Wiley: Journal of Traumatic Stress: Table of Contents

Artificial intelligence in traumatic stress treatment: The TRUST framework for ethical development, clinical applications, and research advancement

Leigh E. Ridings, Philip Held, Eric Kuhn, Shannon Wiltsey‐Stirman — Mon, 08 Jun 2026 22:22:41 -0700

Abstract

Posttraumatic stress disorder (PTSD) and depression are common diagnoses following traumatic events, with several available evidence-based interventions to reduce symptomology. However, trauma populations face significant access barriers that limit their adoption and reach. Artificial intelligence (AI) technologies, such as large language models (LLMs), have the potential to enhance access, cost-efficiency, delivery, and quality of traumatic stress interventions. Their application to traumatic stress treatment and research is understudied and requires responsible and ethical development, evaluation, and monitoring to maintain service quality and delivery for trauma survivors and their providers. We present considerations for the responsible use of AI tools to ethically shape trauma-focused treatment and research, with future use cases to highlight these critical considerations. A multidisciplinary approach to trauma-based LLM development that integrates feedback and evaluation from trauma experts, clinicians, and trauma survivors and prioritizes the quality, safety, effectiveness, and equity of trauma-focused care is essential. We propose a framework, TRUST, that is informed by evidence from adjacent mental health AI applications and emerging research on digital trauma interventions, while acknowledging the limited trauma-specific AI trial data. These topics were presented at the 41st Annual Meeting of the International Society for Traumatic Stress Studies via a panel of experts in AI technologies to support trauma-focused interventions.

Sexual orientation differences in trauma exposure and posttraumatic stress symptoms among adults in treatment for obsessive–compulsive disorder

Thu, 04 Jun 2026 09:35:43 -0700

Abstract

Sexual minority individuals are at increased risk for developing mental health disorders, including obsessive–compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). Prior research has identified that individuals with comorbid OCD and PTSD may have a more complex clinical presentation and worse treatment outcomes. Although PTSD is not the main focus of exposure with response prevention (ERP), the first-line therapy for OCD, symptoms are inadvertently targeted through overlapping mechanisms with exposure-based PTSD treatments. No prior research has compared sexual minority and heterosexual individuals receiving treatment for OCD regarding trauma history and posttraumatic stress symptom (PTSS) treatment outcomes. Participants (N = 696) included heterosexual (n = 554, 80.0%); bisexual, pansexual, and/or queer (bi+ ; n = 87, 13.0%); gay/lesbian (n = 39, 5.6%); and asexual (n = 16, 2.3%) adults in treatment for OCD and related disorders. Sexual minority participants were significantly more likely to report experiencing an interpersonal traumatic event compared to heterosexual participants, χ²(1, N = 695) = 5.97, p = .015. No significant differences were identified regarding noninterpersonal trauma, χ²(1, N = 695) = 0.84, p = .360. Further, bi+ participants reported significantly higher PTSS at baseline compared to heterosexual participants, but gay/lesbian and asexual participants did not differ from heterosexual participants. Participants reported significantly improved PTSS while receiving ERP, and this did not differ by sexual minority status. Clinical implications include assessing trauma among sexual minority patients, especially bi+ individuals; utilizing trauma-informed care; and incorporating sexual minority stressors into treatment for OCD.

A systematic review of the prevalence, risk factors, and protective factors of posttraumatic stress disorder among paramedics

Thu, 04 Jun 2026 09:34:06 -0700

Abstract

Paramedics are frequently exposed to trauma and may be at elevated risk of posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). This review aimed to map PTSD prevalence among paramedics, identify risk and protective factors, and scope existing literature on CPTSD in paramedics. Studies were identified through a systematic database search, appraised using the Appraisal Tool for Cross-Sectional Studies (AXIS) and the Newcastle-Ottawa Quality Assessment Scale (NOS; for cohort studies). Data were analyzed through narrative synthesis. A total of 43 studies involving 12,783 paramedics were included. PTSD prevalence ranged from 1.0% to 82.4% in the 29 studies that reported prevalence, with 15 studies reporting rates of 14.6%–40%. Consistent risk factors included low social support, poor sleep, workplace stress, anxiety, and depression. Protective factors included resilience, social support, and a sense of coherence. Most cross-sectional studies were rated as high quality. The limited longitudinal evidence suggests lower PTSD prevalence or symptom levels than cross-sectional findings. No studies examined CPTSD. Taken together, the findings indicate that PTSD is common among paramedics, although evidence on CPTSD is absent. Future research should prioritize longitudinal designs and examine CPTSD prevalence in paramedics.

Commercial content moderation: Trauma exposure on the digital frontline

Jeffrey Demarco, Patricia Watson, Sonya B. Norman — Thu, 04 Jun 2026 09:31:29 -0700

Abstract

Commercial content moderators (CCMs) serve as the hidden first responders of the internet, sifting through flagged user-generated content to keep online platforms safe. In their work, they have repetitive, frequent exposure to traumatic content, including child sexual abuse material, graphic violence, death, hate rhetoric, and more. Yet, relative to other occupations in which trauma exposure is common, the mental health effects of content moderation have received little study. This is in large part because it is a newer profession that arose with the widespread adoption of social media. In this paper, we describe the work and working conditions typical of CCMs and how these contribute to potential mental health impacts. Global labor inequities are discussed with regard to how outsourcing moderation to low- and middle-income countries with stressful working conditions may exacerbate the risk of posttraumatic stress. Research on the mental health effects of content moderation is synthesized. We propose a research agenda for preventing and mitigating the negative mental health impacts of trauma exposure that CCMs experience. Finally, the paper outlines principles for trauma-informed, psychologically safe moderation systems and discusses implications for clinicians, employers, and occupational health professionals.

Invisible barriers and lasting scars for racially/ethnically minoritized youth: The role of state‐level opportunity on adverse childhood experiences exposure risk

Tue, 02 Jun 2026 23:20:49 -0700

Abstract

Previous research has shown there are racial/ethnic disparities in exposure to adverse childhood experiences (ACEs) that can affect youths’ physical and mental well-being. Structural opportunity factors—including a lack of economic, community, educational, and health resources—may increase exposure to ACEs among youth of color relative to non-Hispanic White youth. This study explored connections between state-level opportunity and ACE exposures and examined differences by race/ethnicity within the United States (N = 46,395). Average cumulative ACEs were generally significantly higher among Hispanic and non-Hispanic Black youth relative to non-Hispanic White youth, p < .001. Non-Hispanic Black youth had higher average cumulative ACEs scores within 28 U.S. states relative to non-Hispanic White youth. Hispanic youth had higher ACE exposures in 18 states relative to non-Hispanic White youth. States with higher opportunity scores were in the U.S. Northeast and Midwest. Multilevel model analyses showed that as state-level opportunity increased (i.e., education, healthcare, economic, community), youth's exposure to ACEs decreased significantly for non-Hispanic White youth but not non-Hispanic Black, p = .031, or Hispanic youth, p = .002, r ² _conditional = .059, who, on average, experienced more ACEs. The findings suggest a structural exclusion of minoritized youth from potential macro-level protective factors (e.g., high state-level opportunity), highlighting a need for systemic interventions to decrease racial/ethnic disparities in ACE exposures. The results align with previous research demonstrating that the historical and institutional effects of discrimination may shape disparities in accessing and benefiting from quality education, health care, economic, and community resources.

From therapeutic promise to evidentiary discipline: Reassessing MDMA‐assisted psychotherapy for posttraumatic stress disorder

Tue, 02 Jun 2026 01:42:21 -0700

Abstract

In this commentary on Morland et al. (2026)’s recent State of the Science article on 3,4-methylenedioxymethamphetamine (MDMA)–assisted psychotherapy for posttraumatic stress disorder (PTSD), we aim to emphasize both MDMA's therapeutic promise and its unresolved scientific challenges. Although recent trials on MDMA-assisted interventions have reported encouraging reductions in PTSD symptoms, the current evidence base remains constrained by several major limitations, including difficulties in blinding, expectancy effects, the absence of robust active comparator conditions, limited mechanistic clarity, and concerns regarding safety monitoring and sample generalizability. This letter argues that these issues are not peripheral but central to the interpretation and future translation of MDMA-assisted psychotherapy. It further highlights the need to move beyond symptom reduction as the primary outcome and incorporate broader indicators of recovery, such as functioning, quality of life, relational restoration, and long-term durability of treatment gains. In addition, we call for stronger attention to equity, scalability, therapist training, and ethical safeguards, particularly if MDMA-assisted psychotherapy is to be considered within a global mental health framework. The discussion aims to stimulate deeper debate on how innovation in trauma treatment should be evaluated before widespread clinical adoption.

