Cited by Sleep Quality and Cognitive Impairments in Children and Adolescents with Post Traumatic Stress Disorder and/or Depressive Symptoms

No two traumas are alike, and neither are two presentations of PTSD DOI

Soraya Seedat

World Psychiatry, Год журнала: 2025, Номер 24(1), С. 90 - 91

Опубликована: Янв. 15, 2025

Significant advances have been made in our understanding of post-traumatic stress disorder (PTSD), and translating an overwhelming body research evidence into clinical practice. However, it is time for researchers clinicians to pause reflect on whether true progress has made. Brewin et al1 convincingly distill the complexity defining, assessing, diagnosing, predicting, preventing treating PTSD diverse populations, across several countries, varying socio-political-cultural societal-structural contexts, at different life stages. The review juxtaposes rapid exponential growth knowledge trauma, complex against significant gaps (and possibly "blind spots") that remain. It brings sharp focus need accelerated consensus building a core set evidence-informed integrated phenotypes biotypes, pursuit categorical dimensional solutions parsing out heterogeneity, intervening timeously effectively. Fine-grained characterization biotypes could propel collective global efforts pave way development tailored, measurement-based personalized interventions adults youth with – yield higher response remission rates than current ones. Trauma ubiquitous, but also individual personal, its impact attributions are highly variable. Prevalence vary considerably by population, demography, social determinants, ascertainment method. Several decades taught us relationship between nature traumatic event (e.g., single or repeated, interpersonal non-interpersonal, intentional non-intentional), peri-traumatic responses triggers, resultant non-linear, and, patient level, may follow convoluted trajectory. Similarly, gathered over acute disorder, first introduced DSM-IV as distinctive early-after-trauma diagnosis retained DSM-5, disappointing regards diagnostic utility predicting PTSD2, 3. Despite abundant literature pre-trauma, peri-trauma post-trauma risk protective factors, ability predict apply biological markers genotypic, epigenetic, transcriptomic, endocrine, immune) stratify trauma-exposed individuals remains very limited. Moreover, low- middle-income country populations disproportionately under-represented longitudinal neurobiological studies aim track signatures alongside symptom trajectories4. Also central challenge astounding within-group heterogeneity (in patterning, illness course, treatment outcome) high comorbidity wide range psychiatric disorders physical illnesses. plausible symptom-based subtypes incrementally refine classification PTSD. To date, empirical strides delineating dissociative subtype, only one recognized which point prevalence 38.1% children adolescents PTSD, unique symptom, profile underpinned fairly robust evidence5, 6. There still ongoing debate about dissociation somewhat common phenomenon marker severity, occurrence limited more circumscribed subgroup people diagnosis. specificity subtype needs further interrogation, beyond Global North, culturally settings where phenomena might be linked somatization other culture-bound phenomena. In vein profiles inform targeted, treatments, few sought map type index trauma clusters concerted fashion. Notable recent investigation 4,069 veterans from 2019-2020 National Health Resilience Veterans Study, applied alternative phenotypic model DSM-5 ICD-11 structure plot traumas (categorized violence, combat/captivity, disaster/accident, illness/injury) symptoms7. resulting eight-symptom phenotype comprised internally-generated intrusions distressing memories), externally-generated emotional reactivity cues), avoidance, negative affect, anhedonia, externalizing behaviors, anxious dysphoric arousal. Findings discriminable who experienced violence combat/captivity versus those illness/injury disaster/accident encouraging. cross-sectional design study precludes addressing question these trauma-symptom hold chronic findings will replicated biopsychosocial mechanisms underlie trauma-PTSD require deep exploration. field long invested large-scale costly identify clinically valid, affordable scalable biomarkers can aid screening timely intervention, lead better outcomes. susceptibility markers, some predictive therapeutic biomarkers, evaluated, including polygenic scores regional brain structural morphology. replication testing large samples before their potential realized8. prospect employing question, discovery biomarker panels requisite reliability, specificity, sensitivity reproducibility cost-effective feasible employ point-of-care off. For multiple sampling commencing early after extending year account evolving dynamics symptoms arguably best resilient, chronic, delayed onset, recovery trajectories, enhance causal pathways. predictors normalization perturbations treatment, trials compare psychotherapies, pharmacotherapies combination treatments needed. addition, innovative strategies, such biomarker-stratified designs (to address what all patients well biomarker-defined subgroups) enrichment biomarker-positive PTSD), serve improve efficiency precision. Though appealing, hugely challenging apply. Generative artificial intelligence tools fast change this landscape, benefits extend identifying novel outcomes, bolstering fidelity boosting engagement9. raise host ethical, legal considerations coalface caring compelled grapple with. Finally, seeking transform scientific endeavors prevent, diagnose treat behooves remember no two presentations alike. art providing individual-level care should always sit science.

