No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
A Review of PTSD and Current Treatment Strategies
Abstract
Current treatment strategies for control of trauma-associated symptoms of Post Traumatic Stress Disorder (PTSD) have recently been updated by the Veterans Affairs (VA) and the Department of Defense (DoD, after over a decade of dedicated research. The most recent evidence is compelling that its use of trauma-focused therapies such as Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE), Eye Movement, Desensitization, and Restructuring (EMDR), and others with significant trauma focus are the current gold standard for treatment. Additional medication use may be of assistance in treatment of symptomology, with special avoidance of benzodiazepines or other sedative hypnotic medications which are causal of increased intrusive and dissociative symptoms over time.
... Current treatment approaches for PTSD involve psychotherapy and pharmacotherapy (Schrader & Ross, 2021). Cognitive-behavioral therapy (CBT), especially exposure therapy, helps modify maladaptive thought patterns and behaviors by encouraging patients to confront traumatic memories in a controlled environment (Schrader & Ross, 2021). ...
... Current treatment approaches for PTSD involve psychotherapy and pharmacotherapy (Schrader & Ross, 2021). Cognitive-behavioral therapy (CBT), especially exposure therapy, helps modify maladaptive thought patterns and behaviors by encouraging patients to confront traumatic memories in a controlled environment (Schrader & Ross, 2021). However, its e cacy depends on patient engagement, and the distress of re-experiencing trauma can lead to dropout or worsened symptoms. ...
... However, its e cacy depends on patient engagement, and the distress of re-experiencing trauma can lead to dropout or worsened symptoms. Pharmacotherapy, mainly selective serotonin reuptake inhibitors (SSRIs), alleviates symptoms of depression and anxiety, stabilizing mood and improving overall functioning (Schrader & Ross, 2021). Limitations include variability in drug e cacy and potential side effects, addressing only symptomatic relief rather than the root cause of PTSD. ...
Objective: Post-traumatic stress disorder (PTSD) remains a significant clinical challenge with limited treatment options. Although electroencephalogram (EEG) neurofeedback has garnered attention as a prospective treatment modality for PTSD, no comprehensive meta-analysis has been conducted to assess its efficacy and compare different treatment protocols. This study aims to provide a multi-variable meta-regression analysis of EEG neurofeedback's impact on PTSD symptoms, while also assessing variables that may influence treatment outcomes.
Methods: A systematic review was performed to identify controlled studies exploring for the efficacy of EEG neurofeedback on PTSD. The overall effectiveness was evaluated through meta-analysis, and a multi-variable meta-regression was employed to discern fact0rs affecting the EEG neurofeedback efficacy.
Results: EEG neurofeedback yielded a statistically significant reduction in PTSD symptoms immediately post-intervention, with sustained effects at one and three months follow-up. A sub-analysis of sham-controlled studies confirmed that outcomes were not driven by placebo effects. Our findings also identified the target frequency and region, as well as feedback modality, as significant factors for treatment success. In contrast, variables related to treatment duration were not found to be significant moderators, suggesting cost-effectiveness.
Conclusions: EEG neurofeedback emerges as a promising and cost-effective treatment modality for PTSD with the potential for long-term benefits. Our findings challenge commonly utilized protocols and advocate for further research into alternative methodologies to improve treatment efficacy.
... Current treatments for PTSD include psychotherapy and pharmacotherapy. Psychotherapeutic approaches include cognitive behavioral therapy (CBT), cognitive processing therapy (CPT), eye movement desensitization and reprocessing, prolonged exposure, and narrative exposure therapy [12,13]. Medications include antidepressants such as selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors [13]. ...
... Psychotherapeutic approaches include cognitive behavioral therapy (CBT), cognitive processing therapy (CPT), eye movement desensitization and reprocessing, prolonged exposure, and narrative exposure therapy [12,13]. Medications include antidepressants such as selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors [13]. Although the conventional aforementioned treatments for PTSD have shown some success, approximately one-third of patients experience treatment resistance [14]. ...
Introduction:
Post-traumaticstress disorder (PTSD) can have debilitating effects on quality of life, andconventional treatments show mixed results. Neuromodulation is emerging as apromising approach for treating PTSD. This review examines currentneuromodulatory treatments for PTSD, and highlights methodologies, clinicaloutcomes, and gaps in the literature to help guide future research.
Areas covered:
APubMed search identified 252 studies on PTSD and neuromodulation, of which 61 wereselected for full review. These included 37 studies on repetitive transcranialmagnetic stimulation (rTMS), 10 on transcranial direct current stimulation (tDCS),4 on deep brain stimulation (DBS) and 2 on focused ultrasound (FUS).
Expert opinion:
The present review supports the potential of neuromodulationto reduce PTSD symptoms. rTMS and tDCS targeting the dlPFC appear effective throughmodulating neural circuits involved in fear processing and conditioning,however literature varies regarding efficacy of stimulation frequencies andhemispheric targets. DBS targeting the amygdala or subcallosal cingulate whitematter tracts improves treatment of refractory PTSD with sustained benefits, whileFUS may improve symptoms through targeted modulation of brain structures suchas the amygdala, though this technique is in the early stages of exploration. Futureresearch should refine established neuromodulatory approaches and address gapsin emerging modalities to enhance treatment efficacy.
... PTSD was first identified and recorded during the Seven Years' War, also known as the French and Indian War. During this profoundly negative time, terms like "nostalgia" were used to describe the condition of the soldiers (Schrader et al., 2021). Other events throughout history have also caused PTSD rates to rise, such as the Holocaust, the Colonization of Native Americans, and American slavery. ...
... PTSD is not limited to military veterans, as there have been many situations in which civilians are exposed to traumatic events such as abuse, natural disasters, and accidents. Approximately 6-7% of the adult United States population and a significant portion of military veterans meet the criteria and are diagnosed with PTSD (Schrader et al., 2021). PTSD can cause impairment in a patient's daily life for more than one month because of the severe distress in sleep patterns and behavioral changes, which take extensive time to change. ...
Post Traumatic Stress Disorder (PTSD) is a mental health condition triggered by exposure to traumatic events. These traumatic events could range from natural disaster traumas to abuse and war traumas. PTSD is usually found in individuals who have served their nation but can be found in anyone who has been exposed to trauma. It is important to understand the causes of PTSD as many individuals suffer improper sleeping patterns and hypervigilance and try to detach themselves from the world. The purpose of this paper is to describe what PTSD is, how it can affect memory loss, and how it can form false memories. PTSD can be harmful if untreated, especially if the patient is isolated. Neurologists have identified that PTSD can cause memory loss and can create false memories; however, treatments for PTSD are developing rapidly such as EMDR which can reduce the probability of developing memory loss and false memories in the future.
... Systematic reviews and meta-analyses have revealed that effect sizes of psychotherapies are larger than those of pharmacotherapies and that trauma-focused psychotherapies produce a greater long-term benefit than medications and avoid the side effects frequently associated with medications. 45 Ninety-five percent of the pharmacotherapeutic history of PTSD may be summarized by one word: antidepressants. Early studies of monoamine oxidase inhibitors and TCAs pointed to their efficacy in PTSD. ...
... Prazosin, an alpha 1 -adrenergic antagonist, has demonstrated improvements in sleep symptoms, including nightmares and night waking, as well as hyperarousal response, and to a lesser extent, it has shown general efficacy for treating PTSD, although weak evidence supports some of these uses. 45,46 A recent approach that is being investigated is secondary pharmacological intervention. 24 This approach involves treating a patient as soon as possible after the traumatic event with agents such as beta-adrenergic blockers or corticosteroids, with the aim of forestalling the development of PTSD. ...
... Posttraumatic stress disorder (PTSD) manifests as persistent maladaptive reactions after experiencing severe emotional or physical distress, including but not limited to, violent assault, military combat, and natural or manmade disasters [1]. According to the latest update to the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, all of the following criteria needs to be met for diagnosis of PTSD: (1) Direct or indirect exposure to death or actual/threatened violence or serious injury; (2) Persistently re-experiencing traumatic events through nightmares, flashbacks, memories; (3) Avoidance of trauma-related stimuli following trauma; (4) Negative thoughts or feelings that began or worsened following trauma; (5) Trauma related arousal and reactivity that began or worsened after trauma; (6) Symptoms must last for longer than one month; (7) Symptoms created distress or functional impairment; (8) Symptoms not explained by medication, substance use, or other illness. ...
... In patients with more severe or persistent PTSD, pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) is shown to be effective alongside psychotherapy. The medications fluoxetine, paroxetine, and venlafaxine have proven to show the most benefit for reducing symptoms [2]. ...
... Post-traumatic stress disorder Trauma focused psychotherapies are currently the gold standard in treatment of trauma-associated symptoms of PTSD and they include cognitive processing therapy, prolonged exposure therapy and eye movement, desensitization and restructuring therapy [26]. For pharmacotherapy, SSRIs and SNRIs such as fluoxetine, paroxetine, sertraline and venlafaxine have been reported to reduce PTSD symptoms when administered at appropriate doses [26]. ...
