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Moral injury among civilians has garnered increased recognition in recent years. However, most moral injury measures have focused on military experiences, with language being military specific. This study aimed to further validate two self-report measures of civilian moral injury, the Moral Injury Events Scale - Civilian (MIES-C) and Expressions of Moral Injury Scale - Civilian (EMIS-C). Participants were 312 adults (99 males, 212 females, Mage = 37.24) who completed the MIES-C, EMIS-C, and a battery of associated measures on two occasions. For the MIES-C, four Confirmatory Factor Analysis (CFA) models were examined. A three-factor model, with covaried items, provided the best fit to the data. For the EMIS-C, three CFAs were examined. A two-factor model, with covaried items, and the bi-factor model provided the best fit to the data, with the two-factor model being preferred for reasons of parsimony and its absence of weak and negative item loadings. Both measures demonstrated acceptable test-retest reliability and convergent validity with associated measures of psychological distress. This study provides psychometrically sound tools for clinicians and researchers of civilian moral injury.

Introduction: Relationship quality plays an important role in mental health, but little is known about its importance among resettled refugees. We investigated the association between perceived relationship quality and psychological symptoms among refugees resettled in Australia. Methods: Participants were 738 adult refugees (principal applicants, 83.5% male, M = 43.2 years, SD = 12.3) and their partners who participated in the Building a New Life in Australia (BNLA) study across 5 years from 2013 to 2017. Participants were assessed for psychological distress, posttraumatic stress symptoms (PTSS), and perceived relationship quality, using the Kessler scale (K6), the Posttraumatic Stress Disorder-8 (PTSD-8), and the Dyadic Adjustment Scale-4 (DAS-4), respectively. Results: Multiple regression analyses found that, among principal applicants, perceived relationship quality predicted psychological distress (p =.0006) at post-arrival, and changes in perceived relationship quality predicted changes in PTSS (p =.0003) across a one-year interval. When partners were analyzed, results were broadly consistent with those of the principal applicants, except that changes in relationship quality did predict changes in psychological distress, but not changes in PTSS. Discussion: Relationship quality appeared to be associated with psychological distress, but improvements in relationship quality may have particular utility for reductions in posttraumatic stress disorder (PTSD) symptoms. These results highlight the importance of relationship quality as a key correlate of refugee mental health.

Background: Impairments in executive functioning associated with posttraumatic stress disorder (PTSD) may impact the capacity of refugees and asylum seekers. Aims: To examine the association between executive functioning and PTSD with and without prominent future-focused threat (FFT) intrusions at rest and after threat priming. Method: 66 Farsi and Dari-speaking asylum-seekers, refugees, and immigrants were recruited into 3 groups: High PTSD & FFT Symptoms; High PTS Symptoms; Low PTSD & FFT symptoms. The Category Fluency Test (animals; food; flora) in Farsi was administered at baseline and after two counter-balanced future- and past-focused threat narrative tasks. Results: Higher PTSD and FFT symptom scores was associated with reduced verbal fluency [correct words (PTS p < 0.001; FFT p < 0.007), clustered words (PTS, p < 0.004; FFT p < 0.009) and clusters (PTS p < 0.017; FFT p < 0.009)]. The PTSD group retrieved fewer correct words (17.6, p < 0.009) using fewer clusters (p < 0.008) than the low-symptom group at baseline. It was only after exposure to the narrative task that the FFT group displayed comparable impairment. Conclusions: A subset of displaced persons with future threat symptoms exhibit cognitive impairment when asked to recount narrative details. Future threat may limit capacity to engage in cognitively demanding activities, such as participating in Refugee Status Determination.

Shame has been identified as a key emotional response to trauma exposure and is implicated in the development and maintenance of PTSD. Despite this, there is a lack of empirical research explaining how and why shame emerges following trauma exposure. Current theoretical models of shame converge on the idea that shame is elicited through internal, stable, and global attributions about the precipitating event. A systematic review was conducted to assess the relationship between causal attributions, shame, and PTSD symptomology. A database search of PsycINFO, PubMED, Medline, EMBASE and PTSDPubs identified articles published between 1980 to 2022 that enabled examination of the relationship between attributions, shame, and PTSD. A total of eight articles met inclusion criteria for this review. There were cross-sectional relationships between internal attributions, shame, and PTSD symptoms, with shame demonstrating the strongest relationship with PTSD symptoms. Significant indirect effects were found between internal attributions, shame, and PTSD. Concerns surrounding reliability of measurements and sampling bias made it difficult to draw definitive conclusions. The current evidence is too preliminary to offer strong support for the mediation hypothesis. However, it does offer important avenues for future research that will have important clinical applications.