Язык: Английский

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The paradox of the biopsychological and sociocultural levels in post‐traumatic stress disorder DOI

Andreas Maercker

World Psychiatry, Год журнала: 2025, Номер 24(1), С. 87 - 88

Опубликована: Янв. 15, 2025

It is fascinating to see how the field of post-traumatic stress disorder (PTSD) has evolved over past 50 years. The team authors led by C. Brewin1 – comprising psychologists, epidemiologists, psychiatrists, and intervention researchers provides a comprehensive analysis significant developments in this underlying empirical evidence. I would like enumerate few points on which am complete agreement with authors. First, there now an accepted set different phenotypes PTSD, includes "classic" PTSD known for several decades, complex severe dissociative condition, other that have been linked childhood trauma. Second, diagnosis should rely pattern symptoms resulting disabilities rather than definitions trauma criterion, as still often case when diagnosing day. Third, delayed essentially based altered sensitivity, patients display isolated prior full development condition. On all these points, authors' thorough presentation deserves gratitude dissemination professional community. Brewin et al's extension core psychopathology theory from disturbed memory identity changes also noteworthy. However, phenomenon trauma-related disorders be highlighted, we refer biopsychological-sociocultural paradox (in brief, fact traumatic experiences mostly disrupt biopsychological processes, while sociocultural processes usually foster recovery). In biology, numerous studies documented existence deficits vulnerabilities related multitude regulatory systems circuits. psychological research initially focused then impairments. clinical setting, evidenced focus patients' suffering, including re-experiencing, avoidance persistent (physiological) sense threat. most effective antidote disturbances social support those affected2. There sufficient evidence multiple confirm appropriate victims or survivors can effectively reduce impact disorders3. This observed clinically shorter recovery times socially well-connected culturally integrated treatment facilities4. worth noting not various factors areas are exclusively pathogenic. To give examples, protective such larger hippocampal volume or, realm, range less avoidant coping strategies. Nevertheless, seeking others friends, family members one's cultural community consistently yields greater effects biological areas. apparent contradiction between predominance social-interpersonal-cultural antidotes may ontological status PTSD. could said "silent suffering" individuals: after traumatization, do complain about their suffering. Those who experienced distress might find it normal inevitable5, 6. Some suggested one reason why mental was "discovered" so late compared depression, psychosis anxiety disorders. possible that, conditions, behaviors, facial expressions body postures signal partners "ill". philosophical basis embodiment recently described journal7 therefore comparatively pronounced psychology its admittedly yet very advanced program, suggests primarily "social disease". This, course, does undermine suffering afflicted disorder. assertion consistent findings prevention research, discussed paper al. According this, current preventive programs place strong emphasis dyadic group cohesion aspects. What pressing transcultural issues reducing future? my view, beneficial first consider low utilization services cultures European-North American (Global North) ones. Even Global North cultures, differences. large groups affected people, no perception needing help. For example, 9/11 attacks New York, quickly established outpatient health emergency help centers had only requests people Could scripts go far beyond symptom descriptions DSM ICD? Many individuals self-perception being "broken" having "a kink lifeline"8. provision lists syndromes idioms consequences trauma, mentioned al, improved scientific standpoint. A key question divergent arise, they into overarching, systematic context. light above, seems reasonable suggest takes account global matrices values, norms traditions logical choice. instance, study conducted Rwanda traumatized individuals, many whom were genocide against Tutsis 1990s, indicated values showing maintaining self- reputation, well Ubuntu short, humanity towards others), apparently mediate expression suffering9. After examination influencing specialized assistance, more nuanced foundation. correctly emphasizes potential community-based interventions, particularly addressing disparities.

