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Posttraumatic stress disorder (PTSD) is a serious health condition that adversely affects the mind and body. Current first-line treatment for PTSD tends to focus on the mind and overlook the impacts of trauma on the body. Trauma Center Trauma-Sensitive Yoga (TCTSY) is an evidence-based adjunctive therapy for complex trauma and PTSD that uses a body-based approach to trauma healing. Although designed to be used in group or individual contexts, previous studies have focused only on TCTSY facilitated in groups. The present study examined the effects of one-to-one TCTSY (i.e., one participant receiving TCTSY services, not in a group TCTSY context) on anxiety, depression, posttraumatic stress, interoception, substance use, and sleep over time. Using an observational approach, all certified TCTSY facilitators received the study invitation to share with clients who were enrolled in one-to-one TCTSY services. Ten clients participated in the study across four countries (women n = 8; mean age 44.80 ± 11.91; PTSD diagnosis n = 9). Clients completed Qualtrics surveys at TCTSY sessions in June-December 2022. Linear mixed-model analyses found that anxiety, depression, posttraumatic stress symptoms, attention regulation, self-regulation, and body listening significantly improved over time. There were no significant changes in sleep or substance use from pre- to post-study. TCTSY is a somatic approach for managing trauma symptoms and enhancing interoceptive awareness. Extensions of the present study are warranted to further understand the effects of one-to-one TCTSY for trauma care.

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Owing to the recent emergence of COVID-19, there is a lack of published research and clinical recommendations for posttraumatic stress disorder (PTSD) risk factors in patients who contracted or received treatment for the virus. This research aims to identify potential molecular targets to inform therapeutic strategies for this patient population. RNA sequence data for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and PTSD (from the National Center for Biotechnology Information [NCBI]) were processed using the GREIN database. Protein-protein interaction (PPI) networks, pathway enrichment analyses, miRNA interactions, gene regulatory network (GRN) studies, and identification of linked drugs, chemicals, and diseases were conducted using STRING, DAVID, Enrichr, Metascape, ShinyGO, and NetworkAnalyst v3.0. Our analysis identified 15 potentially unique hub proteins within significantly enriched pathways, including PSMB9, MX1, HLA-DOB, HLA-DRA, IFIT3, OASL, RSAD2, and so on, filtered from a pool of 201 common differentially expressed genes (DEGs). Gene ontology (GO) terms and metabolic pathway analyses revealed the significance of the extracellular region, extracellular space, extracellular exosome, adaptive immune system, and interleukin (IL)-18 signaling pathways. In addition, we discovered several miRNAs (hsa-mir-124-3p, hsa-mir-146a-5p, hsa-mir-148b-3p, and hsa-mir-21-3p), transcription factors (TF) (WRNIP1, FOXC1, GATA2, CREB1, and RELA), a potentially repurposable drug carfilzomib and chemicals (tetrachlorodibenzodioxin, estradiol, arsenic trioxide, and valproic acid) that could regulate the expression levels of hub proteins at both the transcription and posttranscription stages. Our investigations have identified several potential therapeutic targets that elucidate the probability that victims of COVID-19 experience PTSD. However, they require further exploration through clinical and pharmacological studies to explain their efficacy in preventing PTSD in COVID-19 patients.

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BACKGROUND: The experience of self-hood in posttraumatic stress disorder (PTSD) is altered cognitively and somatically. Dysfunctional negative cognitions about the self are a central mechanism of PTSD symptomatology and treatment. However, while higher-order brain models of disturbances in self-appraisal (i.e., cognitive processes relating to evaluating the self) have been examined in other psychiatric disorders, it is unclear how normative brain function during self-appraisal is impaired in PTSD. METHODS: This paper presents a PRISMA systematic review of functional neuroimaging studies (n = 5), to establish a neurobiological account of how self-appraisal processes are disturbed in PTSD. The review was prospectively registered with PROSPERO (CRD42023450509). RESULTS: Self-appraisal in PTSD is linked to disrupted activity in core self-processing regions of the Default Mode Network (DMN); and regions involved in cognitive control and emotion regulation, salience and valuation. LIMITATIONS: Because self-appraisal in PTSD is relatively under-studied, only a small number of studies could be included for review. Cross-study heterogeneity in analytic approaches and trauma-exposure history prohibited a quantitative meta-analysis. CONCLUSIONS: This paper proposes a mechanistic account of how neural dysfunctions may manifest clinically in PTSD and inform targeted selection of appropriate treatment options. We present a research agenda for future work to advance the field.