Toward a precision medicine treatment model for posttraumatic stress disorder

Joseph Wielgosz, Sonya B. Norman, Brian P. Marx — Tue, 02 Jun 2026 01:42:21 -0700

ABSTRACT

Multiple evidence-based treatments for posttraumatic stress disorder (PTSD) are available, yet they do not benefit all recipients equally due to partial response, early dropout, and persistent symptoms. Despite this, clinicians and patients lack empirically grounded guidance for selecting among treatment options. This commentary argues for the timeliness and clinical promise of a precision medicine approach to treatment research, going beyond estimations of average treatment effects to model the optimal treatment for a given individual and their context. We outline three scientific priorities for progress toward clinically usable decision models: (a) prioritizing heterogeneity in studying treatment response; (b) accounting for provider-, clinic-, and system-level influences along with the patient's social and material context; and (c) increasing rigor and harmonization in outcome measurement. Advancing these priorities will require coordinated efforts to assemble larger and higher-quality PTSD treatment data sources; we highlight several actionable strategies for doing so. To better address the needs of all trauma survivors, the field must not only develop and study effective treatments but also take cohesive steps to understand how, when, and to whom those treatments are best delivered.

State of the Science: The epidemiology of posttraumatic stress disorder

Tue, 02 Jun 2026 01:42:21 -0700

Abstract

Posttraumatic stress disorder (PTSD) is a mental health condition with widespread effects on mental and physical health and mortality. In this paper, we present the current state of research on the epidemiology of PTSD, including its prevalence, risk factors, and impact. The U.S. lifetime prevalence of PTSD is estimated to be 6.1%–8.3%, and the global prevalence is estimated at 3.9%. PTSD prevalence has been consistently found to be higher among certain subgroups, including women and military veterans. Risk factors for PTSD include pretrauma variables, preexisting mental health conditions, sociodemographic characteristics, and features of the traumatic event itself. Consequences of PTSD include effects on psychiatric comorbidity, physical health conditions, and all-cause and cause-specific mortality. Points of consideration and challenges affecting the study of PTSD epidemiology are noted, including debates on specifying a trauma criterion for diagnosis, the validity of complex PTSD as a diagnosis, and the dearth of recent population-based longitudinal data to understand this disorder. Suggestions for future research and clinical implications are discussed.

Moral injury among journalists: A scoping review

Tue, 02 Jun 2026 01:42:21 -0700

Abstract

Moral injury refers to the psychological, social, functional, and spiritual impacts of experiencing an event that transgresses one's deeply held moral beliefs. Recent research has documented the relevance of moral injury among various occupations. This may be of particular applicability to journalists, who operate within ethically complex landscapes and often cover morally reprehensible events. This scoping review aimed to synthesize the existing literature concerning moral injury among journalists to explore (a) the extent to which research has been undertaken, (b) what potentially morally injurious events are experienced by journalists, and (c) how moral injury is measured and defined. Online databases were used to identify sources reporting on moral injury among journalists. A total of 20 articles met the inclusion criteria, with only 10 instances of empirical data on moral injury, highlighting a lack of empirical work in this field. Occupational support, mental health literacy, and avoiding potentially morally injurious events were highlighted as key protective and preventative factors. Future research would benefit from clearly conceptualizing moral injury in alignment with current theoretical frameworks and selecting measures that provide information about psychological experiences. Overall, these findings provide a foundation for improving understanding, awareness, intervention, and preventative strategies to support the mental health of journalists.

Written exposure therapy delivered to trauma‐exposed veterans in primary care: A feasibility study

Tue, 02 Jun 2026 01:42:21 -0700

Abstract

Despite the number of empirically supported treatments for posttraumatic stress disorder (PTSD) available in U.S. Department of Veterans Affairs (VA) specialty mental health settings, many veterans decline referrals to this setting or do not follow through with recommended care. Thus, the expansion of PTSD services into primary care settings is crucial for increasing access to evidence-based treatments among veterans. To this end, the current pilot project examined the acceptability, feasibility, and preliminary effectiveness of written exposure therapy (WET) delivered to veterans with clinically significant trauma-related symptoms presenting to VA primary care. Veterans (N = 36) were assessed pretreatment, posttreatment, and 1-month follow-up. Mean satisfaction ratings assessed via the Client Satisfaction Questionnaire–8 suggest that the treatment was acceptable (M = 28.00, SD = 3.91). Recruitment and retention rates suggest that the treatment was feasible to deliver, with 88.0% of respondents who expressed interest initiating treatment and 66.0% of those who initiated treatment completing treatment. Further, the results revealed large reductions in PTSD symptom severity from pre- to posttreatment, d = 0.94, and pretreatment to 1-month follow-up, d = 0.89, as assessed using the PTSD Checklist for DSM-5. These findings provide initial support for WET when delivered to veterans presenting with trauma-related symptoms in a primary care setting.

Testing the factor structure of the International Trauma Questionnaire in a sample of violence‐exposed women living in Northern Ireland

Tue, 02 Jun 2026 01:42:21 -0700

Abstract

The International Trauma Questionnaire (ITQ) assesses posttraumatic stress disorder (PTSD) and the disturbances in self-organization (DSO) aspect of complex PTSD (CPTSD) per the ICD-11. This study examined the ITQ's factor structure among violence- or abuse-exposed women in Northern Ireland, a region with a history of conflict (i.e., “the Troubles”), to validate its use in this unique sociopolitical context. The sample consisted of the 542 women who participated in the Violence Against Women and Girls Survey in Northern Ireland. All participants completed the ITQ and reported lifetime experiences of various forms of violence and abuse. Construct validity was assessed by testing four models of ITQ's factor structure using confirmatory factor analysis (CFA). Regression analyses were performed on the factors from the two best-fitting CFA models to predict PTSD and DSO scores using age and types of violence as predictors. The two-factor second-order model and the correlated six-factor first-order model both showed good fit. Factor loadings indicated that all ITQ items adequately measured their intended constructs, λs = .697−.973. Regression analyses on both models revealed that physical violence, sexual violence, and digital abuse significantly predicted both PTSD and DSO scores, with stalking predictive of PTSD only, two-factor second-order model: βs = .118−.244, correlated model: βs = .101−.287. Findings suggest that the ITQ is a reliable and valid tool for assessing PTSD and DSO in women living in Northern Ireland. Associations with violence types showed partial differences and overlap, highlighting value in examining PTSD and CPTSD regarding specific trauma types.

Saliendo adelante: Understanding trauma and resilience in immigrant families from Central America

Tue, 02 Jun 2026 01:42:21 -0700

Abstract

Fleeing extreme poverty and violence and seeking safety and survival, families have increasingly migrated to the United States from El Salvador, Guatemala, and Honduras. Limited scholarship has explored the transgenerational transmission of strategies for resilience, survival, and agency among Central American migrant families. Using constructivist grounded theory methods, this study sought to better understand these processes by exploring the transgenerational transmission of trauma and resilience in the context of forced migration and family separation within a sample of 24 mothers and youth who migrated to the United States from Central America. The findings reveal three important concepts that influence how trauma and resilience are transmitted across generations among families who have recently migrated from Central America. Youth and mothers described the transmission of trauma and resilience as multidirectional with impacts across generations. Participants also described experiencing ongoing systemic traumatization in the form of oppressive social, political, legal, and economic systems that perpetuate traumatic stress and cause family separation. Finally, the concept of saliendo adelante, or “moving forward,” was found to be both a process and a goal for mothers and youth, constituting an important form of transgenerational resilience. Results from this study elucidate the complex and intersecting processes that contribute to the transgenerational transmission of trauma and introduce the concept of saliendo adelante, by which immigrant families transmit family goals and build resilience in the face of adversity.