Язык: Английский

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What exactly is post‐traumatic stress disorder? DOI

Richard A. Bryant

World Psychiatry, Год журнала: 2025, Номер 24(1), С. 81 - 82

Опубликована: Янв. 15, 2025

When post-traumatic stress disorder (PTSD) was introduced in the DSM-III, it conceptualized as a uniform syndrome based on extreme fear responses that emerged from over-consolidation of trauma memories. In subsequent 40 years, much has been learnt about nature this and its implications for treatment. As noted by Brewin et al1 their thoughtful review, one issue is repeatedly raised complex condition. Indeed, diagnostic definitions PTSD have evolved over time adding more symptoms, including additional clusters, recognizing various subtypes. Although study advanced since early conceptualizations, likely we are still long way accurately understanding multitude phenotypes stress. Whereas different subtypes identified, these categorizations quite broad, lump many patients into groupings may disguise important differences. The observation most people with unique symptom presentation2 indicates there than simply two or three typologies Emerging evidence demonstrates involves range phenotypic presentations, which can include fear, dysphoria, numbing, anger, several others3. This pattern reflected, part, high rates comorbidity mood anxiety disorders, be attributed to experiencing an array symptoms belie presumption unitary syndrome. Initiatives such Research Domain Criteria attempted move field towards phenotypic-based conceptualization clinical but appear wedded systems our conceptualizations assessments One limitations current they assume somewhat simplistic summation requisite symptoms. For example, DSM-5 requires minimum number each four clusters present order person meet criteria. It presumed equal weight, so summing provides accurate determine if present. approach ignores possibility some others contributing distress functional impairment, therefore require greater weighting other Network analyses provide insights influence psychological well-being others, because allow mapped terms potential downstream impact related problems. shown re-experiencing dysphoric processes particularly influential PTSD4. hierarchy, however, patient another, requiring individualized network analysis. problem identifying major presentations compounded not static. Longitudinal studies indicate fluctuates markedly time5, ecological momentary suggest dynamic shifts occur rapidly6. highlights problematic pigeonhole single category (or category) assessment at point time, presenting has, how interacting, change daily basis. Of course cannot conduct interviews basis, recent developments real-time via smartphone apps opened up opportunity temporally relevant patient's any time7. machine learning artificial intelligence tools become sophisticated thoroughly tested settings, measured manner clinicians reliable information pressing needs. adaptive procedures yielded promising ways assess psychiatric conditions. These approaches utilized multidimensional response item theory framework capture broad experience, using hierarchical system domains, subdomains factors recognize heterogeneity person's presentation8. successful across yet fully applied search capacity measure nuanced academic exercise. al note, varieties trauma-focused psychotherapy alleviate effectively. However, challenges facing half do respond frontline treatments. Moreover, success treatments improved decades, suggesting hit ceiling ability interventions assist patients. problems adopt one-size-fits-all packages treatment (e.g., prolonged exposure, eye movement desensitization reprocessing, cognitive processing therapy) criteria PTSD. practice assumes all same constellation primary problems, static throughout Each assumptions false, tend ignore reality. reason increasing calls flexible process therapy framework. approach, given standard according classification, rather focuses experience9. intrusive memories avoidance, also experience marked substance use relationship issues. case, administering psychotherapy, therapist apply evidence-based strategies address Some therapeutic would involve elements exposure memories, prioritized mitigate summary, highlight complexities definition, difficult advance without stress, accounting oscillating By extending above-mentioned multiple ways, tailored hopefully achieve better outcomes.