... Post-traumatic stress disorder Trauma focused psychotherapies are currently the gold standard in treatment of trauma-associated symptoms of PTSD and they include cognitive processing therapy, prolonged exposure therapy and eye movement, desensitization and restructuring therapy [26]. For pharmacotherapy, SSRIs and SNRIs such as fluoxetine, paroxetine, sertraline and venlafaxine have been reported to reduce PTSD symptoms when administered at appropriate doses [26]. ...
Genetics research has potential to alleviate the burden of mental disorders in low- and middle-income-countries through identification of new mechanistic pathways which can lead to efficacious drugs or new drug targets. However, there is currently limited genetics data from Africa. The Uganda Genome Resource provides opportunity for psychiatric genetics research among underrepresented people from Africa. We aimed at determining the prevalence and correlates of major depressive disorder (MDD), suicidality, post-traumatic stress disorder (PTSD), alcohol abuse, generalised anxiety disorder (GAD) and probable attention-deficit hyperactivity disorder (ADHD) among participants of the Uganda Genome Resource. Standardised tools assessed for each mental disorder. Prevalence of each disorder was calculated with 95% confidence intervals. Multivariate logistic regression models evaluated the association between each mental disorder and associated demographic and clinical factors. Among 985 participants, prevalence of the disorders were: current MDD 19.3%, life-time MDD 23.3%, suicidality 10.6%, PTSD 3.1%, alcohol abuse 5.7%, GAD 12.9% and probable ADHD 9.2%. This is the first study to determine the prevalence of probable ADHD among adult Ugandans from a general population. We found significant association between sex and alcohol abuse (adjusted odds ratio [AOR] = 0.26 [0.14,0.45], p < 0.001) and GAD (AOR = 1.78 [1.09,2.49], p = 0.019) respectively. We also found significant association between body mass index and suicidality (AOR = 0.85 [0.73,0.99], p = 0.041), alcohol abuse (AOR = 0.86 [0.78,0.94], p = 0.003) and GAD (AOR = 0.93 [0.87,0.98], p = 0.008) respectively. We also found a significant association between high blood pressure and life-time MDD (AOR = 2.87 [1.08,7.66], p = 0.035) and probable ADHD (AOR = 1.99 [1.00,3.97], p = 0.050) respectively. We also found a statistically significant association between tobacco smoking and alcohol abuse (AOR = 3.2 [1.56,6.67], p = 0.002). We also found ever been married to be a risk factor for probable ADHD (AOR = 2.12 [0.88,5.14], p = 0.049). The Uganda Genome Resource presents opportunity for psychiatric genetics research among underrepresented people from Africa.
... Additionally, about 28% of adolescents aged 14-17 have experienced childhood trauma, such as sexual victimization. These statistics reinforce the wide-reaching impact of PTSD and emphasize the need for continued, evidence-based treatment strategies [7]. Such a difference is hardly surprising, as recent systematic reviews have shown that the specific features of trauma exposure, for example, natural vs. human-made, or intentional vs. unintentional traumatic events, have important relevance in PTSD diagnosis [8,9]. ...
Background
Post-traumatic stress disorder (PTSD) represents a significant public health burden. Growing evidence suggests that psychological resilience (PR) may act as a protective factor against the development of PTSD. Trauma type may also influence the relationship between PR and PTSD. This meta-analytic study aims to assess the strength of this relationship by focusing on research conducted prior to the COVID-19 pandemic to avoid confounding effects introduced by the pandemic’s unique and widespread stressors.
Methods
A comprehensive literature search for case–control studies published between 2008 and 2019 was performed. Studies conducted after 2019 were excluded to maintain methodological consistency and avoid the pandemic’s effects. Heterogeneity and sampling bias analyses were conducted, followed by pooled effect estimates and 95% confidence intervals using random-effects models. Subgroup and sensitivity analyses were also included to investigate the effects of trauma type and age on the relationship between PR and PTSD.
Results
Thirteen studies were selected for the analysis ( n = 5689). The overall effect of the relationship between PR and PTSD was statistically significant ( p < 0.001), with the robustness and stability of the results corroborated. Subgroup analyses showed a differential effect based on trauma type and age ( p < 0.001).
Conclusions
The results support the hypothesis that lower PR is associated with higher susceptibility to PTSD. Additionally, trauma type and age were found to be significant factors influencing this relationship. Our study’s cross-sectional design and the variability in the data reported by the studies limited the conclusions. Future research should aim to further explore these findings and investigate potential long-term effects of different trauma types.
... It is characterized by symptoms including recurrent intrusive memories, avoidance of trauma-related stimuli, and heightened arousal, each of which notably disrupts the daily functioning of patients. [41] Despite progress in diagnostic and therapeutic approaches, the treatment of PTSD continues to 15 be a challenge, requiring a comprehensive strategy that also targets comorbid conditions like depression and anxiety disorders. [42] Cultural studies on PTSD underscore the importance of incorporating local social and cultural factors into treatment, as these can significantly influence the trajectory and management of the disorder. ...
Introduction and Purpose: Mental health disorders are a global public health challenge, with rising emergency visits, especially among youth. Physical activity has gained recognition as an effective intervention for some mental disorders. PA positively affects mental health by enhancing neuroplasticity, neurotransmitter regulation, and reducing inflammation. Aerobic and resistance exercises, as well as yoga, are effective in alleviating depressive symptoms, anxiety, and PTSD, improving ADHD-related cognitive functions, and decreasing substance cravings. This study aims to analyze the influence of physical activity on mental disorders. Research Objective: The primary aim of this literature is to evaluate the impact of physical activity (PA) on mental health, focusing on depression, anxiety, PTSD, ADHD, and substance use disorders. Materials and Methods: A literature review of studies published from 2019–2024 in the PubMed database analyzed clinical trials, meta-analyses, and systematic reviews on the effects of PA, using the following keywords: “physical activity” ; “depression” ; “anxiety” ; “substance abuse” ; “adhd”. Conclusions: PA is an effective, accessible adjunct therapy for mental health conditions, providing significant physical and psychological benefits. Future research should prioritize optimizing intervention protocols, investigating long-term effects, and adapting treatments to the specific needs of diverse populations.
... Terdapat berbagai teknik konseling yang dapat digunakan dan sudah terbukti efektif dalam membantu menangani PTSD akibat bencana alam di Indonesia, seperti Cognitive Behavioral Therapy (CBT) (Inayati & Harahap, 2022;Maulida & Fitriyani, 2023;Tasijawa et al., 2021), Dialectical behavior Therapy (DBT) (Nuryono & Sya[itri, 2020), Rational Emotive Behavior Therapy (REBT) (Omar & Sinaga, 2022), Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE), Eye Movement, Desensitization, and Restructuring (EMDR) (Schrader & Ross, 2021), Terapi Hipnotik Lima Jari (Rahmawati et al., 2024), dan Play Therapy (Widyastuti et al., 2019). Namun, selain menggunakan teknik konseling yang ada, pendekatan trauma healing juga dapat menjadi salah satu alternatif yang dapat digunakan untuk membantu mengelola dan memproses pengalaman traumatis yang dimiliki, sehingga memiliki kemampuan untuk mengkomunikasikan emosinya secara efektif sesuai dengan kebutuhan (Fitriyah et al., 2021). ...
Indonesia merupakan salah satu dari 35 negara yang memiliki risiko tinggi terhadap bencana alam, dan memberikan dampak psikologis yang serius seperti PTSD. Anak-anak dan remaja merupakan korban bencana alam yang rentan untuk mengalami PTSD karena perkembangan kognitif yang belum berkembang dengan sempurna, sehingga merasa sulit untuk mengungkapkan ketakutannya dan memiliki ingatan yang kuat terhadap bencana alam. Tujuan dari penelitian ini adalah untuk mengembangkan model trauma healingberbasis kearifan budaya lokal untuk membantu mengurangi gejala PTSD yang dimiliki peserta didik, dengan memanfaatkan nilai-nilai dan tradisi budaya setempat, serta menciptakan proses pemulihan yang lebih relevan dan adaptif. Metode penelitian yang digunakan adalah model R&D yang mengacu pada lima tahapan R&D Plomp untuk menghasilkan produk atau layanan yang efektif dan efisien. Terdapat dua instrumen yang digunakan untuk mengembangkan model ini yaitu, instrumen PTSD dan DCM untuk mengetahui gejala PTSD yang dimiliki oleh 2613 peserta didik SMP di Kab. Sumedang. Hasil penelitian menunjukkan pentingnya pengembangan model trauma healing berbasis kearifan budaya lokal untuk memberikan pendekatan baru kepada guru bimbingan dan konseling dalam membantu peserta didik yang mengalami PTSD akibat bencana alam.