Early life abuse and neglect in breast cancer survivors: Associations with physical and psychological health throughout diagnosis and survivorship

Tue, 02 Jun 2026 01:42:21 -0700

Abstract

Childhood abuse and neglect worsen physical and mental health through adulthood. This study examined how childhood adversity affected physical and psychological symptoms associated with breast cancer treatment and survivorship at three points within the cancer trajectory. Breast cancer survivors (N = 209) were recruited following diagnosis and completed three visits at pretreatment, 6 months posttreatment, and 18 months posttreatment. All survivors completed the Childhood Trauma Questionnaire to assess abuse and neglect exposure prior to 18 years of age. At each visit, participants completed self-report measures of depressive symptoms, anxiety symptoms, pain, fatigue, and sleep quality. When controlling for disease-related variables, sexual abuse significantly interacted with study visit to predict pain, p = .002. No other significant interactions emerged. Analyses of main effects revealed that breast cancer survivors who experienced higher rates of each abuse or neglect type experienced poorer sleep quality, Bs = 0.20–0.39, p < .001–p = .002; higher fatigue, Bs = 0.81–1.4, ps < .001–p = .020; more depressive symptoms, Bs = 0.55–0.56, ps ≤$ \le $ .001; and higher anxiety symptoms, Bs = 0.35–0.54, p < .001–p = .002. Only physical neglect was significantly associated with pain, B = 0.12, p = .041. Results suggest that breast cancer survivors who experienced abuse and neglect earlier in life are at increased risk of adverse physical and psychological symptoms throughout survivorship. Providers should consider screening for early life trauma to understand unique risks associated with navigating breast cancer treatment and survivorship.

Potentially morally injurious events and posttraumatic stress symptom change across the military‐to‐civilian transition: A prospective study

Walter J. Sowden, Roland Hart, George A. Bonanno — Tue, 02 Jun 2026 01:42:21 -0700

Abstract

This prospective study examined whether exposure to potentially morally injurious events (PMIEs), specifically self-attributed transgressions, other-attributed transgressions, and experiences of betrayal, predicted change in posttraumatic stress symptoms (PTSS) and reintegration difficulty during the military-to-civilian transition (MCT). U.S. Army soldiers (N = 815) completed surveys approximately 6 months before separation (Time 1 [T1]) and 6 months after separation (Time 2 [T2]). PMIEs were assessed at T1, PTSS was assessed at both points, and reintegration difficulty was assessed at T2. Analyses used hierarchical linear regression and moderation models, adjusting for demographic and service-related covariates. Betrayal-related PMIEs uniquely predicted higher PTSS at T2, β = .09, p = .014, after controlling for baseline PTSS, whereas self- and other-attributed transgressions were nonsignificant. Betrayal-related PMIEs also predicted higher levels of reintegration difficulty above and beyond the contributions of PTSS and combat exposure, β = .13, p = .003. Interaction effects by gender and relationship status were statistically significant but small, ΔR ² = .015. Across models, effect sizes for betrayal-related PMIEs were modest, βs = .09–.15. Because the PTSD Checklist–Military Version was administered without anchoring responses to a specific traumatic event, the findings reflect general stress-related distress rather than DSM-defined PTSD. Overall, the results indicate that betrayal-based PMIEs represent a modest yet consistent risk factor for psychological and functional difficulties during the MCT, underscoring the value of differentiating PMIE subtypes in screening and intervention.

Religion and spirituality as pathways to resilience: The role of positive coping and postmigration stress in displaced populations

Tue, 02 Jun 2026 01:42:21 -0700

Abstract

Faith or spirituality may foster resilience among forcibly displaced individuals facing postmigration stress, including the loss of social networks, cultural adjustment, and uncertainty. Although prayer and community gatherings promote resilience, their role in building individual and community resilience under postmigration stress is less known. Forcibly displaced adults (N = 272) completed measures of positive religious coping, fate and destiny–related beliefs, and religious and spiritual struggles. Outcomes were individual and community resilience, with postmigration living difficulties examined as a moderator. Positive religious coping was associated with higher individual resilience, β = .15, p = .018, whereas higher religious struggles were associated with lower resilience, β = -.22, p = .001. Postmigration stress moderated the association between spiritual struggles and individual resilience, with the negative association between spiritual struggles and resilience weakening as postmigration stress increased. Both higher positive religious coping, β = .35, p < .001, and higher fate and destiny–related beliefs, β = .37, p < .001, were associated with higher community resilience. Higher postmigration stress was modestly associated with higher community resilience, β = .14, p = .015, but did not moderate observed associations. Taken together, spirituality serves as an important social and psychological resource for forcibly displaced individuals, fostering both individual and community resilience. Under higher postmigration stress, individuals adapt by relying on available coping mechanisms, mitigating the impact of religious struggles on resilience. Programs that promote culturally meaningful religious coping and shared spiritual practices may offer community-driven pathways to resilience for populations navigating forced displacement.

Psychometric considerations of Adverse Childhood Experiences Questionnaire: Structure, validity, and the development of a supplementary instrument

Borna Loncar, Robert Fox, Nadja Heym, Alexander Sumich — Tue, 02 Jun 2026 01:42:21 -0700

Abstract

Adverse childhood experiences (ACEs) are linked to numerous negative physical and mental health outcomes. The current study addressed theoretical, conceptual, and measurement problems by evaluating a novel extension to the seminal ACEs questionnaire (ACEs-Q). Two U.K.-based adult samples (N _{Study 1} = 859, N _{Study 2} = 297) were used to examine the structure of the ACEs-Q via principal component analysis (PCA) and, within a structural equation modeling (SEM) framework, reflective and composite–formative models, as well as to develop and validate a supplementary measure—the ACEs-Related Impairment Questionnaire (ACEs-RIQ)—designed to assess the impairment associated with ACEs. In Study 1, PCA supported a two-factor ACEs-Q structure encompassing Childhood Maltreatment (CM) and Household Challenges (HC) factors. Both SEM approaches showed similar associations with internalizing outcomes, primarily driven by CM, composite–formative: β_Depression = .50, β_Anxiety = .43, β_Stress = .42; reflective: β_Depression = .51, β_Anxiety = .43, β_Stress = .42. Although the findings indicate compatibility of the ACEs construct with both modeling approaches, the composite–formative model, where dichotomous items function as contributing indicators that form rather than reflect the construct, is more closely aligned with the current conceptualization of ACEs. In Study 2, the ACEs-RIQ demonstrated high internal consistency, Cronbach's α = .92, and predictive validity comparable to the ACEs-Q, tested through SEM. The ACEs-RIQ was found to be a valid, reliable instrument that extends the ACEs-Q by capturing impairment due to adversity rather than exposure alone.

The central importance of expressive suppression to posttraumatic stress symptoms: A network analysis

Anna C. Cole, Mikael Rubin, Cynthia L. Lancaster — Tue, 02 Jun 2026 01:42:21 -0700

Abstract

Emotion regulation plays a role in the development of posttraumatic stress symptoms (PTSS). Most research in this area has focused on how people regulate their emotions, a process called self–emotion regulation (self-ER). Self-ER strategies are well-established predictors of PTSS. However, people also regulate their emotions with the help of others, a process called social emotion regulation (social ER). Relative to self-ER, social ER is understudied, and its associations with PTSS and self-ER are unclear. Therefore, we used network analysis to examine the associations among self-ER, social ER, and PTSS. Adults with a history of direct trauma exposure (N = 1,061) reported their use of four social ER strategies (soothing, social modeling, perspective taking, and enhancing positive affect), two self-ER strategies (cognitive reappraisal and expressive suppression), and PTSS. We identified ER nodes that had the largest bridge expected influence (EI) centrality with PTSS. Expressive suppression, a self-ER strategy, had the strongest bridge EI centrality in the network, followed by soothing and social modeling, both of which are social ER strategies. Although longitudinal research is needed to establish the direction of effects, these findings underscore the importance of evaluating the roles of both self and social ER in the development and maintenance of PTSS.