Язык: Английский

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Navigating the landscape of trauma treatments: the need for personalized care DOI

Thanos Karatzias

World Psychiatry, Год журнала: 2025, Номер 24(1), С. 83 - 84

Опубликована: Янв. 15, 2025

Post-traumatic stress disorder (PTSD) significantly impairs an individual's daily functioning and quality of life. Although both pharmacological psychological treatments are effective for this disorder, the latter commonly used as a first line support. Fortunately, various have been developed over years proven in managing alleviating symptoms PTSD. Following excellent overview by Brewin et al1, we comment here on primary PTSD, some challenges their implementation, important future research directions area. Traditional trauma laid foundations contemporary therapeutic interventions. Among most widely recognized is trauma-focused cognitive-behavioral therapy (TF-CBT), which combines cognitive restructuring techniques with exposure to address maladaptive thought patterns desensitize individuals traumatic memories. Its structured format, typically delivered series sessions, has garnered empirical support its efficacy treating Eye movement desensitization reprocessing (EMDR) another established treatment modality treatment, integrates bilateral stimulation, such eye movements or taps, guided imagery facilitate processing resolution Despite ongoing debate regarding underlying mechanisms, numerous studies demonstrated effectiveness reducing trauma-related improving overall well-being. While PTSD many patients, they not universally so. This case especially certain groups, those history childhood trauma2, who tend suffer from more complex forms traumatization3, highlighting need innovation. Emerging therapies, virtual reality (VRET), adjuncts offer promising avenues. VRET leverages immersive technology create controlled, realistic simulations environments. can enhance experience providing safe yet vivid context processing. Initial indicates that may be traditional therapy4. Pharmacological therapies also under investigation. For example, use 3,4-methylenedioxymethamphetamine (MDMA) shown promise enhancing process, potentially fear responses facilitating emotional engagement memories5. The introduction new condition ICD-11 provided opportunity identify interventions presentations result stressors. Complex greater number than resulting multiple, interpersonal, chronic and/or stressors6. Therefore, personalized approach care might appropriate. It argued requires different kinds longer course compared Modular behavioral orientation2 target symptom clusters individually sequentially person-centred manner, using skills development memory – enhanced affective interpersonal regulation (ESTAIR) proposed alternative TF-CBT EMDR approaches PTSD7. Preliminary findings suggest modular effective8. However, it possible same equally good outcomes. Considering randomized controlled trials date excluded people presentations, further matter required. breadth available, several persist within field. Access specialized remains significant barrier individuals, particularly marginalized communities remote areas. Additionally, cultural considerations systemic inequalities influence suitability acceptability modalities, underscoring culturally competent equitable access resources9. Furthermore, considering scarce resources delivery parts world, there adapt existing into cost-efficient delivered/facilitated therapists without highly specialist training. Overall, current evidence does match clinical needs. As discussed "although exactly how are, likely benefit them, deliver them all up debate". heterogeneity necessitates nuanced understanding each unique needs preferences. Treatment planning should prioritize collaborative client-centred approaches, empowering survivors actively participate journey. essential elucidate mechanisms action optimize groups patients. Continued innovation these challenges, ensuring heal reclaim lives. work whom. Currently, practice, clients, while aim every survivor right his/her A will improved efficacy, higher patient well clinician satisfaction, reduced dropout rates disengagement. Clients discuss beginning process collaboratively agree one ones use. paradigm agenda, innovative designs identifying what works whom essential. Specific required key question identified al1 whether focus primarily disturbances memory, per theories, identity, theories. Moreover, although substantial adults, less children young people. In addition, life events considered intentional (e.g., domestic violence) toxic associated poorer outcomes, worthwhile explore differently exposed events. progresses, integrating modalities refining crucial effort provide comprehensive, affected trauma. ethos offering component training clinicians.