... For example, the alpha-adrenergic antagonist prazosin is used for the treatment of nightmares and hyper-arousal, though some studies have shown weak evidence for its use. Another medication used as an adjunct to SSRI/SNRI includes Mirtazapine which is used for improvement of sleep duration and reduction of sleep latency (Schrader & Ross, 2021). Additionally, second-generation antipsychotics can be used as monotherapy or augment SSRI's. ...
Introduction: Acute Stress Disorder (ASD) causes symptoms like distractibility, irritability, and emotional detachment, lasting three days to one month after a traumatic event. In 2021, about 40 million emergency department (ED) visits were recorded for acute injuries, highlighting the need for stress quantification. The National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS) measures ASD severity in adults following extreme stress, with scores ≥14 indicating severe symptoms. Few studies have examined the NSESSS for trauma patients. We aim to assess the NSESSS's effectiveness in understanding trauma's impact on patient well-being, identifying patient improvement, and improving outcomes. Methods: This observational single-center study was conducted at a community hospital. Participants were at least 18 years old, arrived at the ED for acute injuries between January 2021 and December 2023, and consented to an ASD evaluation. Social workers administered the NSESSS upon hospital arrival, followed by a psychiatric evaluation within 48 hours. Patients were then reassessed by a psychiatrist with the NSESSS and DSM-5 criteria within seven days, with phone follow-ups for those discharged earlier. Statistical analysis was performed using SPSS software. Results: The study included 27 patients, 17 (63%) of whom were male, and 9 (27%) had pre-existing psychiatric comorbidities. The median age was 41 years (IQR 27-54), and the median NSESSS score was 6 (IQR 2-15). Among participants, 8 were true positives (NSESSS score ≥14 and met ASD DSM-5 criteria), 17 were true negatives (NSESSS score <14 and did not meet ASD DSM-5 criteria), and 2 were false negatives (NSESSS score <14 but met ASD DSM-5 criteria). There were no false positives. Conclusion: The NSESSS demonstrated internal consistency and validity, emerging as a promising tool for assessing ASD severity and tracking treatment progress in trauma patients. Early recognition and intervention for ASD are crucial in mitigating long-term adverse outcomes, highlighting the need for further research to understand its impact on patient well-being.
... Many papers focus on victims in international clinical literature, and trauma is one of the primary concerns. Most articles address the process of victimization (e.g., Beckley et al., 2021;Berliner and Conte, 1990;Gollwitzer et al., 2015;Zur, 1994), the consequences of trauma (e.g., Bodziak et al., 2021;Iffland and Neuner, 2022;Yılmaz, 2021), and how to treat them (e.g., Schrader and Ross, 2021;Stein, 2024;Wild and Gur, 2008). Traumas suffered in childhood, and their long-term effects are particularly well-documented (e.g., Downey and Crummy, 2022;Dye, 2018;Thoma et al., 2022) and have led to broad-spectrum meta-analyses in recent years (e.g., Ireton et al., 2024;Mȃirean et al., 2023;McKay et al., 2021). ...
International literature on power relations and criminal victimization is still scarce. This article explores the intricate dynamics of power relations and victimization in the postcolonial environment of Mayotte, a French island in Africa, through a mixed- methods study incorporating quantitative analysis of 613 case files and qualitative insights from clinical assessments. The results reveal an interplay of power relations based on various forms of authority and the victims' sociodemographics. Societal segmentation based on birthplace and ethnicity shapes the types of offenses, the proximity to offenders, and the appeal to justice. In this context, young females are the most vulnerable part of the population. Eventually, the postcolonial legacy and its effects could influence victimization processes and modalities of appeal to justice
and foster inequalities and stigmas related to social status, ethnicity, gender, and age. These results highlight the necessity of designing adapted public responses and provide a foundation to build tomorrow’s policies.
... Timely and effective intervention is crucial to alleviating distress, preventing chronic conditions, and reducing the burden on healthcare systems. Current evidence-based guidelines recommend psychological therapies such as Cognitive Processing Therapy (CPT), a trauma-focused cognitive-behavioral therapy, Prolonged Exposure (PE) therapy and eye movement desensitization and reprocessing (EMDR), along with pharmacological treatments like selective serotonin reuptake inhibitors (SSRIs) for managing PTSD (13). These guidelines prioritize psychotherapy over medication, reserving antipsychotic drugs for severe or treatment-resistant cases (14). ...
Introduction
Post-Traumatic Stress Disorder (PTSD) entails behavioral changes with increased risk of suicide, and there is no consensus on the preferred antidepressants for treatment of those PTSD patients who are at elevated risk for suicide.
Methods
We conducted a clinical trial emulation study comparing suicide-related events (SREs) among those patients’ initiating antidepressants within 60 days after a qualifying SRE. Patients were followed from initiation of antidepressant until any of the following: treatment cessation, switching, death, or loss to follow-up. The outcome is a new onset of an SRE.
Results
Citalopram exhibited a significantly fewer case with new SREs compared to other most used antidepressants such as venlafaxine, duloxetine, and mirtazapine–even after adjusting for multiple comparisons and other covariants.
Discussion
Findings suggest potential risks associated with certain antidepressants in the PTSD population, emphasizing cautious prescription considerations.
... The factors that cause a fear response to develop into a pathological fear memory after a person experiences the same trauma are poorly understood. However, erasing fear memories in patients is important once they have been formed (1,2). Notably, understanding fear memory erasure and the treatment of disorders caused by fear memories requires elucidating three questions: (i) Can fear memories be erased? ...
Background
In nature, animals must learn to recognize danger signals and respond immediately to threats to improve their environmental adaptation. However, excessive fear responses can lead to diseases such as post-traumatic stress disorder, wherein traumatic events result in persistent traumatic memories. Therefore, erasing pathological fear memories in vivo is a crucial topic in neuroscience for understanding the nature of memories and treating clinically relevant diseases.
Main text
This article reviews recent studies on fear memory erasure, erasure of short- and long-term memory, fear memory erasure and neuroplasticity, the neural circuitry and molecular mechanisms of fear memory erasure, and the roles of engram cells and perineuronal nets in memory erasure.
Conclusion
Research on the mechanism of memory erasure is limited, and a plausible explanation for the essential difference between memory erasure and memory extinction still needs to be provided. Notably, this review may guide future studies on fear memory and its underlying molecular mechanisms, which may help to develop novel treatment strategies for post-traumatic stress disorder, anxiety, and other mental disorders.
... До перших належать препарати класів інгібіторів зворотного захоплення серотоніну та селективних інгібіторів зворотного захоплення норепінефрину, а для коригування побічних ефектів -бензодіазепіни та короткої дії антагоністи адренорецепторів. Серед сучасних методів психотерапії -травмофокусована психотерапія, поведінкова терапія, десенсибілізація очних рухів, письмово-контактна терапія, оповідально-контактна терапія тощо [14]. Оскільки взаємний вплив непліддя та ПТСР є недостатньо вивченим, немає переконливих доказів доцільності лікування синдрому в рамках підготовки до застосування допоміжних репродуктивних технологій. ...
More than 48 million couples in the world suffer from infertility, which, in addition to numerous social consequences, also has a psychological impact. Aim - to study the peculiarities of the cervical local immune status in patients with PTSD and infertility in order to improve the treatment of fertility disorders. Materials and methods. Cervical concentrations of IL-6, IL-8, lactoferrin and secretory leukocyte proteinase inhibitor were studied, as well as their dynamics during treatment in 112 women with infertility, divided into 3 groups. The Group I - 36 women who had the criteria of post-traumatic stress disorder syndrome, which developed after the diagnosis of infertility, the Group II - 31 women with infertility that arose against the background of post-traumatic stress disorder, Group III - 45 patients with infertility without criteria for post-traumatic stress disorder. For control, 50 healthy women were examined. Groups of infertility were divided into 2 subgroups each. 18 women of subgroup IA and 15 of IIA were treated for infertility according to its cause, 18 women of subgroup IV and 16 of IIV additionally received trauma-based psychotherapy sessions. Results. All patients with infertility showed an increased content of all studied pro-inflammatory cytokines. After 3 months, patients of subgroups IA and IIA retained an increased content of pro-inflammatory cytokines. The content of IL-8 and lactoferrin after 3 months reached normal values in subgroups IV and IIV, and SILP - only in patients of subgroup IIV. Conclusions. In patients of all examined groups, the level of IL-6 and IL-8, SILP and lactoferrin in cervical mucus was significantly increased compared to similar values in the control group, which indicates the activation of the anti-inflammatory link of the immunoinflammatory reaction. The highest value of IL-6 and SILP is characteristic of women of group I, lactoferrin - of women of group II. The use of trauma-oriented psychotherapy in the complex treatment of patients with infertility on the background of PTSD allows achieving a more pronounced decrease in IL-8 levels in women of subgroup IA. A decrease in cervical IL-6 and SILP concentrations on the background of psychotherapy was obtained only in women of subgroup IIV, which has a beneficial effect on the implementation of reproductive function. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committee of the participating institution. Informed consent of the patients was obtained for the study. The authors declare the absence of a conflict of interest.