Daily‐life posttraumatic stress symptoms, posttraumatic cognitions, and affect following the processing of positive memories technique: An open‐label case‐control daily diary study

Tue, 02 Jun 2026 01:42:21 -0700

Abstract

The processing of positive memories technique (PPMT) is a promising new treatment for posttraumatic stress disorder (PTSD) involving the detailed narration and processing of specific positive autobiographical memories. This study used an interrupted time series design with daily diary reports to assess changes in daily-level affect, cognitions, and PTSD symptoms pre- to post-PPMT. A convenience sample of trauma-exposed U.S.-based adults (n = 70) recruited through social media and flyers received the 4-week PPMT intervention and completed 21 daily surveys pre- and post-PPMT (42 total surveys) assessing daily positive event pleasantness, negative event unpleasantness, PTSD symptoms, posttraumatic cognition levels, and positive and negative affect levels. Mixed-effects models found post-PPMT reductions in daily negative event unpleasantness ratings, β = −.25, p < .001; PTSD symptoms, β = −.24, p < .001; posttraumatic cognition levels, β = −.32, p < .001; and negative affect levels, β = −.32, p < .001, alongside increases in daily positive affect levels, β = .12, p = .021, compared with the preintervention phase. The association between daily negative event unpleasantness and daily negative affect levels (negative affect reactivity) was weaker postintervention compared with preintervention. There was no significant change post-PPMT in positive event pleasantness ratings, β = −.03, p = .619, or the association between daily positive event pleasantness and daily positive affect levels (positive affect reactivity), β = .00, p = .931. These findings provide support for the beneficial therapeutic effects of PPMT at the daily level for trauma-exposed populations. Further studies should test these patterns with clinical samples.

Direct comparison of reconsolidation of traumatic memories and prolonged exposure therapy: A randomized controlled trial

Tue, 02 Jun 2026 01:42:21 -0700

Abstract

New therapies are needed for posttraumatic stress disorder (PTSD), particularly in military service members (SMs). Reconsolidation of traumatic memories (RTM) is a novel treatment with promising results in small clinical trials. We randomized 94 active duty or retired SMs (M _age = 45.80, 31.0% women) with PTSD to receive up to ten 90-min sessions of RTM (n = 48) or prolonged exposure (PE; n = 46) to ascertain whether RTM achieved a greater and/or faster response. The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) was used to establish eligibility and assess response at 2 weeks and 2, 6, and 12 months postintervention. The PTSD Checklist for DSM-5 was administered before Sessions 2, 4, 6, 8, and 10 to assess response rapidity. We hypothesized that RTM would achieve quicker responses and higher loss of diagnosis rates than PE. From baseline to postintervention, participants in both the RTM (39.13 vs. 22.38), d = 1.42, p < .001, and PE groups (39.26 vs. 22.45), d = 1.50, p < .001, showed improvement on the CAPS-5, with no between-group difference, p = .959. Response (RTM: 74.2%, PE: 72.4%), loss of diagnosis (RTM: 58.1%, PE: 51.7%), and withdrawal (RTM: 18.8%, PE: 32.6%) rates showed no significant differences. Gains were largely sustained through 12 months. RTM had more early responders (72.2%) than PE (27.8%), p = .005; 70.0% of participants addressed multiple traumas with RTM versus 30.0% for PE, p = .022. RTM and PE demonstrated comparable large effect sizes, but RTM achieved more early responses.

Co‐occurring daily minority stressors and dissociation among trauma‐exposed sexual minority women, transgender, and nonbinary people

Kriti Behari, Emily C. Helminen, Michelle J. Zaso, Jillian R. Scheer — Tue, 02 Jun 2026 01:42:21 -0700

Abstract

Sexual minority women, transgender people, and nonbinary (SMW/TNB) people experience disproportionately high rates of traumatic stressors (e.g., child abuse, sexual violence), which are associated with adverse trauma-related mental health outcomes, such as dissociation. SMW/TNB people also experience ongoing stressors related to their minoritized sexual and/or gender identities (e.g., discrimination). Dissociation has been associated with minority stressors in studies primarily using single–time point, cross-sectional approaches. Reliance on single–time point approaches may obscure how minority stressors and trauma-related outcomes, like dissociation, covary within individuals and unfold over time. We conducted a secondary analysis of data from a 14-day daily diary study with trauma-exposed SMW/TNB participants (N = 57) to examine whether variations in daily minority stressors were associated with same-day fluctuations in dissociation. Results indicated minority stressors and dissociation significantly covaried over the 14-day study period. Multilevel models showed that participants’ reports of higher-than-average daily minority stressors were associated with same-day reports of higher-than-average dissociative symptoms, B = 0.24, 95% CI [0.07, 0.41], p = .007. Participants also reported small decreases in dissociation levels over the study period, B = −0.05, 95% CI [-0.08, -0.02], p = .004. The findings highlight the importance of considering the health impacts of consistent state elevations in dissociation associated with minority stressors for SMW/TNB people. Future time-varying approaches should investigate temporal sequencing of minority stressors and dissociation, assess whether minority stressors relate to dissociation independent of trauma exposure, and explore whether trauma exposure characteristics (e.g., identity-relatedness of trauma) moderate this association.

The role of geographical proximity to the October 7th, 2023, attack on Israel: Mental health disorders and related risk factors

Tue, 02 Jun 2026 01:42:21 -0700

Abstract

The current study assessed how mental health outcomes and related risk factors varied by proximity to the October 7, 2023, attacks by Hamas among a community sample from Ofakim, a town in southern Israel. Established cutoff scores on self-report measures of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) were used to estimate disorder prevalence rates. Background and trauma exposure were examined as risk factors in areas that differed in geographical proximity to the attacks. Participants were randomly sampled from two areas in Ofakim during June–August 2024: Sample 1 (S1) included 388 individuals in the attacked neighborhood, and Sample 2 (S2) included 329 individuals located elsewhere in town. Probable PTSD rates were significantly higher in S1 (56.4%) than S2 (44.7%), p < .001. The prevalence of probable MDD was 38.6% in S1 versus 28.7% in S2, p < .001. The prevalence of probable GAD was 42.0% in S1 versus 29.0% in S2, p < .001. In generalized linear models, there were no significant differences in mental health outcomes across neighborhoods. However, interactions between neighborhood type and risk factors emerged such that low income increased the likelihood of probable PTSD and GAD within the attacked neighborhood. The findings highlight the substantial mental health impact of mass trauma on an entire town, worsening with event proximity. Low income was a specific risk factor for individuals in the attacked neighborhood, which raises questions about whether economic support could buffer the impact of mass trauma in low-income individuals.

The physiological and affective mechanisms of shame among veterans with posttraumatic stress disorder symptoms

Tue, 02 Jun 2026 01:42:21 -0700

Abstract

Negative self-evaluative emotions (NSEs), specifically shame and guilt, are notable predictors of the development and maintenance of posttraumatic stress disorder (PTSD) and its most devastating outcomes (e.g., suicide). Yet, there is minimal research examining the real-time affective and physiological experience of NSEs, like shame, among veterans with PTSD symptoms. This study examined 50 veterans with probable PTSD during shame induction, measuring baseline trait NSEs and PTSD symptoms. Emotions were assessed before and after each task to explore the affective and physiological characteristics of shame and their links to trait NSEs and PTSD. The secondary aim was to compare the effects of induction type on outcomes. Across induction types, NSEs increased during shame induction and decreased after induction at higher levels than non-NSEs, η_p ² = .472–589. However, only overall autonomic nervous system (heart rate) activity demonstrated this same pattern, η_p ² = .456, as both parasympathetic nervous system (PNS; respiratory sinus arrhythmia), η_p ² = .103, and sympathetic nervous system (SNS; skin conductance level), η_p ² = .345, activity demonstrated significant withdrawal (PNS) and augmentation (SNS) with no natural recovery. Additionally, PTSD symptoms were positively associated with real-time NSEs, rs = .33–.43, whereas trait guilt was negatively associated with PNS activity, r = −.36. Finally, imaginal shame induction yielded higher NSE reactivity, η_p ² = .039–076, and PNS withdrawal, η_p ² = .046, thus demonstrating the difficulty veterans with PTSD symptoms have recovering from moments of shame, as well as the importance of induction type on eliciting physiological and affective reactivity.