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Posttraumatic stress disorder (PTSD) is a burdensome disorder associated with lower quality of life and increased morbidity and mortality. Veterans are particularly at risk for PTSD resulting from experiencing traumatic events during military service. Current treatments for PTSD often fail to remediate symptoms and are associated with high dropout rates; therefore, complementary and integrative health approaches, such as yoga, are being considered to treat PTSD-related symptoms. The present study investigated the feasibility of a 12-week, 1-hour/week, in-person, trauma-informed mindful resilience yoga intervention for improving PTSD symptom severity and secondary psychological outcomes (e.g., physical and mental health, sleep, mindfulness, and self-efficacy), physiological health-related fitness outcomes (e.g., body composition and muscular strength), and physical activity outcomes (e.g., accelerometry) in a sample of veterans with PTSD. Results demonstrated the intervention to be feasible, with 12 participants (9 male, 3 female; mean age 50.3) completing the program (10 participants completed ≥ 75% of the 12 sessions). Statistically significant improvement was demonstrated in the "nonjudging of inner experience" aspect of mindfulness (p = 0.005, d = 1.280). Although not considered statistically significant (p > 0.008), the majority of outcomes demonstrated trending improvement from pre- to postintervention, with small to large Cohen's d effect sizes. The novelty of this study is represented by the trending improvements in physiological health-related fitness outcomes, with lean mass and handgrip strength demonstrating small effect sizes (d = 0.243 and d = 0.267, respectively). Our results extend the existing literature on the feasibility and potential effectiveness of yoga as a complementary or integrative therapy for PTSD in the veteran population.

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The MOD Rehabilitation Department (RD) offers three types of rehabilitation tracks (RTs): (a) education, (b) work placement, (c) economic independence. This study aimed to examine which of the offered RTs predicted a better integration into the workforce. This is an observational, prospective, case-controlled study. Data were collected from administrative files. The data pertained to soldiers injured in military service, under RD care and recognised as posttraumatic stress disorder (PTSD) patients between 2001 and 2006. As rehabilitation takes 5-6 years, we examined two points in time: 2015 and 5 years later, in 2020. The studied population comprised 462 male military veterans injured during military service and diagnosed with PTSD (mean age at the time of injury was 24.60 [SD 5.70]; median = 22). Of the participants, 87.9% (n = 406) also sustained physical injury, and 12.1% were not injured physically (n = 56; 12.1%). A regression analysis indicated that the educational RT (OR = 19.509; p = .001) predicted integration into the workforce. The whole model explained 49.0% of the variance. Of the three RT types examined, education is the most important. The more years of study, the better the ability to integrate into the workforce.

