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Background: A burn event can elicit symptoms of posttraumatic stress disorder (PTSD) in survivors and their partners and may impact the way these couple members interact with each other. They may try to protect each other from further emotional distress by avoiding talking about the burn event, but they may also show concern towards each other. Objective: The aim of this study was to investigate bidirectional relationships between survivor’s and partner’s PTSD symptoms and two interpersonal processes: partner-oriented ‘self-regulation’, which is avoidance-oriented, and ‘expressed concern’, which is approach-oriented. Method: In this longitudinal multi-centre study, 119 burn survivors and their partners participated. Measures of PTSD symptoms, self-regulation, and expressed concern were administered in the acute phase following the burns, and follow-ups took place up to 18 months postburn. Intra- and interpersonal effects were examined in a random intercept cross-lagged panel model. Exploratory effects of burn severity were also investigated. Results: Within individuals, survivor’s expressed concern predicted later higher levels of survivor’s PTSD symptoms. In their partners, self-regulation and PTSD symptoms reinforced each other in the early phase postburn. Between the two couple members, partner’s expressed concern predicted later lower levels of survivor’s PTSD symptoms. Exploratory regression analyses showed that burn severity moderated the effect of survivor’s self-regulation on survivor’s PTSD symptoms, indicating that self-regulation was continuously related to higher levels of PTSD symptoms over time within more severely burned survivors, but not in less severely burned survivors. Conclusion: PTSD symptoms and self-regulation reinforced each other in partners and possibly also in more severely burned survivors. Partner’s expressed concern was related to lower levels of survivor’s PTSD symptoms, whereas survivor’s expressed concern was related to higher levels of survivor’s PTSD symptoms. These findings emphasize the importance of screening for and monitoring PTSD symptoms in burn survivors and their partner and of encouraging couple’s self-disclosure. PTSD symptoms in burn survivors and their partners are related to both avoidance- and approach-oriented interpersonal processes.In partners, higher levels of self-regulation were bidirectionally related to higher levels of posttraumatic stress symptoms.Concern expressed by partners may mitigate posttraumatic stress symptoms in burn survivors. PTSD symptoms in burn survivors and their partners are related to both avoidance- and approach-oriented interpersonal processes. In partners, higher levels of self-regulation were bidirectionally related to higher levels of posttraumatic stress symptoms. Concern expressed by partners may mitigate posttraumatic stress symptoms in burn survivors.

Background: Partners of burn survivors may develop posttraumatic stress disorder (PTSD) symptoms in response to the potential life threatening nature of the burn event and the burn survivor’s medical treatment. Objective: This longitudinal study examined the prevalence, course and potential predictors of partners’ PTSD symptoms up to 18 months post-burn. Methods: Participants were 111 partners of adult burn survivors. In a multi-centre study, PTSD symptoms were assessed with the Impact of Event Scale-Revised during the acute phase and subsequently at 3, 6, 12 and 18 months post-burn. Partners’ appraisal of life threat, anger, guilt and level of rumination were assessed as potential predictors of PTSD symptoms in an exploratory piecewise latent growth model. Results: Acute PTSD symptoms in the clinical range were reported by 30% of the partners, which decreased to 4% at 18 months post-burn. Higher acute PTSD symptoms were related to perceived life threat and higher levels of anger, guilt, and rumination. Over time, mean symptom levels decreased, especially in partners with high levels of acute PTSD symptoms, perceived life threat and rumination. From three months onward, PTSD symptoms decreased less in partners of more severely burned survivors. At 18 months post-burn, higher levels of PTSD symptoms were related to higher acute PTSD symptoms and more severe burns. Conclusions: One in three partners reported clinical levels of acute PTSD symptoms, of which the majority recovered over time. Perceived life threat, feelings of anger and guilt, and rumination may indicate the presence of acute PTSD symptoms, whereas more severe burns predict long-term PTSD symptom levels. The results highlight the need to screen for acute PTSD symptoms and offer psychological help to partners to alleviate acute elevated stress levels if indicated., HIGHLIGHTS One in three partners reported clinical levels of acute PTSD symptoms, which decreased to 4% at 18 months post-burn. Perceived life threat and higher levels of anger, guilt and rumination predicted higher acute PTSD symptoms. Over time, PTSD symptoms decreased less in partners of more severely burn survivors.

Background: It is estimated that more than 40% of rape victims develops a posttraumatic stress disorder (PTSD), a statistic that is relatively high compared to other types of trauma. PTSD can affect the victims' psychological, sexual, and physical health. Therefore, there is an urgent need for early interventions to prevent the onset of PTSD in this target group. Objective: This randomised controlled trial (RCT) examines the efficacy of early Eye Movement Desensitisation and Reprocessing (EMDR) therapy aimed to reduce the severity of posttraumatic stress symptoms in victims of recent rape. Methods: Subjects (N = 34) are individuals of 16 years and older who present themselves within 7 days post-rape at one of the four participating Sexual Assault Centres in the Netherlands. The intervention consists of two sessions of EMDR therapy between day 14 and 28 post-rape, while the control group receives treatment as usual, consisting of careful monitoring of stress reactions by a case-manager across two contacts during 1-month post-rape. Baseline assessment, posttreatment assessment and follow-up assessments at 8 and 12-weeks post-rape will be used to assess the development of posttraumatic stress symptoms. In addition, the efficacy of the intervention on psychological and sexual functioning will be determined. Linear mixed model analysis will be used to explore the differences within and between the EMDR group and control group at the various time points. Conclusions: The results of this RCT may help the dissemination and application of evidence-based preventative treatments for PTSD after rape.