Язык: Английский

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The PTSD Gestalt switch DOI

Philip Hyland

World Psychiatry, Год журнала: 2025, Номер 24(1), С. 86 - 87

Опубликована: Янв. 15, 2025

Approaching the 45th anniversary of introduction post-traumatic stress disorder (PTSD) in psychiatric nomenclature, Brewin et al1 have written a masterful review history and current status research on this condition. This allows us to reflect level our knowledge think about opportunities challenges that lie ahead. The field traumatic is an odd place. two main diagnostic manuals, DSM-5-TR2 ICD-113, provide distinct descriptions trauma-related psychopathology. What people believe nature psychopathology probably depends large part which system they more closely adhere to. not completely healthy situation4. Reading al's paper was peculiar experience. Through various sections review, I continually stuck by how much has been acquired, but yet unable we are answers so many basic questions, such as: what event; disorders there; defining features PTSD; optimal way assess proportion population whether PTSD same across cultures; causes who most likely develop best treat effective treatments for why do work, when work; benefits from treatment. like Gestalt switch optical illusion. Look at literature one way, seem deep profound understanding fundamental issues. it another understand almost nothing these Consider just few We basically know constitutes event. Any event provokes feelings extreme threat or horror, occurring suddenly gradually, moment occurs sometime later meaning assigned, can be traumatic. Furthermore, core response is, distinguishes other forms psychopathology: occurrence intrusive experiences, usually images also thoughts, sounds, smells bodily sensations, person feels he/she reliving again present moment. Additionally, occurs: cause lies fundamentally operation memory. Extreme fear horror inhibits hippocampal binding while promoting amygdala binding, resulting memory containing little contextual information time place, lots sensory emotions somatic experiences. disjunction between means that, cued, individual Moreover, problem, i.e. reprocessing becomes integrated within autobiographical memory, knows belongs past danger. And achieved clinical setting, distress substantially decreases. Given extensive exists, then there consensus field, after nearly 50 years appear ignorant issues? claim good answer, question must all grapple with. major source problem discrepancy ICD DSM conceptualizations stress. recently had pleasure collaborating with molecular biologist Ukraine works clinic wounded Ukrainian soldiers. He no previous experience but, being faced traumatized, interested might possible identify biological markers PTSD, order efficiently soldiers with, risk of, condition, possibly novel treatments. asked me he thought simple question: "What's PTSD?". found myself unfortunate position having explain version wanted assess. After picked his jaw up off floor, him thorny issues related assessment reviewers leading journals respond different methods. biologist's confusion irritation exchange matched only my embarrassment. As paid-up, card-carrying scientician5, fully recognize dangers ideological homogeneity attempts establish scientific via authoritative declarations6, appreciate value researchers independently pursuing truth using models Nevertheless, progress, settle agreed-upon model am reminded here G. Box's famous aphorism "all wrong, some useful"7. Nowhere truer than diagnoses. Surely nobody believes DSM-5 example, represents something real. At best, approximate real phenomena useful. They common language clinicians researchers; guide applied systematic way; framework determining needs care; help evaluate efficacy Since true, their point if useful? My view situation severely undermining usefulness approach, where answer questions as "What trauma?" "How there?". J. Swift8, S. Freud9, warned narcissism minor differences. While place great importance provides accurate account psychopathology, consider perspective friend Ukraine. It infinitesimally get come shared description reality useful, doing may able break

Язык: Английский

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Reducing the burden of PTSD through digital interventions and development of sequential precision treatment rules DOI

Corina Benjet

World Psychiatry, Год журнала: 2025, Номер 24(1), С. 89 - 90

Опубликована: Янв. 15, 2025

Brewin et al1 provide a comprehensive, thoughtful and up-to-date review of the conceptualization, diagnosis, prevention treatment post-traumatic stress disorder (PTSD). Despite controversies that surround evolving definitions traumatic events criteria for PTSD, there is no doubt about societal burden deleterious impact on population health psychological distress2. Given reportedly high prevalence PTSD1 widespread occurrence trauma exposure – an estimated 70% global has experienced any event 30% been exposed to four or more3 are not enough human financial resources across globe realistically treat all those with let alone whole continuum distress. Furthermore, majority who meet PTSD never seek treatment, given stigma associated mental in general some traumas particular (i.e., rape), variety barriers, both logistical (e.g., time, location) attitudinal beliefs pharmacological treatments)2. Therefore, really we only need novel interventions, but mostly modalities delivering scalable, accessible acceptable target population. Internet mobile-based interventions reduce many barriers. They since once developed they require fewer specialized resources: self-directed versions resources, supported less and/or time per client than traditional in-person modalities. Digital can increase accessibility because generally be used at place where user access. Even low- middle-income countries, often greater access (through mobile phones) centers. Finally, digital may barriers related stigma, as anonymous match often-cited reason seeking help, individual wanting deal problem his/her own2, thus increasing empowerment self-care. While literature effectiveness growing promising, differing levels support4, 5, this one small step road substantially disorder. There great heterogeneity response even well-established options. And certainly, intervention do work all, due differences literacy, access, motivation, other yet-to-be determined factors. further reducing ideally use pragmatic precision-treatment modelling create individualized allocation rules predict patients which modality will best, and, equal probability success, optimal lowest cost resource intensity. To my knowledge, precision nature have yet emerging disorders. For example, development model university students depression, found 28% were more equally helped by self-guided cognitive behavioral (CBT) guided version intervention, based pre-treatment characteristics best whom6. A challenge field depends upon large sample sizes, pooling samples from multiple studies comparable measurements designs, trial emulation observable iteratively tested clinical trials7. An along path identify right person, person order. This achieved using iterative staged approach whereby algorithms determine first-line each if successful, option offer next so on. These conducting sequential assignment randomized trials (SMART)8, wherein participants randomly assigned type/modality first stage then, depending outcome, treatments subsequent stages, resulting individual's response. One example ongoing SMART cancer survivors symptoms 1 app usual. Non-responders arms then re-randomized increased intensity (the guide telephone-administered CBT). therefore decision possible sequences9. Such models could also preventive trauma-exposed individuals. Internet-based trauma-focused CBT currently lower-strength recommendation International Society Traumatic Stress Studies (ISTSS) UK National Institute Health Care Excellence (NICE), public perspective smaller effect size applicable people go globally larger few. set future directions. Extending these, strategic research plan develop (with range scalable including ones) different people, initial response, suffering PTSD.