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Introduction: Sexual victimization (SV) is common among college women, with approximately half of those who have experienced SV meeting criteria for posttraumatic stress disorder (PTSD) within a year. Both SV and PTSD are associated with alcohol misuse among college women, often explained by the self-medication hypothesis. Existing literature focuses on overall PTSD severity rather than potential day-to-day fluctuations in specific symptoms, which might play a crucial role in understanding alcohol misuse risk. Studies also examine only same-day or next-day associations between PTSD and drinking, neglecting the potential for longer-term changes. Methods: This study explores the short-term longitudinal stability and time-lagged predictive dynamics of PTSD symptoms, affect, and drinking behavior among 174 female college heavy episodic drinkers over four weeks. Participants were categorized into three groups: those with a history of SV and PTSD (n = 77), women with SV but without PTSD (n = 59), and women without prior trauma history (n = 38) to be able to examine differences by trauma exposure, and PTSD. We compared the longitudinal stability of PTSD symptom networks, affect (arousal, positive affect, and negative affect), and drinking behavior across groups. Support vector regression determined which PTSD symptom networks and affect best predict drinking behavior at specific time lags within a 0-7 day range. Results: The PTSD group showed higher longitudinal stability for PTSD symptom networks (adjusted ps <.049) and arousal (adjusted ps <.048), but lower stability for negative affect (adjusted p =.013) and drinking behavior, including alcohol cravings (adjusted p =.019) and consumption (adjusted ps =.012), compared to the comparison groups. This suggests individuals with PTSD have more stable symptoms and arousal levels but greater fluctuations in negative affect and alcohol-related behaviors. Secondary analysis revealed PTSD symptom networks optimally predicted alcohol cravings with a three-day time lag (r=.88, p <.001) and consumption with a four-day time lag (r=.82, p <.001). Discussion: These findings challenge assumptions regarding immediate effects of PTSD and affect on drinking behavior and underscore the need for therapeutic approaches that consider longer-range effects. Future research should expand on these findings by incorporating longer-range assessments and exploring a broader range of symptom interactions.

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The recent worldwide surge of warfare and hostilities exposes increasingly large numbers of individuals to traumatic events, placing them at risk of developing posttraumatic stress disorder (PTSD) and challenging both clinicians and service delivery systems. This overview summarizes and updates the core knowledge of the genetic, molecular, and neural circuit features of the neurobiology of PTSD and advances in evidence-based psychotherapy, pharmacotherapy, neuromodulation, and digital treatments. While the complexity of the neurobiology and the biological and clinical heterogeneity of PTSD have challenged clinicians and researchers, there is an emerging consensus concerning the underlying mechanisms and approaches to diagnosis, treatment, and prevention of PTSD. This update addresses PTSD diagnosis, prevalence, course, risk factors, neurobiological mechanisms, current standard of care, and innovations in next-generation treatment and prevention strategies. It provides a comprehensive summary and concludes with areas of research for integrating advances in the neurobiology of the disorder with novel treatment and prevention targets.

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Over recent decades, serious games have become a promising intervention approach for addressing psychological problems by providing users with computerized, engaging, and interactive experiences. An innovative serious game, Traveler, has been developed specifically as an intervention tool for managing posttraumatic responses immediately after trauma. The game incorporates the principle of visuospatial interference, the core elements of Tetris, such as spatial displacement and mental rotation, and the critical phases of eye movement desensitization and reprocessing. To test the intervention efficacy and feasibility of Traveler, we conducted a randomized controlled trial involving 105 young adults. Participants were randomly assigned into three groups: a wait-list control group, a group undergoing five-session written exposure therapy, or a group engaging in one session of Traveler gameplay. Outcome measures included intrusive memories (i.e. vividness of traumatic images, disgust at traumatic images, flashback frequency, and flashback impact) and posttraumatic growth measured by the Posttraumatic Growth Inventory. Traveler significantly outperformed the control and written exposure therapy groups in reducing intrusive memories and enhancing posttraumatic growth, with effects persisting at a 30-day follow-up. Thus, Traveler offers a promising brief and early intervention technique for addressing posttraumatic responses. Yet, its clinical applicability requires further investigation.