Threat conditioning procedures have allowed the experimental investigation of the pathogenesis of Post-Traumatic Stress Disorder. The findings of these procedures have also provided stable foundations for the development of relevant intervention programs (e.g. exposure therapy). Statistical inference of threat conditioning procedures is commonly based on p-values and Null Hypothesis Significance Testing (NHST). Nowadays, however, there is a growing concern about this statistical approach, as many scientists point to the various limitations of p-values and NHST. As an alternative, the use of Bayes factors and Bayesian hypothesis testing has been suggested. In this article, we apply this statistical approach to threat conditioning data. In order to enable the easy computation of Bayes factors for threat conditioning data we present a new R package named condir, which can be used either via the R console or via a Shiny application. This article provides both a non-technical introduction to Bayesian analysis for researchers using the threat conditioning paradigm, and the necessary tools for computing Bayes factors easily.

Background : In eye movement desensitization and reprocessing (EMDR), patients make eye movements (EM) while recalling traumatic memories. Making EM taxes working memory (WM), which leaves less resources available for imagery of the memory. This reduces memory vividness and emotionality during future recalls. WM theory predicts that individuals with small working memory capacities (WMCs) benefit more from low levels of taxing (i.e., slow EM) whereas individuals with large WMC benefit more from high levels of taxing (i.e., fast EM). Objective : We experimentally examined and tested four prespecified hypotheses regarding the role of WMC and EM speed in reducing emotionality and vividness ratings: 1) EM—regardless of WMC and EM speed—are more effective compared to no dual task, 2) increasing EM speed only affects the decrease in memory ratings irrespective of WMC, 3) low-WMC individuals—compared to high-WMC individuals—benefit more from making either type of EM, 4) the EM intervention is most effective when—as predicted by WM theory—EM are adjusted to WMC. Method : Undergraduates with low ( n =31) or high ( n =35) WMC recalled three emotional memories and rated vividness and emotionality before and after each condition (recall only, recall + slow EM, and recall + fast EM). Results : Contrary to the theory, the data do not support the hypothesis that EM speed should be adjusted to WMC (hypothesis 4). However, the data show that a dual task in general is more effective in reducing memory ratings than no dual task (hypothesis 1), and that a more cognitively demanding dual task increases the intervention’s effectiveness (hypothesis 2). Conclusions : Although adjusting EM speed to an individual’s WMC seems a straightforward clinical implication, the data do not show any indication that such a titration is helpful. Keywords: Visual imagery; dual taxation; working memory capacity; EMDR (Published: 4 July 2016) Responsible Editor: Mirjam Nijdam, Academic Medical Center at the University of Amsterdam, Netherlands. This paper is part of the Special Issue: Eye Movement Desensitization and Reprocessing therapy research. More papers from this issue can be found at www.ejpt.net For the abstract or full text in other languages, please see Supplementary files in the column to the right (under ‘Article Tools’) Citation: European Journal of Psychotraumatology 2016, 7 : 29476 - http://dx.doi.org/10.3402/ejpt.v7.29476

Background : Eye movement desensitization and reprocessing (EMDR) is an effective treatment for posttraumatic stress disorder (PTSD). During EMDR, the patient recalls traumatic memories while making eye movements (EMs). Making EMs during recall is associated with decreased vividness and emotionality of traumatic memories, but the underlying mechanism has been unclear. Recent studies support a “working-memory” (WM) theory, which states that the two tasks (recall and EMs) compete for limited capacity of WM resources. However, prior research has mainly relied on self-report measures. Methods : Using functional magnetic resonance imaging, we tested whether “recall with EMs,” relative to a “recall-only” control condition, was associated with reduced activity of primary visual and emotional processing brain regions, associated with vividness and emotionality respectively, and increased activity of the dorsolateral prefrontal cortex (DLPFC), associated with working memory. We used a randomized, controlled, crossover experimental design in eight adult patients with a primary diagnosis of PTSD. A script-driven imagery (SDI) procedure was used to measure responsiveness to an audio-script depicting the participant’s traumatic memory before and after conditions. Results : SDI activated mainly emotional processing-related brain regions (anterior insula, rostral anterior cingulate cortex (ACC), and dorsomedial prefrontal cortex), WM-related (DLPFC), and visual (association) brain regions before both conditions. Although predicted pre- to post-test decrease in amygdala activation after “recall with EMs” was not significant, SDI activated less right amygdala and rostral ACC activity after “recall with EMs” compared to post-“recall-only.” Furthermore, functional connectivity from the right amygdala to the rostral ACC was decreased after “recall with EMs” compared with after “recall-only.” Conclusions : These preliminary results in a small sample suggest that making EMs during recall, which is part of the regular EMDR treatment protocol, might reduce activity and connectivity in emotional processing-related areas. This study warrants replication in a larger sample. Keywords: Posttraumatic stress disorder; eye movement desensitization and reprocessing; working memory; amygdala; functional MRI This paper is part of the Special Issue: The neurobiology of PTSD. More papers from this issue can be found at www.ejpt.net (Published: 29 November 2016) Responsible Editor: Ruth Lanius, Western University of Canada, Canada. For the abstract or full text in other languages, please see Supplementary files in the column to the right (under ‘Article Tools’) Citation: European Journal of Psychotraumatology 2016, 7 : 31371 - http://dx.doi.org/10.3402/ejpt.v7.31371