Язык: Английский

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Augmenting trauma‐focused cognitive behavior therapy for post‐traumatic stress disorder with memory specificity training: a randomized controlled trial DOI

Richard A. Bryant, Katie Dawson,

Srishti Yadav

и другие.

World Psychiatry, Год журнала: 2025, Номер 24(1), С. 113 - 119

Опубликована: Янв. 15, 2025

Although trauma‐focused cognitive behavior therapy (TF‐CBT) is the recommended treatment for post‐traumatic stress disorder (PTSD), up to one‐half of patients do not respond this intervention. There an urgent need develop new strategies improve response. Training people recall specific positive memories may augment gains in TF‐CBT. We conducted a controlled trial Australia with current or former first responders (including police, firefighters and paramedics) PTSD, who were randomized on 1:1 basis 12 weekly 90‐min individual sessions either TF‐CBT combined memory specificity training (TF‐CBT/MT) alone. The primary outcome was change PTSD severity independently assessed at baseline, post‐treatment, six months after (primary timepoint). Secondary outcomes included measures depression, trauma‐related cognitions, alcohol use, quality life. Between October 2021 May 2023, fifty participants TF‐CBT/MT, Most males (71.0%) mean age 46.8±9.9 years. At 6‐month assessment, receiving TF‐CBT/MT showed greater reduction than those alone (mean difference: 9.2, 95% CI: 3.2‐15.1, p=0.003), indicating large effect size (0.9, 0.1‐1.6). Participants also had reductions use 5.3, 1.5‐9.2, p=0.007; size: 0.8, 0.2‐1.4) self‐blame cognitions 0.2‐1.4, p=0.008; 0.5, 0.1‐0.9). These data suggest that adds significantly standard reducing severity. This approach can offer simple easy implement strategy patients.

Язык: Английский

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The promise of ICD‐11‐defined PTSD and complex PTSD to improve care for trauma‐exposed populations DOI

