (e.g., regulation of closeness and distance) that underlie problems in broader domains of social functioning (e.g., lack of perceived social support) in individuals affected by CM; (2) identifying internal (e.g., current emotional state) and external situational factors (e.g., cultural factors, presence of close others) that modulate alterations in specific social processes; and (3) identifying mechanisms that explain the positive health effects of intact social functioning. Methodological recommendations include: (1) assessing social processes through interactive and (close to) real-life assessments inside and outside the laboratory; (2) adopting an interdisciplinary, lifespan perspective to assess social processes, using multi-method assessments; (3) establishing global research collaborations to account for cultural influences on social processes and enable replications across laboratories and countries. The proposed line of research will contribute to globally develop and refine interventions that prevent CM and further positive relationships, which - likely through buffering the effects of chronic stress and corresponding allostatic load - foster resilience and improve mental and physical health, thereby reducing personal suffering and the societal and economic costs of CM and its consequences. Interventions targeting euthymia and psychological well-being are promising therapeutic concepts in this context.

Leveraging Instagram to Engage Adolescents With Depression: The Use of Evidence-Based Brief Video Interventions.

Recent research underscores the vital role social media can play in enhancing mental health awareness and encouraging help-seeking behaviors among youth. Nevertheless, the inherent risks of social media highlight the need for the careful creation of safe, effective content. This editorial outlines our strategy of using crowdsourcing platforms to develop and refine video interventions before launching a targeted Instagram campaign featuring these evidence-based videos. This process ensures the content is both beneficial and secure prior to public exposure. We emphasize the necessity of such meticulous preparation in leveraging social media to foster a supportive environment for adolescents seeking mental health help. Our approach and ongoing adjustments offer guidance for future initiatives aimed at promoting the well-being of young digital users.

Self-stigma mediates the relationships between childhood maltreatment and symptom levels of PTSD, depression, and anxiety.

Background: Childhood maltreatment is a risk factor for developing multiple forms of psychopathology, including depression, posttraumatic stress disorder (PTSD), and anxiety. Yet, the mechanisms linking childhood maltreatment and these psychopathologies remain less clear.Objective: Here we examined whether self-stigma, the internalization of negative stereotypes about one's experiences, mediates the relationship between childhood maltreatment and symptom severity of depression, PTSD, and anxiety.Methods: Childhood trauma survivors (N = 685, Mage = 36.8) were assessed for childhood maltreatment, self-stigma, and symptoms of depression, PTSD, and anxiety. We used mediation analyses with childhood maltreatment as the independent variable. We then repeated these mediation models separately for childhood abuse and neglect, as well as the different subtypes of childhood maltreatment.Results: Self-stigma significantly mediated the relationship between childhood maltreatment and depression, PTSD, and anxiety symptoms. For sexual abuse - but not physical or emotional abuse - a significant mediation effect of self-stigma emerged on all symptom types. For childhood neglect, self-stigma significantly mediated the relationship between both emotional and physical neglect and all symptom types.Conclusion: Our cross-sectional study suggests that different types of childhood maltreatment experiences may relate to distinct mental health problems, potentially linked to increased self-stigma. Self-stigma may serve as an important treatment target for survivors of childhood abuse and neglect.

Childhood maltreatment is linked to depression, PTSD, and anxiety symptoms.Self-stigma, or internalizing negative stereotypes, plays a significant role in mediating this relationship.Different types of maltreatment are linked to varying levels of self-stigma and symptom severity.

Childhood maltreatment and its associations with trauma-related psychopathology: disentangling two classification approaches.

Childhood maltreatment (CM) is associated with various mental health disorders, including PTSD, depression, and anxiety. This study explores how specific classifications - dichotomous (abuse versus neglect) and dimensional (physical, emotional, sexual) - relate to distinct psychopathologies. We recruited 642 individuals, screening them for CM history and symptoms. ANOVA, regression, and SEM analyses compared CM approaches and symptom associations. The dichotomous approach showed significant effects of abuse and neglect on all symptoms. In the dimensional approach, sexual and physical CM were primary features for PTSD, while sexual and emotional CM were primary for depression and anxiety. Overall, the dimensional approach outperformed the dichotomous approach in capturing symptoms, suggesting its importance in understanding psychopathologies and guiding therapeutic interventions. Our findings highlight the differential associations of CM experiences with PTSD, depression, and anxiety symptoms. The findings suggest the importance of a dimensional CM approach for understanding psychopathologies and possibly informing targeted therapeutic interventions.