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Background: Scalable PTSD screening strategies must be brief, accurate and capable of administration by a non-specialized workforce. Methods: We used PTSD as determined by the structured clinical interview as our gold standard and considered predictors sets of (a) Posttraumatic Stress Checklist-5 (PCL-5), (b) Primary Care PTSD Screen for the DSM-5 (PC-PTSD) and, (c) PCL-5 and PC-PTSD questions to identify the optimal items for PTSD screening for public sector settings in Kenya. A logistic regression model using LASSO was fit by minimizing the average squared error in the validation data. Area under the receiver operating characteristic curve (AUROC) measured discrimination performance. Results: Penalized regression analysis suggested a screening tool that sums the Likert scale values of two PCL-5 questions-intrusive thoughts of the stressful experience (#1) and insomnia (#21). This had an AUROC of 0.85 (using hold-out test data) for predicting PTSD as evaluated by the MINI, which outperformed the PC-PTSD. The AUROC was similar in subgroups defined by age, sex, and number of categories of trauma experienced (all AUROCs>0.83) except those with no trauma history- AUROC was 0.78. Conclusion: In some East African settings, a 2-item PTSD screening tool may outperform longer screeners and is easily scaled by a non-specialist workforce.

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Anxiety disorders are among the most commonly diagnosed mental health disorders in the United States - affecting over 40 million adults per year. Although anxiety disorders are commonly treated via psychotherapy and/or pharmacotherapy, there is also accumulating evidence to suggest that physical activity and exercise may play an important role in prevention and treatment. This chapter provides an extensive overview of literature examining the effects of physical activity, acute bouts of exercise, and chronic exercise training on several anxiety outcomes, primarily in adults. The collective evidence to date suggests that: (1) an acute bout of aerobic or resistance exercise generally results in reductions in state anxiety among adults with and without clinical anxiety disorders, (2) greater levels of physical activity are associated with fewer anxiety symptoms and a reduced likelihood of developing an anxiety disorder, (3) exercise training (aerobic and resistance) appears to reduce general anxiety symptoms in adults without a clinical anxiety disorder and adults with a chronic illness (e.g., cardiovascular disease) and may reduce disorder-specific symptoms of anxiety in adults with a clinical anxiety disorder. Although the collective body of evidence is promising, there is a need for additional well-designed and adequately powered randomized controlled trials, especially among adults with clinical anxiety disorders.

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Extinction of traumatic memory, a primary treatment approach (termed exposure therapy) in posttraumatic stress disorder (PTSD), occurs through relearning and may be subserved at the molecular level by long-term potentiation of relevant circuits. In parallel, repetitive transcranial magnetic stimulation (TMS) is thought to work through long-term potentiation-like mechanisms and may provide a novel, safe, and effective treatment for PTSD. In a recent failed randomized controlled trial we emphasized the necessity of correctly identifying cortical targets, the directionality of TMS protocols, and the role of memory activation. Here, we provide a systematic review of TMS for PTSD to further identify how, where, and when TMS treatment should be delivered to alleviate PTSD symptoms. We conducted a systematic review of the literature by searching for repetitive TMS clinical trials involving patients with PTSD and outcomes. We searched MEDLINE through October 25, 2023, for "TMS and PTSD" and "transcranial magnetic stimulation and posttraumatic stress disorder." Thirty-one publications met our inclusion criteria (k = 17 randomized controlled trials, k = 14 open label). Randomized controlled trial protocols were varied in terms of TMS protocols, cortical TMS targets, and memory activation protocols. There was no clear superiority of low-frequency (k = 5) versus high-frequency (k = 6) protocols or by stimulation location. Memory provocation or exposure protocols (k = 7) appear to enhance response. Overall, TMS appears to be effective in treating PTSD symptoms across a variety of TMS frequencies, hemispheric target differences, and exposure protocols. Disparate protocols may be conceptually harmonized when viewed as potentiating proposed anxiolytic networks or suppressing anxiogenic networks.