Background: Earlier studies have shown that horizontal eye movement (EM) during retrieval of a negative memory reduces its vividness and emotionality. This may be due to both tasks competing for working memory (WM) resources. This study examined whether playing the computer game ‘‘Tetris’’ also blurs memory. Method: Participants recalled negative and positive memories in three conditions: recall only, recall with concurrent EM, and recall with playing Tetris. Before and after these conditions, vividness, emotionality, and physiological startle responses during recall were measured. Results: A reaction time task showed that EM and Tetris both draw on WM, compared to no dual-task. Compared to recall only, EM and Tetris decreased reported emotionality and startle responses. Conclusions: The effects of EM and Tetris did not differ, even though the tasks differed in the degree of taxing WM. This suggests that taxing WM and its effects on emotional memories may not be linearly related. Potential clinical implications are discussed. Keywords: Intrusive memory; EMDR; working memory; PTSD (Published: 6 December 2010) Citation: European Journal of Psychotraumatology 2010, 1 : 5623 - DOI: 10.3402/ejpt.v1i0.5623 For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Reading Tools).

Background: Neurophysiological models link dissociation (e.g. feeling detached during or after a traumatic event) to hypoarousal. It is currently assumed that the initial passive reaction to a threat may coincide with a blunted autonomic response, which constitutes the dissociative subtype of post-traumatic stress disorder (PTSD).Objective: Within this systematic review we summarize research which evaluates autonomic nervous system activation (e.g. heart rate, blood pressure) and dissociation in PTSD patients to discern the validity of current neurophysiological models of trauma-related hypoarousal.Method: Of 553 screened articles, 28 studies (N = 1300 subjects) investigating the physiological response to stress provocation or trauma-related interventions were included in the final analysis.Results: No clear trend exists across all measured physiological markers in trauma-related dissociation. Extracted results are inconsistent, in part due to high heterogeneity in experimental methodology.Conclusion: The current review is unable to provide robust evidence that peri- and posttraumatic dissociation are associated with hypoarousal, questioning the validity of distinct psychophysiological profiles in PTSD.

Learning tasks have been used to predict why some, and not others, develop posttraumatic stress disorder (PTSD) after exposure to a traumatic event. There is some evidence from prospective studies in high risk profession samples that reduced extinction learning might represent a marker or even a vulnerability factor for PTSD development.Since the evidence is scarce, the aim of this study was to perform a conceptual replication of an earlier prospective study, testing whether pretrauma extinction learning predicts later PTSD symptom severity.A sample of 529 fire fighters performed a conditioning task at baseline and filled out questionnaires to assess PTSD symptom severity and neuroticism. At six and 12 months follow-up, exposure to stressful events and PTSD symptom severity were measured.Results indicate that previous findings were not replicated: although reduced extinction learning was associated with higher PTSD symptom severity at baseline, extinction learning did not predict PTSD symptom severity at follow-up. Only PTSD symptom severity at baseline and stressor severity predicted PTSD symptom severity at follow-up.Since earlier findings on the predictive value of pre-trauma extinction learning on PTSD symptom severity were not replicated, extinction learning might not be a general risk factor PTSD for all individuals. More prospective studies including multiple factors seem needed to unravel the complex relationships of these factors influencing PTSD development.Reduced extinction learning correlated with higher PTSD symptom severity at baseline.Reduced extinction learning did not predict PTSD symptom severity at follow-up.The predictive effect of pre-trauma extinction learning on PTSD was not replicated.