Does disconfirmatory evidence shape safety-and danger-related beliefs of trauma-exposed individuals?

Recent accounts of predictive processing in posttraumatic stress disorder (PTSD) suggest that trauma-exposed individuals struggle to update trauma-related hypotheses predicting danger, which may be involved in the etiology and maintenance of this disorder. Initial research supports this account, documenting an association between trauma-exposure, impaired expectation updating, and PTSD symptoms. Yet, no study to date has examined biased belief updating in PTSD using a scenario-based approach.Objective: Here, we examined the predictive processing account among trauma-exposed and non-trauma-exposed individuals using a modified Trauma-Related version of the Bias Against Disconfirmatory Evidence task.Method: The task presents both danger-and safety-related scenarios highly relevant for trauma-exposed individuals. For each scenario, participants viewed several explanations and rated their plausibility. Their ability to update their initial interpretation following new-contradictory information was assessed.Results: Preregistered analyses did not reveal any significant findings. Based on indications that our sample may not have been sufficiently powered, we conducted exploratory analyses in an extended sample of participants. These analyses yielded a significant association between reduced belief updating and PTSD symptoms which was evident for disconfirming both safety and danger scenarios. However, the effect sizes we found were in the small-to-medium range.Conclusion: Although preliminary, our current findings support initial evidence that individuals with higher PTSD symptoms show a higher resistance to update their beliefs upon new disconfirmatory evidence. Our results should be interpreted cautiously in light of the extended sample and the limitations of the current study.

We developed a modified version of the Bias Against Disconfirmatory Evidence task.We found significant associations between PTSD symptoms and belief updating.The association was evident for disconfirming both safety and danger scenarios.

To sleep or not to sleep, that is the question: A systematic review and meta-analysis on the effect of post-trauma sleep on intrusive memories of analog trauma.

Distressing intrusive memories of a traumatic event are one of the hallmark symptoms of posttraumatic stress disorder. Thus, it is crucial to identify early interventions that prevent the occurrence of intrusive memories. Both, sleep and sleep deprivation have been discussed as such interventions, yet previous studies yielded contradicting effects. Our systematic review aims at evaluating existing evidence by means of traditional and individual participant data (IPD) meta-analyses to overcome power issues of sleep research. Until May 16th, 2022, six databases were searched for experimental analog studies examining the effect of post-trauma sleep versus wakefulness on intrusive memories. Nine studies were included in our traditional meta-analysis (8 in the IPD meta-analysis). Our analysis provided evidence for a small effect favoring sleep over wakefulness, log-ROM = 0.25, p < .001, suggesting that sleep is associated with a lower number of intrusions but unrelated to the occurrence of any versus no intrusions. We found no evidence for an effect of sleep on intrusion distress. Heterogeneity was low and certainty of evidence for our primary analysis was moderate. Our findings suggest that post-trauma sleep has the potential to be protective by reducing intrusion frequency. More research is needed to determine the impact following real-world trauma and the potential clinical significance.

Leaving the door open: Trauma, updating, and the development of PTSD symptoms.

Humans try to make sense of the world using hypotheses that were formed by prior experiences. After trauma, these hypotheses can be exaggerated and resistant to change. This may result in difficulties to update expectations regarding the negative outcomes associated with traumatic stimuli. Critically, it has been proposed that such difficulties may drive the development of posttraumatic stress disorder (PTSD). However, direct evidence on the associations between trauma and impaired expectation updating is still absent. Moreover, it remains unclear whether such an impairment is correlated with PTSD symptoms. To address these gaps, we compared the ability to update traumatic and neutral stimulus-outcome expectations in 81 active-duty firefighters. Participants completed a performance-based updating task and were assessed for PTSD symptoms. We predicted and found a selective impairment in updating trauma-related expectations. This impairment was evident for negative-to-positive but not for positive-to-negative updating. Moreover, impaired negative-to-positive updating was positively associated with PTSD symptoms. These findings support the predictive processing account of PTSD and suggest that strengthening updating processes could be an important goal for promoting resilience after trauma.

Acting against your own interests: The tension between emotion regulation preference and efficacy and its implications for individuals with depressive symptoms.