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OBJECTIVE: Twin studies have demonstrated that posttraumatic stress disorder (PTSD) is moderately heritable, and the pattern of findings across studies suggests higher heritability in females compared with males. Formal testing of sex differences has yet to be done in twin studies of PTSD. The authors sought to estimate the genetic and environmental contributions to PTSD, and to formally test for sex differences, in the largest sample to date of both sexes, among twins and siblings. METHODS: Using the Swedish National Registries, the authors performed structural equation modeling to decompose genetic and environmental variance for PTSD and to formally test for quantitative and qualitative sex differences in twins (16,242 pairs) and in full siblings within 2 years of age of each other (376,093 pairs), using diagnostic codes from medical registries. RESULTS: The best-fit model suggested that additive genetic and unique environmental effects contributed to PTSD. Evidence for a quantitative sex effect was found, such that heritability was significantly greater in females (35.4%) than males (28.6%). Evidence of a qualitative sex effect was found, such that the genetic correlation was high but less than complete (rg=0.81, 95% CI=0.73-0.89). No evidence of shared environment or special twin environment was found. CONCLUSIONS: This is the first demonstration of quantitative and qualitative sex effects for PTSD. The results suggest that unique environmental effects, but not the shared environment, contributed to PTSD and that genetic influences for the disorder are stronger in females compared with males. Although the heritability is highly correlated, it is not at unity between the sexes.

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Despite the growing incidence of burn injuries globally and the advancements in physical recovery, the psychological aspect of burn trauma recovery remains inadequately addressed. This review aims to consolidate existing literature posttraumatic stress disorder (PTSD) and depression in adult burn survivors, recognizing the need for a holistic approach to burn recovery that encompasses both physical and mental health. The comprehensive analysis of 156 studies revealed significant variations in methodological approaches, leading to challenges in creating standardized protocols for mental health assessment in burn care. Key findings include the identification of a wide range of psychological assessment tools and a substantial research gap in low and middle-income countries, where the majority of burn injuries occur. Only 7.0% of the studies assessed interventions for PTSD or depression, indicating a lack of focus on treatment modalities. The studies identified demographic factors, patient history, psychosocial factors, burn injury characteristics, and treatment course as risk factors for PTSD and depression post-burn injury. The review highlights the need for early screening, intervention, and attention to subjective experiences related to burn injury, as these are strong predictors of long-term psychological distress. It also emphasizes the complexity of addressing psychological distress in burn survivors and the need for more standardized practices in assessing PTSD and depression specific to this population.

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Background: Childhood maltreatment (CM) can be divided into: emotional abuse (EA), physical abuse (PA), sexual abuse (SA), emotional neglect (EN), and physical neglect (PN). CM is associated with (Complex)Posttraumatic stress disorder (PTSD/CPTSD) and substance use disorder (SUD).Objective: This cross-sectional study examined the relationships between CM-subtypes with PTSD-severity and CPTSD in patients with SUD-PTSD.Method: Participants (N = 209) were treatment-seeking SUD-PTSD patients who completed the Childhood Trauma Questionnaire-short form, the Clinician-Administered PTSD Scale for DSM-5 and the International Trauma Questionnaire. Regression analyses and a model selection procedure to select an optimal model were used to examine CM-subtypes as predictors of (C)PTSD, adjusted for sex and age.Results: Total CM and all CM-types significantly predicted PTSD-severity in the univariate regression analysis, with EA begin the strongest predictor. In the multiple regression only SA predicted PTSD-severity. Subsequently, model selection indicated that the optimal model to predict PTSD-severity included EA and SA. In the univariate analyses total CM, EA, and PN significantly predicted CPTSD-classification, and total CM and all CM-types significantly predicted CPTSD-severity. In the multiple regression for CPTSD-classification only EA and PA were significant predictors and for CPTSD-severity EA, PA and SA were significant predictors. In post-hoc multiple regression analyses, only EA was a significant predictor of CPTSD-classification and CPTSD-severity. Finally, in the model selection the most parsimonious model only included EA for both CPTSD-classification and CPTSD-severity. Sex was not a moderator in the relationship between CM and PTSD, nor in CM and CPTSD.Conclusions: These findings indicate that for SUD-PTSD patients, several CM-types have predictive value for (C)PTSD-severity, however SA and especially EA appear to contribute to these complaints. Since EA does not constitute an A-criterion, it is generally more overlooked in PTSD treatment. Its impact should therefore be underlined, and clinicians should be attentive to EA in their treatment.

All types of Childhood Maltreatment are associated with PTSD severity.Emotional Abuse and Sexual Abuse are most predictive for PTSD severity.Emotional Abuse is most predictive for CPTSD classification and symptom severity.