Anger is associated with dysfunction following potentially traumatic events. It is still unclear to what extent different types of anger are differentially related to poor outcomes. To advance knowledge in this area, the Posttraumatic Anger Questionnaire (PAQ) was designed, measuring anger directed at (i) the justice system, (ii) other people, (iii) the self, (iv) people held accountable for the potential traumatic event, and (v) a desire for revenge to those held responsible. Preliminary evidence shows that these types of anger are distinguishable and differentially associated with posttraumatic stress (PTS). No studies have yet examined whether such findings can be generalized to victims of non-fatal traffic accidents, one of the most common potentially traumatic events.This study's aims were (i) to establish if the five-factor structure of the PAQ found in prior studies could be replicated, (ii) to explore whether the intensity of emerging types of anger differed, and (iii) to explore the associations of anger-types with levels of PTS, depression, and functional impairment.Two-hundred and fifty adults who experienced a traffic accident completed the PAQ and instruments measuring PTS, depression, and functional impairment. They also answered questions about their socio-demographic characteristics and features of the accident.Confirmatory factor analysis confirmed that the PAQ measures five types of anger. Levels of anger at people held accountable were the highest. Structural equation modelling showed that both anger at others and anger at the self, but not the other three anger types, were associated with PTS, depression, and functional impairment, when controlling for the shared variance between the anger types, socio-demographic variables, and features of the accident.Findings illustrate the potential importance of considering different types of anger when assessing and treating PTS following traffic accidents.Based on data from people confronted with a traffic accident, we found the Posttraumatic Anger Questionnaire (PAQ) to represent distinguishable dimensions of anger.Anger dimensions were: anger directed at (i) the justice system, (ii) other people, (iii) the self, (iv) people held accountable for the event, and (v) a desire for revenge to those held responsible.Scores on items measuring anger at people held accountable for the event were significantly higher than scores on items measuring other anger types.Anger at the self and other people were most strongly associated with posttraumatic stress, depression, and functional impairment.La ira se asocia con disfunción después de eventos potencialmente traumáticos. Todavía no está claro en qué medida los diferentes tipos de ira dirigidos a diferentes objetivos se relacionan diferencialmente con malos resultados. Para avanzar en el conocimiento en esta área, se diseñó el Cuestionario de Ira Postraumática (PAQ en su sigla en inglés), que mide la ira dirigida a (i) el sistema de justicia, (ii) otras personas, (iii) uno mismo, (iv) las personas responsables del potencial evento traumático, y (v) un deseo de venganza hacia los responsables. La evidencia preliminar muestra que estos tipos se distinguen y se asocian diferencialmente con el estrés postraumático (PTS en su sigla en inglés). Ningún estudio ha examinado aún si tales hallazgos pueden generalizarse a las víctimas de accidentes de tránsito no fatales, uno de los eventos potencialmente traumáticos más comunes.Los objetivos de este estudio fueron (i) establecer si la estructura de cinco factores del PAQ encontrada en estudios anteriores podría replicarse, (ii) explorar si la intensidad de los tipos emergentes de ira difería, y (iii) explorar las asociaciones de tipos de ira con niveles de PTS, depresión y deterioro funcional.Doscientos cincuenta adultos que sufrieron un accidente de tránsito completaron el PAQ e instrumentos que miden PTS, depresión y deterioro funcional. También respondieron preguntas sobre sus características sociodemográficas y características del accidente.El análisis factorial confirmatorio confirmó que el PAQ mide cinco tipos de ira. Los niveles de ira hacia las personas responsables fueron los más altos. El modelo de ecuaciones estructurales mostró que tanto la ira hacia los demás como la ira hacia uno mismo, pero no los otros tres tipos de ira, se asociaron con PTS, depresión y deterioro funcional, al controlar la varianza compartida entre los tipos de ira, variables sociodemográficas, y características del accidente.Los hallazgos ilustran la importancia potencial de considerar diferentes tipos de ira al evaluar y tratar el PTS después de accidentes de tráfico.愤怒与潜在创伤事件后的功能损伤有关。目前尚不清楚针对不同目标的不同类型的愤怒在多大程度上与不良结果相关。为了推进该领域的知识，设计了创伤后愤怒问卷 (PAQ)，测量针对 (i) 司法系统、(ii) 其他人、(iii) 自我、(iv) 对潜在创伤事件负责人的愤怒，以及 (v) 对被追责者进行报复的愿望。初步证据表明，这些类型是可区⁣⁣分的，并且与创伤后应激 (PTS) 有不同的关联。目前还没有研究考查这些发现是否可以推广到最常见的潜在创伤事件之一——非致命交通事故的受害者。.本研究旨在（i）确定是否可以重复先前研究中发现的 PAQ 五因素结构，（ii）探索新出现的愤怒类型强度是否不同，以及（iii）探索愤怒类型与 PTS、抑郁和功能损伤水平的关联。.250 名经历过交通事故的成年人完成了 PAQ 和测量 PTS、抑郁和功能损伤的测量工具。他们还回答了有关其社会人口特征和事故特征的问题。.验证性因素分析证实 PAQ 测量了五种愤怒。对被追责者的愤怒程度最高。结构方程模型表明，在控制愤怒类型、社会人口变量、和事故特点。结构方程模型显示， 在控制愤怒类型、社会人口变量和事故特征之间的共享方差时，对他人的愤怒和对自己的愤怒与 PTS、抑郁和功能障碍相关，但其他三种愤怒类型无关b。/b.研究结果说明了在评估和治疗交通事故后PTS 时考虑不同类型愤怒的潜在重要性。.

Background: Research suggests dissociation and insecure attachment serve as explanatory mechanisms in the pathway from childhood trauma to paranoia. However, past work has not examined these mechanisms concurrently in nonclinical populations. Objective: The current study sought to examine dissociation and insecure attachment as parallel mediators of the association between childhood emotional abuse and paranoid traits. Furthermore, a serial mediation model with insecure attachment preceding dissociation in the explanatory pathway was explored. Methods: Eighty-nine nonclinically ascertained young adults were assessed for childhood emotional abuse, dissociation, attachment styles, and paranoid traits. Parallel and serial mediation models were tested. Results: The association of childhood emotional abuse with both interview-based and self-reported paranoid traits was significantly mediated by dissociation and preoccupied attachment. Fearful attachment was a significant mediator in the model for self-reported paranoid traits. No evidence for a serial mediation effect was found. Conclusions: The present findings extend support for dissociation and attachment insecurity as mechanisms underlying the link between childhood emotional maltreatment and paranoid traits. Longitudinal research is needed to inform whether insecure attachment contributes to dissociation along the pathways to paranoid traits., HIGHLIGHTS Dissociation and insecure attachment mediate the effect of childhood emotional abuse on paranoid traits. Research on etiological trajectories in nonclinical cohorts may offer valuable insights into the traumagenic model of paranoia.