Measuring resilience using language modeling: A computational approach to observing resilience

Tue, 02 Jun 2026 01:42:21 -0700

Abstract

We developed resilience using language modeling (ReLM) to measure resilience in language through a novel natural language processing approach called archetype analysis. Our model conceptualizes resilience as a process of maintaining healthy functioning after an adverse event. ReLM is theoretically synthesized through nine facets of resilience reviewed from various sources as reflected in language that captures its dynamic capacity: optimism, sense of social support, emotional maturity, uncertainty tolerance, flexible mindset, coping toolkit, cognitive reappraisal, belief in a higher power, and continued activities of daily living. ReLM uses a language model to embed language in a semantic space, with cosine similarity to each facet's prototype statements calculated to quantify a theoretically derived facet score. We applied ReLM to 1,859 voicemails collected from 211 responders to the September 11, 2001, World Trade Center terrorist attacks. Principal component analysis on training and test sets identified a single latent factor from the facet scores, λ = 5.02 (56% variance explained), and measurement invariance testing confirmed scalar invariance across training and test subsets, Δχ²(8) = 8.89, p = .352, indicating ReLM scores reflected the same underlying construct in both sets. A one-way analysis of variance showed significant differences in posttraumatic stress disorder (PTSD) symptom trajectories across resilience quartiles, F(3, 169) = 5.18, p = .002, with high resilience showing the largest improvements in PTSD after 4 years (M = −0.212). Using an archetype-based language model, ReLM offers a theoretically grounded approach to measuring resilience through natural language, capturing psychological processes in narratives, and enabling dynamic assessment.

Testing for stress sensitization to war exposure in adult Ukrainian refugees using latent classes of adverse childhood experiences

Anne Agathe Pedersen, Karen‐Inge Karstoft — Tue, 02 Jun 2026 01:42:21 -0700

Abstract

Refugees of war are at high risk of exposure to war-related potentially traumatic events (PTEs) and the development of posttraumatic stress disorder (PTSD). The stress sensitization hypothesis posits that adverse childhood experiences (ACEs) can sensitize individuals to the stress of PTEs in adulthood. This study examined how ACEs might sensitize refugees to war exposure in a sample of 3,486 Ukrainian refugees. We identified four latent classes of ACEs: low exposure (57.4%), household dysfunction (21.5%), maltreatment (16.7%), and high exposure (4.4%). These classes were used in a logistic regression model to test for associations with PTSD, and an ACE Class x War Exposure interaction term was used to test for stress sensitization. Female gender, odds ratio (OR) = 1.99, 95% confidence interval (CI) [1.58, 2.49]; war exposure, OR = 1.55, 95% CI [1.30, 1.83]; and all ACE classes, ORs = 1.14–2.84, were significantly associated with PTSD, whereas we found no effects of stress sensitization. The lack of stress sensitization effects in our analysis might have been caused by uniformly high stress levels in this refugee sample, as well as the broadly defined war exposure measure we used. Future research should aim to assess whether certain types or intensities of exposure better reveal sensitization effects.

Familial genetic risk for posttraumatic stress disorder: Associations with clinical features

Tue, 02 Jun 2026 01:42:21 -0700

Abstract

In the present study, the novel family genetic risk score (FGRS) method, a reliable quantification of latent genetic risk, was applied to posttraumatic stress disorder (PTSD) to examine associations between genetic liability and clinical features of PTSD among 3,097,180 individuals in the Swedish national registries. FGRS was calculated based on lifetime PTSD status for first- through fifth-degree relatives and examined both in PTSD cases with any lifetime registration (PTSD total) and in cases with more than one registration (recurrent PTSD) in relation to sex, age at onset (AAO), recurrence, mode of ascertainment (inpatient [IP], outpatient specialty care [SC], primary care [PC]), and comorbidities. Sex differences were not found for recurrent PTSD, but for PTSD total, female registrants had a lower FGRS value compared to male registrants, M = -.017, 95% CI of difference [-.029-.005]. Higher FGRS was found at earlier AAO for PTSD total and recurrent PTSD, ps < .001, and scores were higher among individuals with comorbidities, ps < .001. Higher FGRS was related to the number of PTSD recurrences among both total PTSD and recurrent PTSD, ps < .001 (linear effect). For both PTSD types, FGRS scores were as follows: PC < SC < IP, ps < .001. The findings indicate that genetic risk for PTSD is associated with several clinical features of the disorder, which should be included in future studies of genetic risk for PTSD. Continued investigation of these clinical features in epidemiological and molecular genetic studies of PTSD is warranted to further validate the findings.

Cognitively augmented behavioral activation for veterans with comorbid mild traumatic brain injury and posttraumatic stress disorder

Tue, 02 Jun 2026 01:42:21 -0700

Abstract

The co-occurrence of mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) is associated with greater impairment relative to the presence of either condition alone. This study evaluated the effectiveness of cognitively augmented behavioral activation (CABA) therapy, compared to treatment as usual (TAU), at reducing mTBI and PTSD symptoms in 71 military veterans randomized to treatment at two urban U.S. Department of Veterans Affairs medical centers. Primary outcomes were PTSD symptom severity, measured by structured clinical interview (Clinician-Administered PTSD Scale for DSM-5; CAPS-5) and self-report questionnaire (PTSD Checklist for DSM-5; PCL-5), and objective cognitive function (neuropsychological test battery). Intent-to-treat analyses using linear mixed-effects regression models (LMM) indicated that CABA significantly outperformed TAU in reducing PTSD symptom severity, CAPS-5: d = 0.11, p = .027, PCL-5: d = 0.11, p = .030 (small effects), and improving performance on neuropsychological tests of verbal learning, d = 0.07 (small effect) and delayed recall, d = 0.26 (small-to-medium effect). Changes in PTSD symptoms were explored via within-group LMM, which revealed significant within-CABA reductions, CAPS-5: d = 0.87, p < .001, PCL-5: d = 0.40, p = .006 (medium-to-large effects), but no significant symptom change within the TAU group, CAPS-5: d = 0.07, p = .195, PCL-5: d = 0.00, p = .978 (small effects). There was no significant difference between groups on treatment satisfaction ratings. This randomized controlled trial provides preliminary evidence that CABA may be a promising intervention for comorbid mTBI and PTSD.

Posttraumatic stress disorder prevalence among former first responders: A systematic review and meta‐analysis

Tue, 02 Jun 2026 01:42:21 -0700

Abstract

First responders are at high risk of posttraumatic stress disorder (PTSD), yet little research has examined PTSD prevalence within this population after individuals retire or resign from service. The current study is the first systematic review and meta-analysis aiming to describe the evidence available on point and lifetime PTSD prevalence among former first responders, estimate pooled PTSD prevalence, and examine differences between subgroups. Searches were conducted across the PsycInfo, Web of Science, Embase, PubMed, and Google Scholar databases in November 2025. Peer reviewed observational studies were included. Separate random effects meta-analyses were run on point PTSD prevalence among studies assessing PTSD related to any (general) exposures and PTSD related to single disasters. A total of 10 studies (12 unique samples) were included in the analyses. Studies were exclusively conducted within high-income, English-speaking countries among nonvolunteer former first responders and predominantly focused on firefighter and police samples. A pooled point PTSD prevalence of 15.4% was found among eight general exposure studies, and a pooled prevalence of 11.8% was found among two single-disaster exposure studies. No subgroup differences were significant, although these analyses were constrained by the restricted pool of available studies. Insufficient data were obtained to examine lifetime PTSD prevalence. The limited attention this population has received in the literature does not reflect their high level of need. Former first responders constitute a high priority for further research and mental health intervention, particularly given their loss of access to systems, services, and social support available to them through their prior roles.

Issue Information ‐ TOC

Tue, 02 Jun 2026 01:42:21 -0700

Journal of Traumatic Stress, Volume 39, Issue 3, Page 349-351, June 2026.

Veterans’ positive parenting practices and satisfaction over time: Examining the impact of moral injury, posttraumatic stress, and internalizing symptoms

Mon, 01 Jun 2026 23:24:09 -0700

Abstract

Little is known about the association between moral injury (MI) and parenting. Although there is evidence that psychological symptoms impact veterans’ parenting, few longitudinal studies exist. The current study used parallel process latent growth curve models to explore the effects of MI and other psychological symptoms on positive parenting practices and satisfaction in a sample of U.S. veterans who served following the September 11, 2001, terrorist attacks (n = 1,078). On average, positive parenting practices, α = −.09, p < .001, and satisfaction, α = −.13, p < .001, declined over time. MI from betrayal and depressive symptoms negatively predicted baseline positive parenting practices, B _MI-Betray = −0.04, p = .004; B _Depression = −0.08, p < .001, and parenting satisfaction, B _MI _-Betray = −0.04, p = .026; B _Depression = −0.08, p < .001, and MI from self-induced (in)action negatively predicted baseline positive parenting practices, B = −0.04, p = .036. Posttraumatic stress disorder (PTSD) symptoms were negatively associated with positive parenting practices, B = −0.04, p = .010, and parenting satisfaction, B = −0.06, p = .001, over time. MI appears to have a negative, short-term impact on parenting behaviors and satisfaction within the first 3 months of military separation. PTSD symptoms seem to exert a persistent, negative effect on parenting, which aligns with previous research in the military and veteran context.