... Trauma-focused psychological therapies (TFPT) are the best-evidenced interventions for PTSD, and they are typically first line (Schrader and Ross, 2021). However, only about 50% of patients complete a course of treatment, and the response rates for those who do are roughly 50% (Schottenbauer et al., 2008). ...
... Trauma-focused therapies such as prolonged exposure therapy, cognitive processing therapy, eye movement, desensitization, and restructuring are recommended for the management of PTSD. [27] Custom-tailored specific exercises may be useful to increase balance in those who have high risk of falling. Exercises mainly involving balance and functional training can reduce the risk of falls. ...
Objectives: This study aims to evaluate fear of falling, balance, and kinesiophobia among survivors of the earthquake that occurred in Türkiye on February 6th, 2023 and to identify potential predictors of fear of falling and impaired balance.
Patients and methods: In this single-center, cross-sectional study, a total of 260 Kahramanmaraş earthquake survivors (105 males, 155 females; median age: 44.0 years; range, 18 to 91 years) between May 08, 2024 and July 08, 2024 were included. The sociodemographic data including age, sex, body mass index (BMI), marital status (single, married, widow), education status (years), monthly income (TL), smoking status (never smoked, smoking before the earthquake or started smoking after the earthquake), alcohol intake (never, regular use of alcohol before the earthquake, or started alcohol consumption after the earthquake) of the participants were recorded. Comorbidities were evaluated using the modified Charlson Comorbidity Index (CCI), anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), post-traumatic stress disorder using the National Stressful Events Survey for PTSD-Short Scale (NSESSS-PTSD), sleep disorders using the Jenkins Sleep Evaluation Scale (JSS), fear of falling using the Falls Efficacy Scale (FES), functional balance using the Berg Balance Scale (BBS), and kinesiophobia using the Tampa Scale for Kinesiophobia (TSK).
Results: Of the survivors (n=260), 4.6% and 33.8% experienced loss of first-degree relatives and house damage, respectively. The FES and TSK scores were higher, while the BBS score was lower in older adults (n=56) compared to younger counterparts (n=204) (p<0.001). Multivariate linear regression analysis revealed that increased age affected the BBS (β=–0.124; 95% CI: –0.263 to –0.185; p<0.001) and FES scores (β=0.404; 95% CI: 0.255 - 0.451; p<0.001). The PTSD-SS score had a significant effect on the FES score (β=0.915; 95% CI: 0.734 - 1.110; p<0.001).
Conclusion: The Kahramanmaraş earthquake caused detrimental effects. Older people were more affected in terms of balance, fear of falling, and kinesiophobia. Increased age and post-traumatic stress are significantly associated with fear of falling following the earthquake. As a potential risk factor for fear of falling, post-traumatic stress should be managed properly in survivors of such disasters, particularly in those at older age.
... The worker had experienced multiple traumatic events, including retrieving bodies of acquaintances and managing evacuations amid residents' distress, while personally affected by nuclear evacuation orders. The case demonstrated a complex clinical course: initial improvement with rest and medication was followed by recurrence, necessitating prolonged exposure (PE) therapy [6,7]. The PE intervention proved effective, enabling the patient to return to work and maintain stability even during subsequent disasters, including a major flood and the coronavirus disease (COVID-19) pandemic. ...
This report presents the follow-up treatment course of a previously published case that demonstrated the effectiveness of prolonged exposure (PE) therapy for a disaster relief worker. The patient, a municipal employee in Fukushima Prefecture, developed post-traumatic stress disorder (PTSD) and mood disorders after the 2011 Great East Japan Earthquake and subsequent disasters. This follow-up focuses on the period from 2021 to early 2024, during which the patient experienced symptom recurrence after his father’s death. This event revealed psychological patterns similar to his disaster-related responses. Schema therapy was introduced to address over-adaptive work behaviors and vulnerabilities in relationships, identified as relapse risk factors. Combined with antidepressants, schema therapy achieved sustained improvement. This longitudinal perspective demonstrates schema therapy’s effectiveness in addressing underlying vulnerabilities when symptoms re-emerge after trauma-focused treatment. The findings underscore how initial trauma responses may interact with subsequent life events and suggest schema therapy’s potential as a secondary intervention for disaster relief workers facing complex challenges.
... Prazosin, an alpha-1 adrenergic antagonist, which is FDAapproved for hypertension and benign prostatic hyperplasia, has historically been used off-label in PTSD for the treatment of nightmares, hyperarousal, and autonomic symptoms [10]. A recent systematic review pooling 10 research studies demonstrated the significant success of prazosin in reducing sleep disturbances in PTSD [11]. ...
Nightmares and flashbacks are common debilitating symptoms of posttraumatic stress disorder (PTSD) that can disrupt daily functioning. Prazosin, an alpha-1 adrenergic antagonist, has been commonly used off-label for the treatment of these intrusion symptoms, although its short half-life makes it so that often multiple doses are needed. Doxazosin, another alpha-1 antagonist, is starting to be investigated in the treatment of PTSD-related nightmares due to its lesser side effect profile and longer half-life. In our case series, we present three cases of patients with PTSD-related nightmares who were successfully treated with doxazosin following a relapse of symptoms after discontinuation of prazosin for various reasons. The success of doxazosin immediate release for PTSD-related nightmares warrants further studies into its efficacy and use as an alternative treatment to prazosin.
... In addition to medication, trauma-focused therapies such as Eye Movement, CPT, Prolonged Exposure Therapy, Desensitization, EMDR, and others with significant trauma focus are the current gold standard for the treatment of PTSD, 15 but psychotherapy tends to provide greater and more long-lasting outcome improvements. 16 A study aimed to compare the effectiveness of psychotherapies for posttraumatic stress disorder in clinical practice showed CPT and PE 4 produce the same improvement. ...
Background:
This study aimed to investigate the effects of CPT on PTSD, depression, and anxiety symptoms in female victims of domestic violence.
Methods:
A two-arm randomized clinical trial was conducted in Bandar-Abbas involving 62 female victims of domestic violence referred from private gynecology and obstetrics clinics. Initial screening for domestic violence was based on the World Health Organization violence questionnaire. Participants were randomly assigned to either a control group (n=32) or an intervention group (n=28) for a study duration of six months in 2022. Twelve group CPT sessions were conducted. The domestic violence questionnaire, Beck's Depression Inventory, Beck's Anxiety Inventory, and the Impact of Event Scale-Revised were completed in three time points: pre-test, post-test, and follow-up.
Results:
There was a statistically significant difference in the mean scores of depression, PTSD, and domestic violence (P less than .001) between the two groups; however, no significant difference was found in anxiety scores (P greater than .050).
Conclusions:
CPT is recommended for female victims of domestic violence to reduce symptoms of depression, PTSD, and domestic violence.
... About 6-7% of the population will meet the criteria for PTSD in their lifetime, with those experiencing traumatic events most likely to develop PTSD. Individual, trauma-focused therapies are most effective to treat the disorder; those who are unable to access trauma-focused therapies can also benefit from "symptom reduction" using selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (Schrader and Ross, 2021). Different types of PTSD may benefit from different therapies. ...
This study examines the pervasive nature of trauma exposure in journalism and its impact across all stages of the news reporting cycle. Drawing from a comprehensive literature review, we highlight the significant gap in research on the neuroscience of journalism and journalist PTSD, despite the high prevalence of PTSD among war correspondents and photojournalists. We present a conceptual framework illustrating how primary and secondary trauma exposures occur during news gathering, reporting, and consumption phases. The study also reviews empirical findings on PTSD's effects on brain structure and function, identifying symptom subclusters and their associated brain regions. This knowledge informs the development of biotypes for more personalized and effective treatment strategies for journalists with PTSD while also emphasizing an urgent need for comprehensive support systems for journalists. This interdisciplinary approach uniting research in journalism, neuroscience, psychology, and organizational management, also advances the understanding of trauma in journalism and its broader implications for news consumption and societal trust in media institutions. Interventions that can support journalists’ mental well-being can also enhance the quality of news reporting and contribute to a more resilient and informed society.
... [11] The last couple of decades have seen significant progress in terms of PTSD research. [12] However, there has not been any quantitative charting of the evolution in evidencebased treatment modalities of PTSD in terms of improved outcomes. This study aims to do a bibliometric analysis to bridge this gap in knowledge and aid the scientific community in determining the future directions for PTSD treatment. ...
Posttraumatic stress Disorder (PTSD) is seen in a substantial proportion of
individuals experiencing trauma. The last few decades have been significant in terms of PTSD-related research. However, a quantitative charting of the evolution in evidence-based treatment modalities for PTSD is lacking. Our research seeks to address this gap.
... According to the VA/DoD, the cost of psychotherapy clearly exceeded that of pharmacological approaches because psychotherapy treatments typically required at least ten weekly sessions of therapy. However, various studies indicate that the use of trauma-focused therapies represented the "gold standard" for treatment [19]. ...