Background About 40% of rape victims develop post-traumatic stress disorder (PTSD) within three months after the assault. Considering the high personal and societal impact of PTSD, there is an urgent need for early (i.e. within three months after the incident) interventions to reduce post-traumatic stress in victims of rape. Objective To assess the effectiveness of early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce symptoms of post-traumatic stress, feelings of guilt and shame, sexual dysfunction, and other psychological dysfunction (i.e. general psychopathology, anxiety, depression, and dissociative symptoms) in victims of rape. Method This randomized controlled trial included 57 victims of rape, who were randomly allocated to either two sessions of EMDR therapy or treatment as usual (‘watchful waiting’) between 14 and 28 days post-rape. Psychological symptoms were assessed at pre-treatment, post-treatment, and 8 and 12 weeks post-rape. Linear mixed models and ANCOVAs were used to analyse differences between conditions over time. Results Within-group effect sizes of the EMDR condition (d = 0.89 to 1.57) and control condition (d = 0.79 to 1.54) were large, indicating that both conditions were effective. However, EMDR therapy was not found to be more effective than watchful waiting in reducing post-traumatic stress symptoms, general psychopathology, depression, sexual dysfunction, and feelings of guilt and shame. Although EMDR therapy was found to be more effective than watchful waiting in reducing anxiety and dissociative symptoms in the post-treatment assessment, this effect disappeared over time. Conclusions The findings do not support the notion that early intervention with EMDR therapy in victims of rape is more effective than watchful waiting for the reduction of psychological symptoms, including symptoms of post-traumatic stress. Further research on the effectiveness of early interventions, including watchful waiting, for this specific target group is needed., HIGHLIGHTS Two sessions of EMDR therapy between two and four weeks post-rape were no more effective than treatment as usual in reducing symptoms of post-traumatic stress and other psychopathology.

Background Prolonged grief disorder (PGD) is newly included in the text revision of the DSM-5 (DSM-5-TR). So far, it is unknown if DSM-5-TR PGD is distinguishable from bereavement-related posttraumatic stress disorder (PTSD). Prior research examining the distinctiveness of PTSD and pathological grief focused on non-traumatic loss samples, used outdated conceptualizations of grief disorders, and has provided mixed results. Objective In a large sample of traumatically bereaved people, we first evaluated the factor structure of PTSD and PGD separately and then evaluated the factor structure when combining PTSD and PGD symptoms to examine the distinctiveness between the two syndromes. Methods Self-reported data were used from 468 people bereaved due to the MH17 plane disaster (N = 200) or a traffic accident (N = 268). The 10 DSM-5-TR PGD symptoms were assessed with the Traumatic Grief Inventory-Self Report Plus (TGI-SR+). The 20-item Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) was used to tap PTSD symptoms. Confirmatory factor analyses were conducted. Results For PTSD, a seven factor, so-called ‘Hybrid’ model yielded the best fit. For PGD, a univariate factor model fits the data well. A combined model with PGD items loading on one factor and PTSD items on seven factors (associations between PGD and PTSD subscales r ≥ .50 and ≤.71), plus a higher-order factor (i.e. PTSD factors on a higher-order PTSD factor) (association between higher-order PTSD factor and PGD factor r = .82) exhibited a better fit than a model with all PGD and PTSD symptom loading on a single factor or two factors (i.e. one for PGD and one for PTSD). Conclusions This is the first study examining the factor structure of DSM-5-TR PGD and DSM-5 PTSD in people confronted with a traumatic loss. The findings provide support that PGD constitutes a syndrome distinguishable from, yet related with, PTSD., HIGHLIGHTS This is the first factor analytic study on PGD and PTSD after traumatic loss.PTSD and PGD factors are related, but distinguishable.DSM-5-TR PGD is distinct from DSM-5 PTSD.

We welcome the opportunity offered by the editor to further explain the details and rationale of our protocol, by responding to Nijenhuis and colleagues’ letter to the editor, in which they comment...

The American Psychiatric Association (APA) has proposed to change the position of disturbed grief in DSM-5, replacing criteria for Persistent Complex Bereavement Disorder (PCBD), currently in Section III (APA, 2013), for criteria for Prolonged Grief Disorder, to be moved into Section II (APA, 2020). In our view, it is a welcome step if criteria for DSM-5 PGD are added to Section II, as disordered grief would then be recognized as a formal DSM diagnosis. We also have some concerns about the DSM-5 PGD proposal, that we hope can be allayed in the process toward the appearance of the revised DSM-5. These concerns are articulated in this letter.