Adapting and validating the Deployment Risk and Resilience Inventory–2 for use in Ukraine

Mon, 01 Jun 2026 23:18:37 -0700

Abstract

Direct exposure to combat is a leading cause of poor mental and physical health in military veterans. Recent findings suggest that a complex set of interconnected social, economic, and cultural factors further increase the risk of postdeployment symptomatology. The Deployment Risk and Resilience Inventory–Second Edition (DRRI-2) is a 17-scale questionnaire that measures psychosocial risk and resilience factors among military personnel. The DRRI-2 has been validated for use in the United States, French-speaking Canada, and Israel. This study aimed to adapt and psychometrically validate the DRRI-2 for use in Ukraine. A sample of 373 military personnel completed a translated version of the DRRI-2 along with existing validated Ukrainian-language measures of posttraumatic stress, depression, anxiety, and global functioning. A focus group of military personnel established face validity of the Ukrainian version of the DRRI-2. Internal consistency (Cronbach's alpha) for the 17 scales ranged from .57 to .96, with an average of .83. Concurrent validity was established by comparing the measure to widely used validated measures. Risk factor scales correlated positively with posttraumatic stress disorder (PTSD), depressive, and anxiety symptom severity, rs = .10–.58, and negatively with physical and mental health, rs = −.35–.05, whereas resilience factor scales correlated negatively with symptom severity, rs = −.42–−.22, and positively with functioning, rs = −.01–.38. These findings suggest that the Ukrainian DRRI-2 demonstrates acceptable-to-strong reliability and validity and can be used to assess deployment-related risk and resilience factors among Ukrainian military personnel.

Emotion regulation flexibility and momentary psychopathology symptoms among trauma‐exposed veterans with and without posttraumatic stress disorder

Mark S. Chen, Simon M. Li, George A. Bonanno — Sun, 17 May 2026 20:59:27 -0700

Abstract

Recent research has challenged the assumption that specific emotion regulation (ER) strategies are universally adaptive, emphasizing instead ER flexibility—the ability to adjust strategies in response to shifting situational demands. Contemporary theory conceptualizes ER flexibility as a multicomponent process involving context sensitivity, access to an effective strategy repertoire, and feedback responsiveness. Although ER flexibility is positioned as key to adaptation following traumatic events, empirical work has largely focused on normative, nonclinical samples, leaving real-world affective benefits in trauma-exposed populations unclear. Using ecological momentary assessment, we examined momentary associations between ER flexibility components and momentary psychopathology symptoms in 64 trauma-exposed U.S. veterans (4,371 observations), including 27 who met posttraumatic stress disorder (PTSD) diagnostic criteria. Participants completed four surveys per day for 21 days assessing emotional situations, situational characteristics, ER strategy use and change, and momentary symptoms. Multilevel models tested within-person associations between flexibility components and symptoms and examined whether effects differed by PTSD status. Higher context sensitivity, β = −.09; repertoire use, β = −.05; and feedback responsiveness (strategy switching and initial effectiveness interaction), β = .10, were independently associated with lower momentary psychopathology symptoms, ps < .05. Within feedback responsiveness, ps < .01, maintaining initially effective strategies was associated with lower anxiety, β = .27, whereas switching from ineffective strategies was associated with lower depression, β = −.17. Associations did not differ by PTSD status. ER flexibility supports adaptive emotional functioning in daily life among trauma-exposed veterans regardless of PTSD diagnosis, highlighting its potential clinical relevance as a transdiagnostic process.

Occupational outcomes of posttraumatic stress disorder residential treatment in active duty service members: Predictors of military separation

Thu, 14 May 2026 22:58:50 -0700

Abstract

Posttraumatic stress disorder (PTSD) significantly impacts active duty service members, posing challenges to both individual well-being and military readiness. This study examined the long-term outcomes of a residential PTSD treatment program, focusing on the association between symptom change and military separation. Participants were 282 active duty service members diagnosed with PTSD. PTSD symptom severity was assessed weekly using the PTSD Checklist–Military version (PCL-M). Military separation data were collected from administrative records. A multivariate joint model analyzed the association between PTSD symptoms and time to separation, whereas a Cox regression analysis explored differences across treatment response subgroups. On average, participants reported a significant 0.83-point weekly decrease in PTSD symptom severity, B = −1.49, p < .001. The linear slope of PCL-M scores significantly predicted separation, with each 1-point weekly decrease in symptoms associated with a 2.4% lower risk of separation. Critically, service members classified as “improved” demonstrated a significantly lower risk of separation compared with those characterized as “worsened,” hazard ratio = 1.51, 95% CI [1.01, 2.26], p = .044. The findings highlight that PTSD symptom improvement during residential treatment is a significant predictor of military retention. This underscores the importance of effective PTSD treatment not only for improving psychological well-being but also for contributing to force readiness.

Variation in early‐life maltreatment effects on adolescent psychopathology due to contamination

Fri, 08 May 2026 22:34:24 -0700

Abstract

This study examined the effect of early-life maltreatment on adolescent psychopathology and whether the significance and magnitude of this effect varied based on the presence of contamination (i.e., when individuals in a comparison group are exposed to maltreatment). Data were drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN; N = 1,354), a prospective cohort of children at risk for maltreatment. Children in the study were recruited by the time they were 4 years old (M _age = 4.56 years, SD = 0.70), and the sample was 50.8% female and 51.8% Black (25.7% White, 8.0% Hispanic, 1.0% Native American, 0.5% Asian, 11.3% mixed race, 1.7% other). Confirmed indicators characterized maltreatment prior to and after age 4 years. Adolescent self-report indicators identified maltreatment prior to 16 years of age and corrected contamination. Psychopathology was assessed via self-report at the LONGSCAN Age 16 assessment. Propensity score analyses indicated that maltreatment prior to 4 years of age only predicted significantly greater adolescent psychopathology symptoms after correcting contamination, B = 6.40, 95% CI [2.02, 10.79], SMD = 0.32, p = .004. Further, effect magnitudes increased 67% by correcting contamination. The results were robust to adjustments for maltreatment reexposure and covariate quality informing propensity score analyses. Correcting contamination can aid the discovery and replication of the effects of early life maltreatment on psychopathology.

Psychometric properties of the Chinese version of the Posttraumatic Cognitions Inventory (PTCI) in male first responders

Fan Zhang, Xiaofei Mao, Xin Ji, Weizhi Liu — Wed, 06 May 2026 05:46:25 -0700

Abstract

This study aimed to conduct the first psychometric evaluation of both the full 33-item and short-form nine-item versions of the Posttraumatic Cognitions Inventory (PTCI and PTCI-9, respectively) in a sample of first responders from China. A total of 1,448 male first responders completed the PTCI, Life Events Checklist for DSM-5 (LEC-5), and PTSD Checklist for DSM-5 (PCL-5). Confirmatory factor analysis (CFA), measurement invariance, internal consistency, and criterion validity were used to examine the validity and reliability of the PTCI and PTCI-9. Optimal cutoff scores were determined via receiver operating characteristic (ROC) curve analysis. CFA results indicated inadequate fit for the original three-factor and alternative four-factor models of the PTCI, whereas the PTCI-9 demonstrated good model fit, root mean square error of approximation (RMSEA) = .052, confirmatory fit index (CFI) = .96, Tucker–Lewis index (TLI) = .93, goodness of fit index (GFI) = .98. The PTCI-9 showed measurement invariance across subgroups with and without interpersonal trauma exposure. Both versions of the measure were significantly related to PCL-5 scores, with no difference in correlation strength. Both versions showed good internal consistency, PTCI: ω = .98, PTCI-9: ω = .90. ROC analyses suggested optimal cutoff scores of 53 for the PTCI and 16 for the PTCI-9. These results indicate that the PTCI-9 demonstrates comparable or superior psychometric properties to the full PTCI among first responders, showing greater practical utility due to its brevity.