PTSD cases represents a growing expense for society and the U.S. Veterans Administration since the proportion of veterans with PTSD symptom exceed proportions in the civilian population. The PTSD literature is not in agreement whether a “cure” for PTSD exists and what a “cure” would look like. A wide variety of PTSD treatment approaches have been applied with differing results regarding mitigation of symptoms and the duration of the mitigation. Authoritative sources from the United States, the United Kingdom and Australia identity specific psychotherapies as the “gold standard” for treatment. Despite warnings, patients have been prescribed pharmacological remedies. In the United States only two drugs have been approved by the US Food and Drug Administration (FDA) for PTSD treatment. However, a wider array of drugs has been prescribed. The US Department of Veteran Affairs (DVA) specifically concluded that benzodiazepines use is not a recommended strategy for PTSD treatment, yet it is dispensed to veterans, although at a more limited rate than previously. Knowledge about relative effectiveness of alternative treatments is still emerging. As indicated by changes in US guidelines, the conventional wisdom regarding PTSD treatment is fluid and in need of periodic reassessment. Research on new types of treatment should be ongoing.
... Playing a pivotal role in diverse brain functions, the serotonin system has emerged as a central focus in mental health treatment since the late 1980s, when SSRIs were introduced on the antidepressant market. Today, SSRIs are recommended not only for treating depressive disorders but also for addressing various mood-related conditions, such as anxiety disorders, post-traumatic stress disorder, obsessive-compulsive disorder, generalized anxiety disorder, and PMDD (Hantsoo & Epperson, 2015;Schrader & Ross, 2021;Socialstyrelsen, 2019). The mechanism of action of SSRIs can be briefly described as an inhibition of the serotonin transporter (SERT), a protein located primarily on the cell membrane of serotonergic neurons, responsible for eliminating serotonin from the synaptic space. ...
Introduction
Given that many armed conflicts are currently ongoing worldwide, a thorough study of issues related to providing medical care for the wounded is essential.
Material and methods
We included 45 participants aged 20–60 years with limb injuries in our study. The participants were surveyed using a visual analog pain scale, the PHQ-9, and the PTSD-5. We formed three groups: the first group included patients with limb amputations, the second group consisted of patients with limb trauma, and the third group involved patients with limb burns.
Results
We found that the average pain level in Group 1 was higher, though statistical significance was not achieved (p > 0,05). According to the PHQ-9, all participants exhibited depressive symptoms of varying severity. In the trauma group, patients reported fewer PTSD symptoms. Among the amputees, a significant predominance of Gram-negative microorganisms was noted. The correlation between the slightly higher pain levels and the significant predominance of Gram-negative flora in amputee patients was negative (P > 0.05).
Conclusions
In the amputee group, there was a trend toward higher mean pain scores compared to the other groups (p > 0,05). The same presence and distribution of depressive and PTSD symptoms were observed across all groups. Correlation analysis between pain intensity and contamination with Gram-negative bacteria did not reveal a relationship between these two variables. The study requires a larger patient sample. Gram-negative pathogens such as Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella oxytoca, and Proteus mirabilis were found more frequently among all patients.
Mobile apps are increasingly being used to help individuals manage symptoms of posttraumatic stress disorder (PTSD). A few preliminary studies suggest that apps have potential, but also face many challenges. Despite eye movement desensitization and reprocessing’s (EMDR) unique characteristics and its efficacy with PTSD, there has been no research regarding mobile apps based on this method. This pilot study examined the feasibility, safety, and potential utility of 4 apps based on EMDR, the Healing Trauma App Series (HTAS), designed for PTSD sufferers with comorbid problems such as somatic problems. Online advertising recruited 77 chronic PTSD/pain sufferers who were randomized to either the treatment group ( n = 38) or a waitlist condition ( n = 39). Participants in the treatment group were given the 4 apps, which comprise the HTAS series, and instructed to use them daily (“as needed”) for 3 months. Participants who used the apps for the treatment period experienced moderate reductions in PTSD symptoms (PTSS). The results were confounded by high attrition rates, a common problem in app research. Implications for future research and app design together are discussed. A larger-scale study of mobile apps based on EMDR, with some modifications to address the limitations encountered in this study, is recommended.
Post-traumatic stress disorder (PTSD) remains a significant clinical challenge with limited treatment options. Although electroencephalogram (EEG) neurofeedback has garnered attention as a prospective treatment modality for PTSD, no comprehensive meta-analysis has been conducted to assess its efficacy and compare different treatment protocols. This study aims to provide a multi-variable meta-regression analysis of EEG neurofeedback’s impact on PTSD symptoms, while also assessing variables that may influence treatment outcomes. A systematic review was performed to identify controlled studies exploring for the efficacy of EEG neurofeedback on PTSD. The overall effectiveness was evaluated through meta-analysis, and a multi-variable meta-regression was employed to discern factors affecting the EEG neurofeedback efficacy. EEG neurofeedback demonstrated a statistically significant reduction in PTSD symptoms immediately post-intervention, with sustained effects observed at one-month and three-month follow-ups. A sub-analysis of sham-controlled studies confirmed that outcomes were not attributable to placebo effects. Sensitivity analysis revealed that excluding two outlying studies resolved heterogeneity entirely, and all subsequent analyses were conducted on the refined dataset. While initial analyses identified target frequency, target region, and feedback modality as significant moderators, meta-regressions controlling for publication year revealed that these effects were confounded by temporal trends in study design and methodological rigor. In contrast, variables related to treatment duration, such as session number, session length, or weeks of intervention, were not significant moderators. These findings suggest that EEG neurofeedback is robust across protocol variations and highlight the importance of methodological advancements in interpreting treatment efficacy. EEG neurofeedback emerges as a promising and robust treatment modality for PTSD, demonstrating sustained therapeutic effects across follow-up periods. Our findings confirm its efficacy beyond placebo effects and highlight the stability of outcomes across diverse neurofeedback protocols. This study underscores the importance of methodological rigor and standardization in EEG neurofeedback research and advocates for larger, well-controlled trials to refine and optimize treatment protocols. These findings reaffirm EEG neurofeedback’s potential as a cost-effective and scalable intervention, while encouraging future research into alternative methodologies to enhance efficacy and expand accessibility.
Objective
This single‐arm effectiveness study explored changes in trauma‐related symptoms—including dissociation, depression, anxiety, sexual issues and sleep disturbances—throughout a multimodal, phased trauma intervention, to explore treatment response in real‐world settings with varied populations and complex clinical presentations, as well as varied degrees of clinician experience.
Method
Symptom change was assessed among participants undergoing a triphasic trauma therapy called trauma practice. Data were collected at five time points: pretreatment ( n = 41), Phase 1 ( n = 37), Phase 2 ( n = 25), Phase 3 ( n = 20) and follow‐up ( n = 16). Participants completed self‐report measures at the start of therapy, after each therapy phase and 6 months post treatment. The average age of participants was 37.6 years (SD = 12.5). Approximately 63.8% identified as female, 55% were born in Canada and 47.5% identified as Caucasian.
Results
The findings revealed statistically and clinically significant reductions in symptoms across all measured domains. On average, participants transitioned from clinically elevated levels of dissociation, anxiety, depression, sexual difficulties and sleep disturbances at baseline to non‐clinical levels by the end of therapy. Moderate to large effect sizes, clinically significant reliable change indices and sustained treatment gains were demonstrated at follow‐up.
Conclusion
These results suggest that trauma practice holds promise as an effective intervention for trauma in community clinical settings.
Research on the benefits of medical cannabis (MC) is emerging and supports its use as a treatment for post-traumatic stress disorder (PTSD). This study aimed to evaluate the cost effectiveness of MC as an adjunctive therapy for moderate PTSD under varying reimbursement scenarios.
A cost-utility analysis was conducted from the US payor perspective, using pricing data from the largest multi-state MC producer and established literature on standard PTSD treatments. We analyzed eight MC product types: dried flower, oral solutions, tablets, and edibles, each available in low/moderate (LM) and high-cost formulations. Incremental cost-utility ratios (ICURs) were calculated for these products across reimbursement levels of 100%, 75%, 50%, and 25%. Probabilistic sensitivity analyses with 10,000 Monte Carlo simulations were conducted to assess cost-effectiveness acceptability across willingness-to-pay (WTP) thresholds of 0–100,000 per quality-adjusted life year (QALY) gained.
Non-flower MC products (edibles, oral solutions, and tablets) consistently demonstrated cost-effectiveness under a WTP threshold of $50,000, even at 100% reimbursement. Dried flower products, while less cost effective due to higher costs, achieved cost effectiveness under 75% or lower reimbursement levels for LM cost formulations. Sensitivity analyses confirmed robust ICURs for non-flower products, with narrower variability compared to dried flower products.
Medical cannabis products, particularly non-flower formulations, represent a cost-effective adjunctive therapy for moderate PTSD under various reimbursement scenarios. This analysis underscores the importance of evidence-based reimbursement policies to improve patient access to cost-effective treatments while ensuring financial sustainability for payors.