The aim of this study was twofold: first, to compare individuals' strategy choices in low and high intensity conditions and the actual efficacy of these strategies; second, to assess whether and how perceived intensity levels of aversive situations moderate the relationship between depressive symptoms and a strategies' efficacy. In Experiment 1A (N = 58), we replicated previous results, showing that individuals prefer distraction in high- and reappraisal in low-intensity conditions, irrespective of depressive symptom levels. Experiment 1B (N = 50) assessed the efficacy of distraction and reappraisal strategies in aversive conditions with low and high intensity. Contrary to our prediction, reappraisal was more effective than distraction, independent of the intensity of the aversive conditions. In Experiment 2 (N = 113), we tested the interactive relationship between perceived intensity levels and depression on the relative effectiveness of reappraisal and distraction. We found that while in perceived low-intensity situations the advantage of distraction over reappraisal increased as depressive symptoms increased, no such relationship was found in high-intensity situations. The results suggest that while all individuals prefer to apply reappraisal in both low- and high-intensity conditions, for those with high level of depressive symptoms, such a preference acts against their own interests. The study highlights the need to distinguish between emotion regulation preferences and their actual efficacy, while illuminating possible implications for individuals with depressive symptoms.

The Tension Between Cognitive and Regulatory Flexibility and Their Associations With Current and Lifetime PTSD Symptoms.

In recent years, researchers have tried to unpack the meaning of the term flexibility and test how different constructs of flexibility are associated with various psychopathologies. For example, it is apparent that high levels of flexibility allow individuals to adaptively cope and avoid psychopathology following traumatic events, but the precise nature of this flexibility is ambiguous. In this study we focus on two central constructs: cognitive flexibility - the ability to recognize and implement possible responses to a situation- and regulatory flexibility - the ability to modulate emotional expression and experience across situations. We aim to explore the connection between cognitive and regulatory flexibility and evaluate their relative effect on PTSD symptoms. Trauma-exposed college students (N = 109, M age = 25.31, SD = 4.59) were assessed for cognitive and regulatory flexibility and current and lifetime PTSD symptoms. We predicted and found a relatively weak, yet significant, overlap between participants' cognitive and regulatory flexibility. Importantly, while both cognitive and regulatory flexibility were associated with lifetime PTSD symptoms, only cognitive flexibility was associated with current PTSD symptoms. The findings illuminate the possible value of differentiating between constructs of flexibility in predicting short and long-term effects of traumatic exposure and may pave the ground for developing personalized intervention methods.

To Be or Not to Be Flexible: Selective impairments as a means to differentiate between depression and PTSD symptoms.

During the course of their lives, most individuals experience at least one potentially traumatic event. For some individuals this experience may result in them developing depression and/or post-traumatic stress disorder (PTSD) symptoms. The aim of the present study was to test the interactive effect of traumatic exposure and impaired cognitive flexibility on the tendency to develop either depression or PTSD symptoms. Eighty-two college students (M age = 25.32, SD age = 4.09) were assessed for exposure to traumatic events, depressive and PTSD symptoms. In addition, they completed a performance-based learning paradigm to evaluate the unique patterns of cognitive flexibility, defined as reduced and enhanced updating of prior knowledge in the face of new information. We predicted and found that for individuals with reduced updating, greater exposure to trauma was associated with elevated depressive symptoms. Contrary to our prediction, for individuals with enhanced updating, greater exposure was associated with elevated PTSD symptoms. While cognitive flexibility is traditionally associated with adaptive outcomes, our results illuminate the important role of a delicate updating balance to adaptively cope with aversive life events. The findings highlight the possible different roles of cognitive flexibility in the development of psychopathology and may serve as a first step toward developing tailored prevention and treatment methods.

No distance is too far between friends: associations of comfortable interpersonal distance with PTSD and anxiety symptoms in Israeli firefighters.

Background: Previous research indicates that PTSD patients may show alterations in interpersonal distance regulation (IDR). However, it is not clear whether altered IDR is correlated with psychopathology after trauma and whether attentional processes might be involved in these alterations. Objective: The current study investigated IDR and attentional processing in a sample of Israeli firefighters. Method: Twenty-four participants completed an experimental IDR task as well as measures of PTSD and anxiety. During the task, event-related potentials were recorded to assess attentional processing as reflected in the P1 and N1 components. Results: Participants who did not choose a closer distance towards friends than strangers experienced greater anxiety. Moreover, participants who showed attentional avoidance towards strangers reported more PTSD symptoms. By contrast, participants who showed hypervigilant attention towards strangers reported greater anxiety. Conclusions: Our results demonstrate an association between IDR, PTSD, and anxiety after trauma. Future studies should re-investigate these associations in larger samples and explore potential implications for prevention and treatment.