Background: The diagnosis of complex posttraumatic stress disorder (CPTSD) has been suggested for inclusion in the 11th version of the International Classification of Diseases (ICD-11), with support for its construct validity coming from studies employing Latent Class Analysis (LCA) and Latent Profile Analysis (LPA).Objective: The current study aimed to critically evaluate the application of the techniques LCA and LPA as applied in previous studies to substantiate the construct validity of CPTSD.Method: Both LCA and LPA were applied systematically in one sample (n = 245), replicating the setup of previous studies as closely as possible. The interpretation of classes was augmented with the use of graphical visualization.Results: The LCA and LPA analyses indicated divergent results in the same dataset. LCA and LPA partially supported the existence of classes of patients endorsing different PTSD and CPTSD symptom patterns. However, further inspection of the results with scatterplots did not support a clear distinction between PTSD and CPTSD, but rather suggested that there is much greater variability in clinical presentations amongst adult PTSD patients than can be fully accounted for by either PTSD or CPTSD.Discussion: We argue that LCA and LPA may not be sufficient methods to decide on the construct validity of CPTSD, as different subgroups of patients are identified, depending on the statistical exact method used and the interpretation of the fit of different models. Additional methods, including graphical inspection should be employed in future studies. Antecedentes: El diagnostico de Trastorno por Estres Postraumatico Complejo (TEPTC) ha sido sugerido para su inclusion en la 11 version de la Clasificacion Internacional de Enfermedades (CIE-11), con el respaldo de su validez de constructo proveniente de estudios que emplean Analisis de Clases Latentes (LCA) y Analisis de Perfil Latente (APL).Objetivo: El presente estudio tuvo como objetivo evaluar criticamente la aplicacion de las tecnicas LCA y APL, utilizadas en estudios anteriores, para corroborar la validez de constructo del TEPTC.Metodo: Se aplicaron sistematicamente, tanto la tecnica LCA como la tecnica APL, en una muestra (n = 245), que busco replicar lo mas fielmente posible las configuraciones empleadas en estudios previos. La interpretacion de las clases se potencio con el uso de visualizacion grafica.Resultados: Los analisis LCA y APL indicaron resultados divergentes en el mismo conjunto de datos. LCA y APL apoyaron parcialmente la existencia de clases de pacientes que validan diferentes patrones de sintomas para el TEPT y el TEPTC. Sin embargo, una mayor inspeccion de los resultados con diagramas de dispersion no respaldo una distincion clara entre el TEPT y el TEPTC, sino que sugirieron que existe una variabilidad mucho mayor en las presentaciones clinicas entre los pacientes adultos con TEPT de lo que pueda explicarse ya sea por el TEPT o el TEPTC.Discusion: Proponemos que los analisis LCA y APL pueden ser metodos insuficientes para decidir sobre la validez de constructo del TEPTC, ya que se identifican diferentes subgrupos de pacientes, que depende del metodo estadistico utilizado y la interpretacion del ajuste de diferentes modelos. En futuros estudios deben emplearse metodos adicionales que incluyan la inspeccion grafica.??: ?????????? (CPTSD) ??????????11?> (ICD-11) , ?????????? (LCA) ??????? (LPA) ?????????????: ????????LCA?LPA???????CPTSD?????????????: ???245????????LCA?LPA, ????????????????????????????????: LCA?LPA???????????????? LCA?LPA???????PTSD?CPTSD????????????, ???????????????PTSD?CPTSD????????, ??????PTSD???????????????PTSD?CPTSD?????????????: ????, LCA?LPA??????CPTSD?????, ????????????????????????, ???????????????????????, ???????

Objective: To review the safety and efficacy of early interventions after sexual assault in reducing or preventing posttraumatic stress disorder (PTSD). Method: Systematic searches were performed on studies (1980–2018) that examined the efficacy of interventions for PTSD within 3 months after sexual assault. Results: The review identified 7 studies (n = 350) with high risk of bias that investigated 5 interventions. Only two studies reported on safety. Contact with the authors of six studies provided no indications for the occurrence of adverse events. Two studies reported the efficacy using PTSD diagnosis as dependent variable but found no difference between groups. All studies reported on efficacy using PTSD severity as dependent variable. For the meta-analysis, 4 studies (n = 293) were included yielding significantly greater reductions of PTSD severity than standard care at 2 to 12 months follow-up (g = −0.23, 95% CI [−0.46, 0.00]), but not at 1 to 6 weeks post-intervention (g = −0.28, 95% CI [−0.57, 0.02]). The heterogeneity of the interventions precluded further analyses. Discussion: Findings suggest that early interventions can lead to durable effects on PTSD severity after sexual assault. However, due to limited availability of data, it is impossible to draw definite conclusions about safety and efficacy of early interventions, and their potential to prevent PTSD.

Background: Domestic violence (DV) is a widespread yet commonly underdetected problem with severe impact on physical and mental health. To date, only limited information is available on prevalence and detection-rates of victims of DV in hospital settings. Objective: The aim of this study was (a) to assess the prevalence and impact of DV on physical and mental health as well as risk-factors associated with it, (b) to determine how many patients had been asked directly about DV in the hospital and (c) to investigate patients’ preferences about being asked about DV in a hospital setting. Methods: Adult inpatients and outpatients at seven somatic departments at the University Hospital Innsbruck (Austria) were included consecutively in this ad-hoc, cross-sectional paper-and-pencil questionnaire-based study. In total, n = 2,031 patients were assessed regarding their experiences with DV. They also reported on whether they had been asked about DV at the hospital and whether they would mind being asked about it. To evaluate the impact of DV on patients’ self-reported physical and mental health, odds ratios were calculated using binary logistic regression. Results: DV was reported by 17.4% of patients, with 4.0% indicating current DV exposure. Lifetime DV exposure was associated with a significant risk for both physical and mental health-problems. Only 4.8% of patients with DV exposure had ever been asked about it by hospital staff. While patients with a history of DV were more open to being asked about DV than patients without DV (78.2% vs. 72.9%), overall acceptance was still high (74%). Conclusion: DV is a frequently overlooked problem with detrimental effects on physical and mental health. While high acceptance of DV assessment was found, only a small proportion of affected patients had indeed been assessed for DV. Screening for DV in hospitals may thus increase the number of identified patients.