Given the widespread interest and ongoing study on MDMA-assisted therapy (MDMA-AT) for PTSD, its implications for unique populations—such as adolescents—require further understanding. Social workers will likely play a crucial role in the potential implementation of this intervention, but their perspectives remain unknown. The study includes 222 social workers randomized to read one of two vignettes about MDMA-AT or selective serotonin reuptake inhibitor–assisted therapy (SSRI-AT) for treating adolescent treatment-resistant PTSD. Participants rated each treatment’s acceptability, appropriateness, and feasibility, followed by drug stigma, perceptions of drug risk, and psychedelic knowledge. Participants in the SSRI-AT condition reported significantly higher mean ratings of treatment acceptability (p < .001; d = .72), appropriateness (p < .001; d = .72), and feasibility (p < .001; d =. 64). In the MDMA-AT condition, perceptions of MDMA risk were greater (p < .001; d = .59) and psychedelic stigma positively correlated with perceived risk of MDMA (r = .46, p < .001). Moreover, greater psychedelic knowledge was significantly related to less stigma (r = –.33, p < .001) and less perceived risk of MDMA (r = –.21, p < .001). Concerns among social workers about the acceptability, appropriateness, and feasibility of MDMA-AT for adolescents with PTSD may limit clinical trial recruitment, engagement, and future implementation.
A practical handbook providing a succinct overview of the different aspects of mental health disorders, facilitating a solid base knowledge of the field of psychiatry. Offering a systematic, straightforward approach, the book covers the importance and relevance of mental health disorders, their causes, presentation, and the best approaches for their treatment. Written by mental health professionals with a high level of expertise and practical experience in the treatment of patients with mental health issues, the book includes numerous clinical vignettes, bulleted lists, tables, diagrams, and algorithms to facilitate understanding. It covers the important topics across psychiatry, including the psychiatric interview; psychosocial theories and their implications for psychiatry; neurostimulation treatments; the suicidal patient; and dementias, as well as full coverage of the depressive, bipolar, anxiety, and psychotic disorders. Essential reading for medical students, trainees in psychiatry, and other healthcare professionals interested in expanding their knowledge of psychiatry and mental health.
Background and Objectives: Post-traumatic stress disorder (PTSD) is a debilitating condition worldwide. The limited effectiveness of current psychological and pharmacological treatments has motivated studies on meditation techniques. This study is a comprehensive, multiple-treatments meta-analysis comparing the effectiveness of different categories of meditation in treating PTSD. Methods and Materials: We followed Prisma guidelines in our published protocol to search major databases and to conduct a meta-analysis of the studies. Results: We located 61 studies with 3440 subjects and divided them logically into four treatment groups: Mindfulness-Based Stress Reduction (MBSR, 13 studies); Mindfulness-Based Other techniques (MBO, 16 studies), Transcendental Meditation (TM, 18 studies), and Other Meditations that were neither mindfulness nor TM (OM, 14 studies). Trauma populations included war veterans, war refugees, earthquake and tsunami victims, female survivors of interpersonal violence, clinical nurses, male and female prison inmates, and traumatized students. Of those offered, 86% were willing to try meditation. The baseline characteristics of subjects were similar across meditation categories: mean age = 52.2 years, range 29–75; sample size = 55.4, range 5–249; % males = 65.1%, range 0–100; and maximum study duration = 13.2 weeks, range 1–48. There were no significant differences between treatment categories on strength of research design nor evidence of publication bias. The pooled mean effect sizes in Hedges’s g for the four categories were MBSR = −0.52, MBO = −0.66, OM = −0.63, and TM = −1.13. There were no appreciable differences in the study characteristics of research conducted on different meditations in terms of the types of study populations included, outcome measures, control conditions, gender, or length of time between the intervention and assessment of PTSD. TM’s effect was significantly larger than for each of the other categories, which did not differ from each other. No study reported serious side effects. Conclusions: All categories of meditation studied were helpful in mitigating symptoms of PTSD. TM produced clinically significant reductions in PTSD in all trauma groups. We recommend a multisite Phase 3 clinical trial to test TM’s efficacy compared with standard treatment.
Post-Traumatic Stress Disorder (PTSD) is a multifaceted psychiatric disorder triggered by traumatic events, leading to prolonged psychological distress and varied symptoms. Rat models have been extensively used to explore the biological, behavioral, and neurochemical underpinnings of PTSD. This review critically examines the strengths and limitations of commonly used rat models, such as single prolonged stress (SPS), stress–re-stress (S-R), and predator-based paradigms, in replicating human PTSD pathology. While these models provide valuable insights into neuroendocrine responses, genetic predispositions, and potential therapeutic targets, they face challenges in capturing the full complexity of PTSD, particularly in terms of ethological relevance and translational validity. We assess the degree to which these models mimic the neurobiological and behavioral aspects of human PTSD, highlighting areas where they succeed and where they fall short. This review also discusses future directions in refining these models to improve their utility for translational research, aiming to bridge the gap between preclinical findings and clinical applications.
This study investigated the implementation and efficacy of trauma-focused psychotherapies at a psychiatric clinic in Minamisoma City, Fukushima, after the 2011 Great East Japan Earthquake and nuclear disaster. Analyzing medical records from April 2016 to March 2021, the authors identified a significant dropout rate of 43.2% among post-traumatic stress disorder (PTSD) patients within the first 5 years. These findings highlight the challenges and effectiveness of trauma-focused treatments like prolonged exposure therapy in disaster-stricken areas, where PTSD incidence is notably high. This study emphasizes the necessity to establish robust therapeutic frameworks capable of addressing PTSD in such contexts, considering the limited coverage of comprehensive psychotherapies by Japan’s healthcare system.
O Transtorno do Estresse Pós-Traumático (TEPT) é caracterizado por um conjunto de sinais e sintomas associados a um profundo sofrimento psicológico após a vivência ou testemunha de um episódio traumático. Apesar de muito prevalente na população, a abordagem atual do transtorno possui importantes limitações, o que afeta de maneira significativa a qualidade de vida dos afetados. Diante desse cenário, há a busca por substâncias capazes de aprimorar a aliança e a experiência psicoterápica, uma vez que estas atuam como importantes preditores de resultados terapêuticos positivos. Assim, o MDMA, uma anfetamina psicodélica, tem apresentado interessantes resultados na abordagem do transtorno. O presente artigo se trata de um levantamento bibliográfico de caráter transversal, correspondente a uma pesquisa de abordagem qualitativa do tipo revisão integrativa de literatura. Nela, foram incluídos artigos científicos publicadas em português e inglês, no período de 2018-2024 e com livre acesso nas bases de dados PubMed e Google Acadêmico. Este estudo tem como objetivo descrever os atuais achados da literatura acerca do papel das psicoterapias assistidas por MDMA no tratamento do Transtorno do Estresse Pós-Traumático. Foram encontrados, após aplicação dos critérios de inclusão e exclusão, 16 artigos elegíveis. Neles foram avaliados os resultados obtidos nos ensaios clínicos de fase 2 e 3 com uso de MDMA, o papel da droga sobre a aliança terapêutica, o papel dela sobre os mecanismos de extinção do medo e de reconsolidação de memórias e sobre os sistemas neurobiológicos. Além disso, foi traçado um comparativo entre a anfetamina em questão e as atuais drogas usadas no tratamento do TEPT. O ano de 2021 foi o que mais se destacou no quesito de quantidade de publicações. Apesar dos promissores resultados obtidos, evidencia-se a necessidade de mais estudos para determinar a exata ação da droga sobre os sistemas neurobiológicos, bem como os efeitos de sua utilização a longo prazo.
Stress profoundly affects physical and mental health, particularly when experienced early in life. Early-life stress (ELS) encompasses adverse childhood experiences such as abuse, neglect, violence, or chronic poverty. These stressors can induce long-lasting changes in brain structure and function, impacting areas involved in emotion regulation, cognition, and stress response. Consequently, individuals exposed to high levels of ELS are at an increased risk for mental health disorders like depression, anxiety, and post-traumatic stress disorders, as well as physical health issues, including metabolic disorders, cardiovascular disease, and cancer. This review explores the biological and psychological consequences of early-life adversity paradigms in rodents, such as maternal separation or deprivation and limited bedding or nesting. The study of these experimental models have revealed that the organism’s response to ELS is complex, involving genetic and epigenetic mechanisms, and is associated with the dysregulation of physiological systems like the nervous, neuroendocrine, and immune systems, in a sex-dependent fashion. Understanding the impact of ELS is crucial for developing effective interventions and preventive strategies in humans exposed to stressful or traumatic experiences in childhood.
Objective
Natural variation in ovarian steroid hormones across the female lifespan contributes to an increased risk for depressive and posttraumatic stress disorder (PTSD) symptoms in women. However, minimal work has focused on understanding the impacts of reproductive aging on the brain and behavioral health of trauma-exposed women. This systematic review examines the bidirectional relationship between trauma-related psychopathology and reproductive aging.