Oppression‐based stressors, posttraumatic stress symptoms, and self‐injurious thoughts and behaviors among a national sample of queer adolescents of color

Tara R. Sullivan, Marianna Amato, Jeremy T. Goldbach, Ethan H. Mereish — Wed, 22 Apr 2026 22:37:30 -0700

Abstract

Oppression-based stressors (OBS; e.g., heterosexism-based stressors) are associated with a higher risk of trauma-related symptoms and self-injurious thoughts and behaviors (SITB) for queer (e.g., lesbian, gay, bisexual) adolescents. However, prior research has yet to examine posttraumatic stress symptoms (PTSS) and SITB in the context of the unique, intersectional OBS experienced by queer adolescents who are also Black, Indigenous, and/or people of color (BIPOC). This study examined the associations among intersectional OBS, PTSS, and SITB and tested identity outness as a potential moderator of these associations. A national sample of 1,009 queer BIPOC adolescents (M _age = 15.97 years, SD = 0.93; 62.0% cisgender girls, 50.1% plurisexual) was recruited online. After accounting for sociodemographic characteristics and overall perceived stress, OBS, β = .08, and identity outness, β = .08, were significantly associated with higher PTSS. OBS and identity outness were also associated with a higher likelihood of endorsing all three suicide outcomes (suicidal ideation, suicide planning, and suicide attempts), adjusted odds ratios (aORs) = 1.35 and 1.55, respectively, as well as a higher likelihood of nonsuicidal self-injury, aORs = 1.22 and 1.21. Identity outness did not serve as a moderator in the associations among OBS, PTSS, and SITB. The findings suggest that intersectional OBS may serve as a risk factor for PTSS and severe levels of SITB among queer BIPOC adolescents. Further research is needed to identify the unique role of outness among queer BIPOC adolescents and additional factors that may protect against the negative mental health outcomes associated with OBS.

Psychosocial contributions of discrimination to traumatic stress adaptation among transgender and nonbinary adults: A longitudinal examination

Danielle S. Berke, Madalyn M. Liautaud, Yikai Xu — Thu, 09 Apr 2026 21:13:54 -0700

Abstract

Transgender and nonbinary individuals (TNBI) face disproportionate exposure to identity-based discrimination and violence, yet limited research has examined how discrimination prospectively influences trauma adaptation. This longitudinal study examined predictors of posttraumatic stress disorder (PTSD) symptom adaptation among TNBI (N = 75, M _age = 30.6 years, 48.0% White, 44.0% nonbinary, 77.3% met PTSD criteria) with past-year DSM-5 Criterion A trauma exposure who completed structured diagnostic interviews and daily diary assessments at baseline and 3-, 6-, and 12-month follow-ups. Mixed linear modeling was used to estimate PTSD adaptation as a function of trauma characteristics and gender minority stress/resilience. A small, significant PTSD symptom reduction was observed over time, B = -0.44, p < .001. Average PTSD symptoms over time were significantly higher for participants with greater gender nonaffirmation exposure, B = 0.43, p = .039, and those who met the criteria for a mood disorder, B = 10.70, p < .001, at baseline. Participants whose “worst” trauma exposure entailed interpersonal violence, B = 9.26, p = .009; were revictimized, B = 7.83, p = .006; and experienced higher exposure to daily discrimination during the follow-up period, B = 0.52, p < .001, demonstrated significantly higher average PTSD symptom severity over time. Unexpectedly, identity pride was associated with significantly higher PTSD symptoms over time, B = 0.36, p = .031, whereas community connectedness was marginally associated with lower symptoms, B = -0.57, p = .054. Findings underscore the roles of identity affirmation, discrimination, and revictimization in shaping TNBI trauma adaptation.

Posttraumatic stress symptom reduction after gender‐affirming medical interventions: A longitudinal study

Thu, 09 Apr 2026 00:00:00 -0700

ABSTRACT

Transgender and gender expansive (TGE) people experience high levels of posttraumatic stress disorder (PTSD). Gender-affirming medical interventions (GAMIs) may be helpful in reducing PTSD symptoms. This study examined whether GAMIs were associated with reduced PTSD symptom severity longitudinally and whether the association was mediated by gender minority stress (GMS) and depressive symptoms. TGE participants (N = 2,514) from a national cohort study were included if they attained at least one GAMI at one or more points during 2019–2022. Two longitudinal models were run, adjusted for time and baseline covariates: (a) an interrupted time series analysis (ITSA) examining changes in PTSD scores after receiving at least one GAMI (GAMI indicator) at each annual time point and (b) a mixed-effects longitudinal model examining the association between GAMI count and PTSD scores. Structural equation modeling tested whether latent GMS and depressive symptoms mediated these longitudinal associations. Unadjusted and minimally adjusted models demonstrated significant PTSD score reductions (a) immediately after the third GAMI indicator (ITSA model), B _unadjusted = -0.70, p = .017; B _{min. adjusted} = -0.61, p = .037, and (b) as GAMIs accumulated, mixed-effects: B _unadjusted = -0.09, p = .001; B _{min. adjusted} = -0.06, p = .033, with support for depression and GMS mediating these effects. These findings suggest that cumulative GAMIs may be linked to meaningful reductions in PTSD symptoms among TGE individuals. This effect appears to be influenced by improvements in GMS and depression. The results highlight the potential benefits of GAMIs in reducing PTSD burden in TGE populations.

Intersectional discrimination, identity conflict, and posttraumatic stress symptoms among bisexual+ people of color

Fri, 20 Mar 2026 09:14:13 -0700

Abstract

Bisexual and other multigender-attracted (e.g., pansexual, queer) people (bi+) report disproportionately high posttraumatic stress symptoms (PTSS) linked to a high frequency of discrimination and general trauma exposure. Bi+ people of color (POC) may be particularly vulnerable to PTSS given exposure to intersectional discrimination (e.g., LGBTQ+ racism, racial/ethnic heterosexism). Identity conflict (i.e., perceived incongruence between one's sexual and racial/ethnic identities) may link intersectional discrimination to PTSS. Using cross-sectional survey data from 295 bi+ POC (M _age = 27.6 years), we estimated three structural equation models to test associations between intersectional discrimination and PTSS severity (Model 1), provisional posttraumatic stress disorder (PTSD) diagnosis (Model 2), and PTSD symptom domains (intrusions, avoidance, negative alterations in cognitions and mood [NACM], arousal/reactivity; Model 3). Each model adjusted for exposure to potentially traumatic events (PTEs) and estimated indirect effects via identity conflict. Accounting for PTEs, intersectional discrimination was associated with higher PTSS severity, β = .21, p = .003, and all PTSD symptom domains, βs = .15–.21, ps = .005–.025, but not provisional PTSD diagnosis, β = .15, p = .071. Discrimination direct effects were nonsignificant (accounting for identity conflict); however, indirect effects via identity conflict were significant for PTSS severity, β = .11, p < .013 (Model 1), and avoidance, β = .13, p = .007, and NACM symptoms, β = .12, p = .005 (Model 3). Other indirect effects were nonsignificant. Findings highlight intersectional minority stressors as risk factors for PTSS among bi+ POC, above and beyond trauma exposure, which may inform trauma-focused treatments.

The dialectics of trauma and political conscientization: A psychosocial study of activism for supporting sexual and gender minoritized communities in Brazil

Gab C. Siqueira, Luisa F. Velásquez Vallejo, Antonio Euzebios Filho — Wed, 25 Feb 2026 06:55:01 -0800

Abstract

This qualitative study examined the dialectical association between psychosocial trauma and political conscientization in the lives of activists advocating for persons with marginalized sexual orientations and gender identities (2SLGBTQIA+) in São José dos Campos, Brazil. Drawing on participatory research and grounded in liberation psychology and intersectionality, the study involved collaboration with 10 activists through participation in advocacy activities, semistructured interviews, and collective reflection. Our reflexive thematic analysis indicated four main themes: (a) addressing psychosocial harm and trauma in the realm of sexual orientation and gender identity, highlighting how activists navigate the effects of historical violence and activist work and employ strategies of self- and collective care; (b) decoding and confronting intersecting power structures, capturing how activists interpret and resist institutional and everyday oppression; (c) reclaiming and preserving collective memory, describing activists’ efforts to resignify and document 2SLGBTQIA+ histories through art, research, and the transformation of cultural traditions; and (d) cultivating citizenship and political consciousness, reflecting the pursuit of rights and recognition by pressuring state institutions and creating autonomous spaces for community support. These interwoven themes illustrate how activism is lived as a dialectical process, both a site of conflict exposure and a space for resignifying suffering, fostering critical awareness, and enacting collective agency. The analysis highlights that responses to psychosocial trauma and resistance are deeply interconnected and continually negotiated through conscientization and collective engagement. Findings indicate that social movements, health professionals, and researchers should support intersectional, community-led initiatives centering psychosocial care, critical reflection, and the dialectical reinterpretation of collective memory.