Antecedentes: Investigaciones anteriores indican que los pacientes con TEPT pueden mostrar alteraciones en la regulación de la distancia interpersonal (IDR en su sigla en inglés). Sin embargo, no está claro si la IDR alterada se correlaciona con la psicopatología después del trauma y si los procesos atencionales podrían estar involucrados en estas alteraciones.Objetivo: El estudio actual investigó la IDR y el procesamiento atencional en una muestra de bomberos israelíes.Método: Veinticuatro participantes completaron una tarea de IDR experimental, así como medidas de TEPT y ansiedad. Durante la tarea, se registraron los potenciales relacionados con evento para evaluar el procesamiento de la atención como se refleja en los componentes P1 y N1.Resultados: Los participantes que no eligieron una distancia más cercana con los amigos que con los extraños experimentaron una mayor ansiedad. Además, los participantes que mostraron evitación atencional hacia extraños reportaron más síntomas de TEPT. Por el contrario, los participantes que mostraron una atención hipervigilante hacia los extraños reportaron una mayor ansiedad.Conclusiones: Nuestros resultados demuestran una asociación entre IDR, TEPT y ansiedad después de un trauma. Los estudios futuros deberían volver a investigar estas asociaciones en muestras más grandes y explorar las posibles implicaciones para la prevención y el tratamiento.

A chink in the armor: The influence of training on generalization learning impairments after viewing traumatic stimuli.

Studies have demonstrated that similarly to individuals with PTSD, non-PTSD individuals with repeated traumatic-exposure display selective impairments in hippocampal-related functions. A central example is their impaired generalization learning. Interestingly, previous findings revealed that the nature of this impairment varied as a function of occupation; while firefighters display impaired generalization of negative context, police crime scene investigators (CSI) display impaired generalization of negative cue. One possible explanation for these discrepancies may relate to the different job requirements and unique training. Specifically, firefighters are primed to regard the context during traumatic events whereas CSI police are primed to regard specific objects (cues) in the environment. The aim of the present study was to examine the interactive effect of exposure and training on generalization learning. Eighty-two healthy volunteers were exposed to either neutral or traumatic images while receiving instructions to refer either to the images' general contexts or to their specific cues. It was found that while both groups equally acquired and retained stimulus-outcome associations, only participants who were exposed to traumatic images showed impaired generalization learning. This impairment demonstrated a particular difficulty to generalize negative but not positive outcomes. Most importantly, as expected, there was a significant interaction between type of training and the observed impairments. Specifically, individuals who were previously trained to refer to general contexts showed a selective overgeneralization of negative contexts, while individuals who were trained to refer to specific cues displayed a selective overgeneralization of negative cues. The results suggest that trauma exposed individuals show the most vulnerability in precisely the areas in which they were most trained. We discuss the ways in which improving generalization learning may impact individuals' process of trauma recovery and might set the ground for developing treatment and prevention methods.

The interactive effect of valence and context on reversal learning in individuals with Parkinson's disease.

Cognitive deficits in Parkinson's disease (PD) have increasingly been recognized over the last decade and reversal learning in particular has received a great deal of attention. In a classical reversal-learning paradigm, participants learn to associate various stimuli with specific responses (i.e. A →Positive; B→ Negative), and subsequently learn to associate the same stimuli with opposite outcomes (i.e., A→Negative; B→ Positive). Prior studies have revealed that medicated PD patients have a selective impairment with learning from negative, but not positive, outcomes, even when both reward- and punishment-related stimuli were equally relevant. The aim of the present study was to further understand this impairment by applying a novel reversal-learning paradigm, which enables the differentiation between positive/negative and cue/context reversal impairments. Twenty-seven medicated PD patients and twenty-nine healthy individuals matched for age, gender and education completed the cue-context reversal learning paradigm. The results revealed no significant differences in context reversal learning between individuals with PD and healthy controls. However, in cue reversal learning, healthy controls were significantly better at performing positive-to-negative reversal trials compared to individuals with PD, while individuals with PD were significantly better in negative-to-positive reversal trials compared to healthy controls. As such, the present study distinguishes between different types of reversal learning and suggests that different neural circuits are responsible for context and cue learning. These results improve our understanding of the possible effects of dopaminergic medications and may have important clinical implications.