Method
Following PRISMA guidelines, a systematic review of PubMed, PsychInfo, and Medline databases was undertaken to identify controlled studies on how trauma history impacts psychopathology and menopause symptoms during reproductive aging.
Results
Twenty-one studies met the eligibility criteria, with only four utilizing the gold standard STRAW+ 10 criteria for defining reproductive aging stages. The peri and postmenopausal periods appear to be particularly vulnerable phases for individuals with trauma exposure. Menopause symptoms and trauma-related psychopathology symptom severity increase during reproductive aging with increases in the degree of trauma exposure. However, mechanistic insights that may explain this interaction are currently neglected in this area of research.
Conclusion
There is a significant lack of understanding regarding how reproductive aging and its related neuroendocrine changes impact the brain to influence PTSD and depression symptoms related to trauma exposure. This lack of basic understanding impedes the ability to identify, assess, and treat PTSD and depressive symptoms in trauma-exposed women most effectively, and mitigate the long-term consequences of these behavioral health symptoms on morbidity and mortality in aging women.
Objective: Post-traumatic stress disorder (PTSD) remains a significant clinical challenge with limited treatment options. Although electroencephalogram (EEG) neurofeedback has garnered attention as a prospective treatment modality for PTSD, no comprehensive meta-analysis has been conducted to assess its efficacy and compare different treatment protocols. This study aims to provide a multi-variable meta-regression analysis of EEG neurofeedback's impact on PTSD symptoms, while also assessing variables that may influence treatment outcomes.
Methods: A systematic review was performed to identify controlled studies exploring for the efficacy of EEG neurofeedback on PTSD. The overall effectiveness was evaluated through meta-analysis, and a multi-variable meta-regression was employed to discern fact0rs affecting the EEG neurofeedback efficacy.
Results: EEG neurofeedback yielded a statistically significant reduction in PTSD symptoms immediately post-intervention, with sustained effects at one and three months follow-up. A sub-analysis of sham-controlled studies confirmed that outcomes were not driven by placebo effects. Our findings also identified the target frequency and region, as well as feedback modality, as significant factors for treatment success. In contrast, variables related to treatment duration were not found to be significant moderators, suggesting cost-effectiveness.
Conclusions: EEG neurofeedback emerges as a promising and cost-effective treatment modality for PTSD with the potential for long-term benefits. Our findings challenge commonly utilized protocols and advocate for further research into alternative methodologies to improve treatment efficacy.
Introduction
Pulmonary tuberculosis (PTB) remains a life-threatening disease in Tanzania, with negative physical, financial, economic and psychosocial consequences to individuals and the society. It mainly lowers the quality of life of patients, survivors and their families, especially those in the poorest and socially deprived categories.
Objectives
To report and discuss a qualitative study that assessed the nature of social support desired and received by PTB patients and survivors. Participants were given a chance to share their experiences and their perceptions on whether the social support they desired had an impact on their treatment-seeking behaviour and treatment adherence.
Methods
Face-to-face interviews were conducted with the three aforementioned groups, purposively selected at a TB clinic between October 2020 and March 2021. The questions covered topics related to the types of social support desired and the sources of support during and after treatment, if any. Interviews were concluded until no new information was obtained. Data analysis was facilitated using NVivo 12 software.
Results
Participants pointed out a need for psychosocial, financial, and material support during and after treatment. However, they sometimes miss support from family/household members or the rest of the community. Because of this experience, they lived with difficulties, facing hardships when required to pay out of pocket for transport during the care-seeking. Survivors testified experience of a denial of support by even their close relatives who regarded them as no longer needing it after recovering. Patients and survivors also reported experience of social isolation as they were believed able to transmit PTB infections. Limited psychological support at the contacted TB clinics was another experience reported. TB clinic staff's experiences confirmed almost all the experiences shared by their clients. With limited support, resilience and self-care were identified as key mechanisms for coping.
Conclusion
Complete recovery from PTB is possible, but reverting to a normal life is difficult without social support. Policies and programs need to increase opportunities for social support for TB patients and survivors. Doing so is likely to improve TB-related treatment, care-seeking practices, and adherence.
Although there are a number of effective treatments for posttraumatic stress disorder (PTSD), there is a need to develop more efficient evidence-based PTSD treatments to address barriers to seeking and receiving treatment. Written exposure therapy (WET) is a potential alternative that is a 5-session treatment without any between-session assignments. WET has demonstrated efficacy, and low treatment dropout rates. However, prior studies with WET have primarily focused on civilian samples. Identifying efficient PTSD treatments for military service members is critical given the high prevalence of PTSD in this population. The current ongoing randomized clinical trial builds upon the existing literature by investigating whether WET is equally efficacious as Cognitive Processing Therapy (CPT) in a sample of 150 active duty military service members diagnosed with PTSD who are randomly assigned to either WET (n = 75) or CPT (n = 75). Participants are assessed at baseline and 10, 20, and 30 weeks after the first treatment session. The primary outcome measure is PTSD symptom severity assessed with the Clinician Administered PTSD Scale for DSM-5. Given the prevalence of PTSD and the aforementioned limitations of currently available first-line PTSD treatments, the identification of a brief, efficacious treatment that is associated with reduced patient dropout would represent a significant public health development.
Background:
Current clinical practice guidelines (CPGs) for posttraumatic stress disorder (PTSD) offer contradictory recommendations regarding use of medications or psychotherapy as first-line treatment. Direct head-to-head comparisons are lacking.
Methods:
Systemic review of Medline, EMBASE, PILOTS, Cochrane Central Register of Controlled Trials, PsycINFO, and Global Health Library was conducted without language restrictions. Randomized clinical trials ≥8 weeks in duration using structured clinical interview-based outcome measures, active-control conditions (e.g. supportive psychotherapy), and intent-to-treat analysis were selected for analyses. Independent review, data abstraction, and bias assessment were performed using standardized processes. Study outcomes were grouped around conventional follow-up time periods (3, 6, and 9 months). Combined effect sizes were computed using meta-analyses for medication versus control, medication pre-/posttreatment, psychotherapy versus control, and psychotherapy pre-/posttreatment.
Results:
Effect sizes for trauma-focused psychotherapies (TFPs) versus active control conditions were greater than medications versus placebo and other psychotherapies versus active controls. TFPs resulted in greater sustained benefit over time than medications. Sertraline, venlafaxine, and nefazodone outperformed other medications, although potential for methodological biases were high. Improvement following paroxetine and fluoxetine treatment was small. Venlafaxine and stress inoculation training (SIT) demonstrated large initial effects that decreased over time. Bupropion, citalopram, divalproex, mirtazapine, tiagabine, and topiramate failed to differentiate from placebo. Aripiprazole, divalproex, guanfacine, and olanzapine failed to differentiate from placebo when combined with an antidepressant.
Conclusions:
Study findings support use of TFPs over nontrauma-focused psychotherapy or medication as first-line interventions. Second-line interventions include SIT, and potentially sertraline or venlafaxine, rather than entire classes of medication, such as SSRIs. Future revisions of CPGs should prioritize studies that utilize active controls over waitlist or treatment-as-usual conditions. Direct head-to-head trials of TFPs versus sertraline or venlafaxine are needed.
Trauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area.
A consecutive sample of 330 patients with PTSD (age 17-83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects.
CT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience.
The results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.
The objective of this research was to obtain national estimates of exposure to the full spectrum of the childhood violence, abuse, and crime victimizations relevant to both clinical practice and public-policy approaches to the problem.
The study was based on a cross-sectional national telephone survey that involved a target sample of 4549 children aged 0 to 17 years.
A clear majority (60.6%) of the children and youth in this nationally representative sample had experienced at least 1 direct or witnessed victimization in the previous year. Almost half (46.3%) had experienced a physical assault in the study year, 1 in 4 (24.6%) had experienced a property offense, 1 in 10 (10.2%) had experienced a form of child maltreatment, 6.1% had experienced a sexual victimization, and more than 1 in 4 (25.3%) had been a witness to violence or experienced another form of indirect victimization in the year, including 9.8% who had witnessed an intrafamily assault. One in 10 (10.2%) had experienced a victimization-related injury. More than one third (38.7%) had been exposed to 2 or more direct victimizations, 10.9% had 5 or more, and 2.4% had 10 or more during the study year.
The scope and diversity of child exposure to victimization is not well recognized. Clinicians and researchers need to inquire about a larger spectrum of victimization types to identify multiply victimized children and tailor prevention and interventions to the full range of threats that children face.