Marylène Cloître

World Psychiatry, Год журнала: 2025, Номер 24(1), С. 82 - 83

Опубликована: Янв. 15, 2025

Brewin et al1 provide an engaging and thorough review of the empirical literature on nature, prevalence, assessment, potential prevention, treatment post-traumatic stress disorder (PTSD). An important contribution is summary evidence validity new ICD-11 diagnoses PTSD complex PTSD. Here we focus benefits these in improving outcomes increasing engagement into care, two concerns treatment. To date, most evidenced treatments for as defined by DSM-5 are trauma-focused cognitive behavioral therapies (TF-CBTs) eye movement desensitization reprocessing (EMDR), which have clinically significant equivalent effects. Nevertheless, only 40-50% recipients interventions no longer meet criteria at end, many experience residual symptoms. In addition, completion rates modest: medical records reviewed US Veterans Health Administration from 2001 to 2015 indicated that, veterans with offered evidence-based psychotherapy, 23% initiated 9% completed treatment2. The increased number symptoms diagnostic order recognize more extensive diverse problems found among those who chronic repeated trauma. This decision has led criticism that possible unique symptom profiles generated algorithm so numerous construct does not warrant a unified approach At very least, applying single individuals different may constrain benefits. taken approach. It organizes trauma sequelae diagnoses, each limited empirically supported clusters. As al, PTSD/complex distinction been documented various trauma-exposed populations, including children, college students, first responders, combat veterans, refugees, adults histories childhood domestic violence. Rates shown be higher than populations recently experienced exposure3, there some convert over time subset patients4. These observations suggest clinical utility planning, well scientific value terms allowing better understanding risk factors change time, what drives development. Most conceptualize resulting fear-generated disruptions memory organization alterations belief systems perceptions. Accordingly, current typically include key elements: exposure traumatic memories reduce fear responses, exploration reappraisal facilitate adaptive evaluation experience. application techniques relevant appropriate ICD-11. profile reflects impact severe, usually interpersonal trauma, conceptualized within social-attachment framework5. Interpersonal activates system, threat sense safety mediated disruption or violation attachment processes. Moreover, – particularly betrayal people communities strong negative self-identity, leading fundamental shifts worth. Lastly, emotion regulation capacities substantially influenced social context, during developmental years, form internalization observed behaviors attitudes, but also across lifespan, via presence absence support. formulation provides theoretical foundation developing extending established protocols they patient Given status newly recognized guidelines their Two recent meta-analyses orient practice while about effective develops. Coventry al6 evaluated trials included (e.g., abuse) representative might qualify PTSD, phase-based multimodal were unimodal therapies. Another meta-analysis7 all randomized controlled (RCTs) through 2018 TF-CBTs provided meaningful improvements clusters represented (i.e., re-experiencing, avoidance, hypervigilance, dysregulation, self-concept, relationship difficulties), was moderator outcome associated lesser six Therapies symptom-specific modules regulation, difficulties) delivered flexible sequence, depending needs preferences patient, efficient treating PTSD8. Previous work matching patients this result shorter duration relative full disorder. clinician satisfaction uptake systems8. One RCT9 sequential four-module compared usual (TAU) seeking national UK charity. Results indicate superiority modular treatment, 80% 11% TAU participants meeting either ICD-11-defined gains maintained 3-month follow-up. dropout low (18% vs. 14%). latter trial did delivery component. addition collaborative process between therapist according preference, beginning set interest would bring true meaning therapeutic goal "meeting where at" increase completion. sessions vary course improvement, can tailored success rather protocol designated endpoint, creating mental health service optimally distributes resources adapted specific patient. There few RCTs comparing versions differences outcomes. However, studies DSM-5, fulfilling both criteria, tested developed profile. Future will need evaluate innovative regardless status.

Язык: Английский

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Sleep Quality and Cognitive Impairments in Children and Adolescents with Post Traumatic Stress Disorder and/or Depressive Symptoms DOI

Mauricio Valencia, Liliana Calderón Delgado, Ana Adán

и другие.

Journal of Clinical Medicine, Год журнала: 2025, Номер 14(3), С. 1010 - 1010

Опубликована: Фев. 5, 2025

Background/Objectives: Sleep and cognitive alterations are common symptoms associated with child Post-traumatic stress disorder (PTSD) depression (DEP). This study aims to investigate the relationship between sleep disturbances in PTSD DEP. Methods: Using a quantitative, cross-sectional exploratory design, we examined 130 students (106 girls 24 boys) aged 11 16 years (mean age = 12.9, SD 1.35) from 6th 8th grade. Twenty-eight participants met criteria for PTSD, 15 DEP, 43 both PTSD+/DEP+, 44 served as control group. Comparative analyses were conducted using MANOVA multiple one-way ANOVA tests. Results: The test indicated an interaction alterations. Post hoc analysis revealed that patterns significantly altered among groups PTSD+/DEP+ (F(3, 126) 16.98, p 0.001). In contrast, most pronounced 63.97, < Conclusions: These findings emphasize impact of DEP on cognition sleep. Potential clinical implications suggest need interventions targeting underscores complex traumatic experiences, depression, cognitive/sleep

Язык: Английский

Процитировано