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Digital terror refers to the use of digital technology to disseminate graphic images of acts of violence to frighten the public. On October 7, 2023, militants of the Palestinian organization Hamas launched a brutal attack on Israel and used digital terror to magnify their acts. Although the purposeful spreading of terror via digital means is not new, the Hamas attack was significant for the scope, immediacy, and widespread dissemination of its digital content. This column aims to describe and analyze the psychological significance of this new form of terror, the public mental health challenges raised, and the interventions needed to assist those exposed to digital terror.

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Introduction: The incorporation of animals into interventions focused on military families is a relatively new concept. Though animal-assisted interventions (AAIs) have been studied in the context of military veterans, few studies incorporate members of the military family or focus on the family members' experiences. Methods: This systematic review investigates the effects of AAIs on the wellbeing of military family members beyond the veteran themselves through three aims: (1) by describing the characteristics of AAIs for military family members, (2) by evaluating the quality of the methodology present within the current literature, and (3) by identifying key concepts and knowledge gaps within the findings reported to date. Results: A total of nine articles met the criteria to be included in the review. Though the inclusion criteria and search terms included all types of animal-assisted interventions, the only interventions represented were service dogs (n = 4) and equine-assisted services (n = 5). Discussion: Findings suggest AAIs could be beneficial in areas such as communication, relational bonds, and psychosocial well-being. Though additional research is necessary, AAIs may be an effective complementary intervention for military families.

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BACKGROUND: Many women experience new onset or worsening of existing posttraumatic stress disorder (PTSD) symptoms during pregnancy and the early postpartum period. However, perinatal PTSD symptom profiles and their predictors are not well understood. METHODS: Participants (N = 614 community adults) completed self-report measures across three methodologically similar longitudinal studies. Mixture modeling was used to identify latent subgroups of trauma-exposed women with distinct patterns of symptoms at pregnancy, 1-month, and 3-month postpartum. RESULTS: Mixture modeling demonstrated two classes of women with relatively homogenous profiles (i.e., low vs. high symptoms) during pregnancy (n = 237). At 1-month postpartum (n = 391), results suggested a five-class solution: low symptoms, PTSD only, depression with primary appetite loss, depression, and comorbid PTSD and depression. At 3-months postpartum (n = 488), three classes were identified: low symptoms, elevated symptoms, and primary PTSD. Greater degree of exposure to interpersonal trauma and reproductive trauma, younger age, and minoritized racial/ethnic identity were associated with increased risk for elevated symptoms across the perinatal period. LIMITATIONS: Only a subset of potential predictors of PTSD symptoms were examined. Replication with a larger and more racially and ethnically diverse sample of pregnant women is needed. CONCLUSIONS: Results highlight limitations of current perinatal mental health screening practices, which could overlook women with elevations in symptoms (e.g., intrusions) that are not routinely assessed relative to others (e.g., depressed mood), and identify important risk factors for perinatal PTSD symptoms to inform screening and referral.

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Forcibly displaced Muslims, including refugees, internally displaced persons, and asylum seekers who have fled their homes to escape violence, conflict, and persecution, often have inequitable access to quality mental health services, despite substantial trauma exposure and high rates of posttraumatic stress disorder (PTSD). Understanding factors associated with domains of perceived need (i.e., community, individual, friends/family) for culturally-responsive, trauma-focused mental health interventions among forcibly displaced Muslims may provide insight into those most likely to seek psychological treatment. A sample of 108 forcibly displaced Muslims endorsed moderate to high perceived need across all three domains for a trauma healing group tailored for Muslim refugees. PTSD severity related to perceived individual need, regardless of locus of displacement. Among participants with minimal PTSD symptoms, those who were externally displaced had higher perceived community and friends or family need than those who were internally displaced. Findings highlight a need for culturally responsive, trauma-focused mental health services to facilitate access to mental health care for forcibly displaced Muslims.

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