Adopting Registered Reports is an important step for the European Journal of Psychotraumatology to promote open science practices in the field of psychotrauma research. However, adopting these practices requires us as individual researchers to change our perspective fundamentally. We need to put fears of being scooped aside, adopt a permissive stance towards making mistakes and accept that null-results should be part of the scientific record. This is difficult because the culture in academia is competitive. Incentives are on publishing novel and positive results in high impact journals. A change in journal policies, such that openness and transparency are reinforced, can facilitate an attitude change in individual researchers.La adopción de Reportes Registrados es un paso importante para la Revista Europea de Psicotraumatología para promover las prácticas de la ciencia abierta en el campo de la investigación en psicotrauma. Sin embargo, la adopción de esta práctica requiere de nosotros como investigadores individuales de cambiar fundamentalmente nuestra perspectiva. Necesitamos poner a un lado nuestros temores de ser apartados, adoptar una postura permisiva para cometer errores y aceptar que los resultados nulos deben formar parte del registro científico. Esto es difícil porque la cultura en la academia es competitiva. Los incentivos están en la publicación de resultados novedosos y positivos en revistas con impacto alto. Un cambio en las políticas de las revistas, tales como la apertura y transparencia se refuerzan, pueden facilitar una actitud de cambio en los investigadores individuales.采用注册报告(Registered Reports)是《欧洲创伤心理学期刊》推动心理创伤研究领域开放科学实践的重要一步。然而，采用这些实践需要我们作为个体研究人员从根本上改变我们的观点。我们需要把担心放在一边，对犯错误采取宽容的立场，并接受无效结果应成为科学记录的一部分。这很困难，因为学术界的竞争文化。激励措施是在高影响力期刊上发表新颖而正向的成果。期刊政策的变化，如开放性和透明度得到加强，可以促进个体研究人员的态度变化。.

Background: A category of disorders frequently associated with a history of trauma are the dissociative disorders, of which Dissociative Identity Disorder (DID) is the most severe and chronic form. DID is associated with high levels of impairment, treatment utilization, and treatment costs, yet systematic research into treatment effects is scarce. Practice-based clinical guidelines advise a phase-based approach which is lengthy and has rather high reported dropout rates. Therefore, in the current proposal the efficacy of an alternative treatment for DID (i.e. schema therapy) is tested. Objective: The aim of this study is to critically test the effectiveness of schema therapy for DID patients, for whom at present no evidence-based treatment is available. Method: In light of the low prevalence of DID, and the proposed treatment length of three years, a case series experimental approach is used (non-concurrent multiple baseline design). Ten outpatients are included, who are diagnosed with DID by an independent rater using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R), which is double-checked by another independent expert. Primary outcomes are a (bi)weekly assessed state measure of dissociative symptoms, a pre-, post- and follow-up measure of the presence of the DID diagnosis, and drop-out rate. Secondary outcomes include various measures of trait dissociative symptoms, comorbid symptomatology, and global symptomatic distress. Trial registration: Netherlands Trial Register (NTR): NTR4496.

Background: Studies on mental health following disasters have primarily focused on posttraumatic stress disorder (PTSD), yet severe, enduring and disabling grief (i.e., complicated grief, CG) also appears relevant.Objective: The present study examines symptom profiles of PTSD and CG among bereaved Sichuan earthquake survivors one year after the disaster.Methods: Self-report measures of demographic, disaster, and loss-related characteristics and symptoms of PTSD and CG were administered among 803 survivors (63% women, mean age = 46.7 years). Latent class analysis (LCA) was performed to identify subgroups of people with different PTSD and CG symptom profiles.Results: The LCA demonstrated that a five class solution yielded the best fit, consisting of a CG class with low PTSD and high CG (N = 208), a combined class with high PTSD and high CG (N = 205), a class with low PTSD and partial CG (N = 145), a class with partial PTSD and CG (N = 136), and a resilient class with low PTSD and CG (N =108). Being a woman (vs. man), losing a child or spouse (vs. other), being injured (vs. non-injured), and/or having a missing family member (vs. non-missing) predicted membership of the CG class compared to other classes.Conclusions: CG appears a unique consequence of disasters involving many casualties. Disaster survivors should be screened for CG and provided with appropriate psychological treatment.

Background Losing a loved one during the COVID-19 pandemic is a potentially traumatic loss that may result in symptoms of persistent complex bereavement disorder (PCBD), posttraumatic stress disorder (PTSD), and depression. To date, grief-specific cognitive-behavioural therapy (CBT) has mostly been delivered through individual face-to-face formats, while studies have shown that online treatment also yields promising results. Offering treatment online is now more than ever relevant during the pan demic and may offer important benefits compared with face-to-face CBT, such as lower costs and higher accessibility. Our expectation is that grief-specific online CBT is effective in reducing PCBD, PTSD, and depression symptoms. Objective Our aim is to evaluate the short-term and long-term effectiveness of grief-specific online CBT in reducing PCBD, PTSD, and depression symptom-levels for adults who lost a loved one during the COVID-19 pandemic. Method This study consists of two parts. In part 1, a two-armed (unguided online CBT versus waitlist controls) randomized controlled trial will be conducted. In part 2, a two-armed (guided online CBT versus unguided online CBT) controlled trial will be conducted. Symptoms of PCBD, PTSD, and depression will be assessed via telephone interviews at pre-treatment/pre-waiting period, post-treatment/post-waiting period, and six months post-treatment. Potential participants are people who lost a loved one at least three months earlier during the COVID-19 pandemic with clinically relevant levels of PCBD, PTSD, and/or depression. Analysis of covariance and multilevel modelling will be performed. Discussion This is one of the first studies examining the effectiveness of online grief-specific CBT. More research is needed before implementing online grief-specific CBT into clinical practice., HIGHLIGHTS This is the first study examining the effectiveness of online treatment in reducing psychopathology levels in people who lost loved ones during the COVID-19 pandemic.