Female assault survivors (N=171) with chronic posttraumatic stress disorder (PTSD) were randomly assigned to prolonged exposure (PE) alone, PE plus cognitive restructuring (PE/CR), or wait-list (WL). Treatment, which consisted of 9-12 sessions, was conducted at an academic treatment center or at a community clinic for rape survivors. Evaluations were conducted before and after therapy and at 3-, 6-, and 12-month follow-ups. Both treatments reduced PTSD and depression in intent-to-treat and completer samples compared with the WL condition; social functioning improved in the completer sample. The addition of CR did not enhance treatment outcome. No site differences were found: Treatment in the hands of counselors with minimal cognitive- behavioral therapy (CBT) experience was as efficacious as that of CBT experts. Treatment gains were maintained at follow-up, although a minority of patients received additional treatment.
Importance:
It is often difficult for members of the US military to access high-quality care for posttraumatic stress disorder (PTSD) and depression.
Objective:
To determine effectiveness of a centrally assisted collaborative telecare (CACT) intervention for PTSD and depression in military primary care.
Design, setting, and participants:
The STEPS-UP study (Stepped Enhancement of PTSD Services Using Primary Care) is a randomized trial comparing CACT with usual integrated mental health care for PTSD or depression. Patients, mostly men in their 20s, were enrolled from 18 primary care clinics at 6 military installations from February 2012 to August 2013 with 12-month follow-up completed in October 2014.
Interventions:
Randomization was to CACT (n = 332) or usual care (n = 334). The CACT patients received 12 months of stepped psychosocial and pharmacologic treatment with nurse telecare management of caseloads, symptoms, and treatment.
Main outcomes and measures:
Primary outcomes were severity scores on the PTSD Diagnostic Scale (PDS; scored 0-51) and Symptom Checklist depression items (SCL-20; scored 0-4). Secondary outcomes were somatic symptoms, pain severity, health-related function, and mental health service use.
Results:
Of 666 patients, 81% were male and the mean (SD) age was 31.1 (7.7) years. The CACT and usual care patients had similar baseline mean (SD) PDS PTSD (29.4 [9.4] vs 28.9 [8.9]) and SCL-20 depression (2.1 [0.6] vs 2.0 [0.7]) scores. Compared with usual care, CACT patients reported significantly greater mean (SE) 12-month decrease in PDS PTSD scores (-6.07 [0.68] vs -3.54 [0.72]) and SCL-20 depression scores -0.56 [0.05] vs -0.31 [0.05]). In the CACT group, significantly more participants had 50% improvement at 12 months compared with usual care for both PTSD (73 [25%] vs 49 [17%]; relative risk, 1.6 [95% CI, 1.1-2.4]) and depression (86 [30%] vs 59 [21%]; relative risk, 1.7 [95% CI, 1.1-2.4]), with a number needed to treat for a 50% improvement of 12.5 (95% CI, 6.9-71.9) and 11.1 (95% CI, 6.2-50.5), respectively. The CACT patients had significant improvements in somatic symptoms (difference between mean 12-month Patient Health Questionnaire 15 changes, -1.37 [95% CI, -2.26 to -0.47]) and mental health-related functioning (difference between mean 12-month Short Form-12 Mental Component Summary changes, 3.17 [95% CI, 0.91 to 5.42]), as well as increases in telephone health contacts and appropriate medication use.
Conclusions and relevance:
Central assistance for collaborative telecare with stepped psychosocial management modestly improved outcomes of PTSD and depression among military personnel attending primary care.
Trial registration:
clinicaltrials.gov Identifier: NCT01492348.
The dramatic rise in healthcare expenditures calls for innovative and scalable strategies to achieve measurable, near-term improvements in health. Our objective was to determine whether a remotely delivered behavioral health intervention could improve medical health, reduce hospital admissions, and lower cost of care for individuals with a recent cardiovascular event.
This retrospective observational cohort study included members of a commercial health plan referred to participate in AbilTo’s Cardiac Health Program. AbilTo is a national provider of telehealth, behavioral change programs for high risk medical populations.
The program is an 8-week behavioral health intervention delivered by a licensed clinical social worker and a behavioral coach via phone or secure video.
Among the 201 intervention and 180 comparison subjects, the study found that program participants had significantly fewer all-cause hospital admissions in 6 months (293 per 1000 persons/year vs 493 per 1000 persons/year in the comparison group) resulting in an adjusted percent reduction of 31% (P = .03), and significantly fewer total hospital days (1455 days per 1000 persons/year vs 3933 per 1000 persons/year) with an adjusted percent decline of 48% (P = .01). This resulted in an overall savings in the cost of care even after accounting for total program costs.
Successful patient engagement in a national, remotely delivered behavioral health intervention can reduce medical utilization in a targeted cardiac population. A restored focus on tackling barriers to behavior change in order to improve medical health is an effective, achievable population health strategy for reducing health costs in the United States.
Objective:
Patient decision aids have been used in many clinical situations to improve the patient centeredness of care. A patient decision aid for patients with posttraumatic stress disorder (PTSD) has not been developed or tested. The authors evaluated the effects of a patient decision aid on the patient centeredness of PTSD treatment.
Methods:
The study was a randomized trial of a patient decision aid for PTSD versus treatment as usual (control group). The participants were 132 male and female veterans who presented to a single U.S. Department of Veterans Affairs hospital with a new diagnosis of PTSD. Patient centeredness was assessed by knowledge of PTSD and its treatment, level of decisional uncertainty, and ability to state a preferred treatment option. Secondary outcomes included treatments received and PTSD symptoms in the six months after study entry.
Results:
Compared with the control group (N=65), participants who reviewed the patient decision aid (N=63) had higher scores for PTSD knowledge (p=.002) and less conflict about their choice of treatment (p=.003). In addition, participants who reviewed the patient decision aid were more likely to select and receive an evidence-based treatment for PTSD (p=.04) and had superior PTSD outcomes (p=.004) compared with the control group.
Conclusions:
Use of a patient decision aid was associated with improvements in patient-centered PTSD treatment. The patient decision aid was also associated with greater use of evidence-based treatments and improvement of PTSD symptoms. This study suggests that clinics should consider using a patient decision aid for patients with PTSD.
A meta-analysis was conducted on 61 treatment outcome trials for post-traumatic stress disorder (PTSD). Conditions included drug therapies (TCAs, carbamazepine, MAOIs, SSRIs, and BDZs), psychological therapies (behaviour therapy, Eye-Movement Desensitization and Reprocessing (EMDR), relaxation training, hypnotherapy, and dynamic therapy), and control conditions (pill placebo, wait-list controls, supportive psychotherapies, and non-saccade EMDR control). Psychological therapies had significantly lower drop-out rates than pharmacotherapies (14% versus 32%), with attrition being uniformly low across all psychological therapies. In terms of symptom reduction, psychological therapies were more effective than drug therapies, and both were more effective than controls. Among the drug therapies, the SSRIs and carbamazepine had the greatest effect sizes, although the latter was based upon a single trial. Among the psychological therapies, behaviour therapy and EMDR were most effective, and generally equally so. The most effective psychological therapies and drug therapies were generally equally effective. Differences across treatment conditions were generally evident across symptom domains, with little matching of symptom domain to treatment type. However, SSRIs had some advantage over psychological therapies in treating depression. Follow-up results were not available for most treatments, but available data indicates that treatment effects for behaviour therapy and EMDR are maintained at 15-week follow-up. © 1998 John Wiley & Sons, Ltd. Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/35192/1/153_ftp.pdf
Little is known about lifetime prevalence or age of onset of DSM-IV disorders.
To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication.
Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview.
Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older.
Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders.
Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups.
About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
This controlled study evaluated the relative efficacy of Prolonged Exposure (PE) and Eye Movement Desensitization and Reprocessing (EMDR) compared to a no-treatment wait-list control (WAIT) in the treatment of PTSD in adult female rape victims (n = 74). Improvement in PTSD as assessed by blind independent assessors, depression, dissociation, and state anxiety was significantly greater in both the PE and EMDR group than the WAIT group (n = 20 completers per group). PE and EMDR did not differ significantly for change from baseline to either posttreatment or 6-month follow-up measurement for any quantitative scale.
Seventy-eight motor vehicle accident survivors with chronic (greater than 6 months) PTSD, or severe sub-syndromal PTSD, completed a randomized controlled comparison of cognitive behavioral therapy (CBT), supportive psychotherapy (SUPPORT), or a Wait List control condition with two detailed assessments. Scores on the CAPS showed significantly greater improvement for those in CBT in comparison to the Wait List and to the SUPPORT conditions. The SUPPORT condition in turn was superior (p=0.012) to the Wait List. Categorical diagnostic data showed the same results. An analysis of CAPS scores including drop-outs (n=98) also showed CBT to be superior to Wait List and to SUPPORT with a trend for SUPPORT to be superior to Wait List. The CBT condition led to significantly greater reductions in co-morbid major depression and GAD than the other two conditions. Results held up well at a 3-month follow-up on the two active treatment conditions.
2010 National Ambulatory Medical Care Survey
- Cdc
CDC. (http://www.cdc.gov/nchs/ahcd.htm). 2010 National Ambulatory
Medical Care Survey. online, accessed 11/02/2021.
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
American Psychiatric Association. (2013). Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition. Arlington, VA: American
Psychiatric Association.