Associations between health care access and posttraumatic stress disorder symptoms among rural and urban lesbian, gay, bisexual, transgender, and queer adults

Sat, 07 Feb 2026 05:44:48 -0800

Abstract

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals experience elevated rates of trauma exposure, minority stress, and posttraumatic stress disorder (PTSD). Yet, research examining how geographic location and LGBTQ+ identity shape PTSD outcomes is scant, particularly studies considering structural facilitators and barriers, such as health care access. This cross-sectional, secondary study investigated associations between several individual- and structural-level factors and PTSD symptoms in LGBTQ+ adults (N = 131) recruited from urban and rural U.S. regions, most of whom identified as non-Hispanic White, bisexual, cisgender women. Analyses examined whether intersecting demographic characteristics, urban or rural location, perceived health care access, LGBTQ+ identity disclosure to providers, and experiences of LGBTQ+ discrimination were associated with PTSD symptom severity and probable PTSD diagnosis. Approximately 62% of participants reported experiencing a DSM-5 Criterion A traumatic event; of these individuals, 24.4% met the criteria for probable PTSD. General health care access, β = −.27, 95% CI [−.45, −.09], p = .003, and LGBTQ+ identity disclosure, β = −.19, 95% CI [−.31, −.07], p = .039, were significantly associated with PTSD symptom severity. Higher health care access was associated with 50.0% lower odds of probable PTSD, OR _adj = 0.50, 95% CI [0.29, 0.84], p = .009. Bisexual cisgender women had 4-times higher odds of a probable PTSD diagnosis compared to LGQ+ participants, OR _adj = 3.96, 95% CI [1.15, 13.7], p = .030. Improving access to health care and supporting identity disclosure may reduce PTSD risk among LGBTQ+ adults, especially for bisexual cisgender women and rurally situated individuals.

Transness is our salve: How trans identity facilitates healing from relational trauma with parental figures

Wed, 28 Jan 2026 05:32:26 -0800

Abstract

Transgender and nonbinary (TNB) individuals experience high rates of relational trauma from parental figures, yet their pathways to healing remain underexplored. This qualitative study used constructivist grounded theory to develop a theoretical framework of how TNB adults heal from parental relational trauma. In-depth interviews with 15 racially and socioeconomically diverse U.S.-based TNB adults who experienced parental relational trauma generated the core phenomenon: “TNB identity and experiences initiate and sustain pathways of healing from parental relational trauma.” This captures that rather than being a source of this trauma, recognizing and actualizing one's TNB identity is the central catalyst for healing from it. The healing process began with three conditions: (a) connecting with one's TNB identity/self, (b) gaining new clarity in parental harm through TNB-related parental harm, and (c) experiencing joy and oppression as TNB while lacking parental support. These conditions gave rise to strategies including (d) creating safer homes through queer/TNB chosen family, (e) committing to individual healing through therapy, and (f) reimagining life through ongoing actualization as TNB. The consequences of these strategies, in turn, created conditions that enabled subsequent strategies, including (g) attempting repair and intergenerational work with families of origin, (h) distancing as self-preservation, and (i) returning to TNB communities to sustain healing across generations. The consequences of these processes included personal, intergenerational, and collective healing. The study offers implications for research, clinical practice, and advocacy, calling for approaches that frame TNB identity not as a source of familial conflict but as a central resource for recovery.

Inclusion of sexual‐ and gender‐minoritized individuals in randomized clinical trials of first‐line treatments for posttraumatic stress disorder: A systematic literature review

Marley Warren, Lia J. Smith, Sarah A. Pridgen, Philip Held — Mon, 19 Jan 2026 22:50:41 -0800

Abstract

Clinical treatment guidelines consistently recommend cognitive processing therapy (CPT), prolonged exposure (PE), and eye movement desensitization and reprocessing (EMDR) for posttraumatic stress disorder (PTSD). The efficacy of these interventions among sexual- and/or gender-minoritized (SGM) individuals has not been thoroughly investigated within randomized clinical trials (RCTs), despite known elevations in exposure to potentially traumatic events and PTSD symptoms relative to cisgender heterosexual individuals. We conducted a systematic literature review to examine the frequency with which SGM adults were enrolled in RCTs of CPT, PE, and EMDR and investigate these interventions’ efficacy in reducing PTSD symptoms among SGM adults. We searched eight databases to identify RCTs published before August 7, 2025. The inclusion criteria were: written in English; RCT investigating the impact of CPT, PE, or EMDR on PTSD symptoms; utilized a standardized PTSD measure; reported PTSD outcome data; and enrolled individuals who were at least 18 years old. Literature reviews, case studies, protocols, and non–peer reviewed articles were excluded. Our search returned 1,821 unique records, with 519 meeting all eligibility criteria. Ten records reported sexual orientation and gender identity (SOGI) information and enrolled at least one SGM individual. Among studies that reported SOGI information, 12.1% and 2.2% of participants identified as sexual- and gender-minoritized, respectively. Results highlight that SOGI information is underreported in PTSD treatment research, posing significant challenges in determining the relative efficacy of these treatments and the extent to which SGM-affirmative adaptations are necessary. We offer recommendations for clinicians and researchers, including consistent reporting of full SOGI data.

Comparing treatment outcomes of prolonged exposure therapy across trauma type and veteran status

Nitsa Nacasch, Roy Aloni, Chen Avni, Lilach Rachamim, Edna Foa, Paz Toren — Tue, 02 Sep 2025 02:05:07 -0700

Abstract

This retrospective cohort study evaluated the effectiveness of prolonged exposure therapy (PE) across trauma types (combat, terror, civilian) and veteran status (military veterans vs. civilians) in a real-world clinical setting. We hypothesized that individuals who experienced combat- and terror-related trauma would have higher baseline posttraumatic stress disorder (PTSD) symptom scores than those who experienced civilian trauma but that PE would result in comparable symptom reductions across all groups. Participants were 98 patients with chronic PTSD who were treated at two community mental health centers in Israel by clinicians trained and supervised in PE. Participants were categorized by trauma type combat: n = 34, terror: n = 25, civilian: n = 39) and veteran status (military veteran: n = 43, civilian: n = 55). PTSD symptoms were assessed using the PTSD Symptom Scale–Interview Version (PSS-I). Participants showed significant symptom reductions across all trauma types and veteran statuses. No interaction effects were detected for trauma type or veteran status. Effect sizes were large across all groups, ds = 2.20–2.28. The findings support the hypothesis that PE is effective in reducing PTSD symptoms regardless of trauma type or veteran status. These results are particularly significant given that modern conflicts often occur in civilian-populated areas rather than traditional battlefields, making the findings relevant to various regions worldwide, including Israel, Ukraine, and Gaza.

Understanding and improving the mental health of refugees and asylum‐seekers: Reflections from the closing panel of the 2024 International Society for Traumatic Stress Studies Annual Meeting

Angela Nickerson, B. Heidi Ellis, Naser Morina, Frank Neuner, Lori Zoellner — Sun, 15 Jun 2025 21:14:58 -0700

Abstract

Forcible displacement due to war and persecution has reached unprecedented heights across the globe. The mental health impact of trauma and displacement on refugee communities is profound. Although there are several evidence-based therapies that are efficacious in reducing symptoms of posttraumatic stress disorder and depression in refugees, many refugees do not have access to these, and, for those who do, a significant proportion do not respond. This article summarizes the closing panel at the 2024 International Society for Traumatic Stress Studies Annual Meeting, where four researchers and clinicians with expertise in refugee mental health reflected on core outstanding questions in the field and promising approaches to addressing these knowledge gaps. Common themes emerged from this discussion, including the importance of considering and addressing environmental stressors when providing psychological treatment for refugees, the critical role of the social and cultural context in refugee mental health, and the necessity of partnering with refugee communities to improve the quality and efficacy of research and clinical activities. This article concludes with suggestions for early-career researchers and clinicians who are working with refugee communities to facilitate trauma recovery and improve well-being.