We have read with interest the recent debate paper ‘Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability’ by Killikelly and Maercker (2018). Establis...

Background: A growing body of evidence supports the notion that the emotional profile of Posttraumatic Stress Disorder (PTSD) may be more diverse than traditional accounts presume. PTSD's image as an anxiety-based disorder is undergoing change as the significance of other emotions in its development becomes more evident. Experimental research is needed in order to expand the understanding of underlying processes driving the development of PTSD.Objective: Experimentally test the influence of stressor-related guilt on the occurrence of PTSD symptomatology.Method: A non-clinical student sample faced an analogue trauma, a stressor in the form of a computer crash and related loss of data. We either personally blamed participants for causing the incident (blame group) or told them that it was a technical failure and therefore not their fault (no-blame group). Levels of guilt before and after the incident as well as number and associated distress of incident-related intrusions were assessed using a one-day diary and compared between groups.Results: The guilt manipulation was successful: feelings of guilt significantly increased in the blame group but not in the no-blame group. Furthermore, the blame group showed a significantly higher number of intrusions and associated distress compared to the no-blame group at one-day follow-up.Conclusions: These laboratory findings indicate that feelings of guilt may lead to increased PTSD symptomatology, supporting the view that guilt experienced in reaction to a traumatic event may be part of a causal mechanism driving the development of PTSD.

Background The disappearance of a loved one is a unique type of loss, also termed “ambiguous loss”, which may heighten the risk for developing prolonged grief (PG), depression, and posttraumatic stress (PTS) symptoms. Little is known about protective and risk factors for psychopathology among relatives of missing persons. A potential protective factor is self-compassion, referring to openness toward, and acceptance of one’s own pain, failures, and inadequacies. One could reason that self-compassion is associated with lower levels of emotional distress following ambiguous loss, because it might serve as a buffer for getting entangled in ruminative thinking about the causes and consequences of the disappearance (coined “grief rumination”). Objective The current study sought to test this mediational model. In a sample of relatives of missing persons we aimed to examine (1) the prediction that greater self-compassion is related to lower symptom-levels of PG, depression, and PTS and (2) to what extent these associations are mediated by grief rumination. Method Dutch and Belgian relatives of long-term missing persons (N = 137) completed self-report measures tapping self-compassion, grief rumination, PG, depression, and PTS. Mediation analyses were conducted. Results Self-compassion was significantly, negatively, and moderately associated with PG, depression, and PTS levels. Grief rumination significantly mediated the associations of higher levels of self-compassion with lower levels of PG (a*b = -0.11), depression (a*b = -0.07), and PTS (a*b = -0.11). Specifically, 50%, 32%, and 32% of the effect of self-compassion on PG, depression, and PTS levels respectively, was accounted for by grief rumination. Conclusions Findings suggest that people with more self-compassion experience less severe psychopathology, in part, because these people are less strongly inclined to engage in ruminative thinking related to the disappearance. Strengthening a self-compassionate attitude using, for instance, mindfulness-based interventions, may therefore be a useful intervention to reduce emotional distress associated with the disappearance of a loved one.

Background: Confrontation with a traumatic (e.g. disaster-related) loss is a risk factor for the development of psychopathology, including symptoms of prolonged grief (PG), posttraumatic stress (PTS), and depression. Although interventions have been developed for reducing post-loss psychopathology, more research into the effectiveness of treatment is needed to improve care for bereaved persons. Cognitive therapy (CT) and eye movement desensitization and reprocessing (EMDR) have been shown to be effective in trauma-exposed populations. We hypothesize that CT and EMDR are also effective in reducing symptoms among people exposed to traumatic loss.Objective: In this article we describe the rationale of a randomized controlled trial (RCT) to examine (1) treatment effects of CT and EMDR for reducing PG, PTS, and depression among traumatically bereaved people, and (2) the associations between improvements in PG, PTS, and depression symptoms on the one hand and tentative mechanisms of change, including a sense of unrealness, negative cognitions, avoidance behaviour, and intrusive memories, on the other hand.Method: A two-armed (intervention versus waiting list controls) RCT will be conducted. Participants will be asked to fill in questionnaires prior to treatment, during treatment, and one, 12, and 24 weeks post-treatment. Potential participants are people who have lost one or multiple significant other(s) in the Ukrainian plane disaster in 2014 with clinically significant levels of self-rated PG, PTS, and/or depression. Multiple regression, including analysis of covariance, and multilevel regression analyses will be used.Discussion: There is a need for treatment for psychopathology following traumatic loss. Strengths of this study are the development of a treatment that targets grief and trauma-related complaints and the examination of potential mechanisms of change in CT and EMDR. Bereaved people, clinicians, and researchers could benefit from the results of this study.