PURPOSE: The self-medication hypothesis suggests people may develop Alcohol Use Disorder (AUD) or Non-Alcohol Substance Use Disorder (NA-SUD) following PTSD as a maladaptive way of coping with PTSD symptoms. Given that an accumulation of trauma experiences and interpersonal trauma increase the likelihood and severity of PTSD, we sought to determine whether the number and type of traumas additionally predict AUD and NA-SUD following PTSD. METHODS: We analysed data from 36,309 adult participants in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) study (M = 45.63 years, SD = 17.53, 56.3% female) who were administered semi-structured diagnostic interviews of trauma exposure and PTSD, AUD and NA-SUD symptoms. RESULTS: Individuals with PTSD were more likely to have an AUD or NA-SUD than those without PTSD. Endorsement of a greater number of traumas was associated with greater odds of having PTSD, AUD, or NA-SUD. Experience of interpersonal trauma was related to greater odds of having PTSD and subsequent AUD or NA-SUD than not experiencing interpersonal trauma. Multiple experiences of interpersonal trauma compared to one interpersonal trauma exposure also increased the odds of having PTSD followed by AUD or NA-SUD. CONCLUSIONS: Interpersonal trauma and multiple experiences of interpersonal trauma may result in individuals turning to alcohol and substances as a way to alleviate intolerable PTSD symptomology, aligning with the self-medication hypothesis. Our findings highlight the importance of ensuring services and support for interpersonal trauma survivors and for those who have experienced multiple traumas given their increased for unfavourable outcomes.

The original version of the article unfortunately contained a mistake in Figure captions for Figs. 1 and 2. The correct caption for Fig. 1 is “Proposed moderated mediation model” and the correct caption of Fig. 2. Is “Mediation model”. This has been corrected with this erratum. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial- NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, and provide a link to the Creative Commons license. You do not have permission under this license to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Although shame is a common emotional response to trauma exposure, it may be precipitated by distinct trauma types. To our knowledge, our study is the first to investigate the relationship between shame and PTSD symptom severity and whether exposure to at least one interpersonal trauma influences the relationship between shame and PTSD symptoms. One-hundred and fifty-seven participants from Australia, Canada, United States, United Kingdom, and New Zealand completed a series of self-report measures. Although shame was significantly associated with PTSD symptom severity, it was not an independent predictor of PTSD when considering anxiety, depression, trauma history and guilt. Participants exposed to at least one interpersonal traumatic event endorsed higher levels of shame and PTSD compared to those who did not. Interpersonal trauma exposure also moderated the relationship between shame and PTSD. Clinical implications and directions for future research are also discussed.

BACKGROUND AND OBJECTIVES: Intrusive memories are a common feature of depression, thought to be related to the onset and maintenance of the disorder. Intrusive memories have been successfully targeted in posttraumatic stress disorder through imagery rescripting. Yet there is limited evidence for the effectiveness of this technique in depression. We examined whether 12 weekly sessions of imagery rescripting was associated with reductions in depression, rumination and intrusive memories in a sample of patients with major depressive disorder (MDD). METHODS: Fifteen clinically depressed participants completed 12 weeks of imagery rescripting treatment while completing daily measures of depression symptoms, rumination and intrusive memory frequency. RESULTS: There were significant reductions on pre-post treatment and daily assessment measures of depression symptoms, rumination and intrusive memories. Reductions in depression symptoms represented a large effect size, while 13 participants (87%) showed reliable improvement and 12 participants (80%) demonstrated clinically significant improvement and no longer met diagnostic criteria for MDD. LIMITATIONS: The sample size was small, however the intensive daily assessment protocol ensured the viability of within-person analyses. CONCLUSIONS: Imagery rescripting as a stand-alone intervention appears to be effective at reducing depression symptoms. Additionally, the treatment was well tolerated by clients and observed to overcome several traditional treatment barriers in this population.

Thwarted expectations regarding one's post-settlement life may challenge the mental health of refugees. The present study aimed to investigate the relationship between pre-arrival expectations and the course of psychological symptoms across time. A secondary analysis of 1,496 principal visa applicants across five waves of the Building a New Life in Australia (BNLA) study was conducted. The cross-sectional associations between expectations on the one hand, and post-traumatic stress (PTSD-8) symptoms and psychological distress (Kessler-6; K6) on the other, were assessed using multiple regression. Latent class growth analysis (LCGA) was used to identify discrete symptom trajectories of psychological symptoms across five years following settlement, and multinomial regressions were used to determine if violated expectations predicted membership of identified PTSD-8 and K6 class trajectories. LCGA supported a four-class solution for the PTSD-8 Resilient Post Traumatic Stress (PTS) (54.1%), Improving PTS (15.0%), Deteriorating PTS (17.3%), and Persistently High PTS (13.6%). For the K6, three classes were identified: Persistently Mild K6 (60.4%), Resilient K6 (9.4%), and Persistently High K6 (30.2%). Thwarted expectations were found to significantly predict membership of less favourable symptom trajectories classes in the context of other established predictors. Post-settlement expectations may thus have weak but unique predictive value for the course of psychological symptoms alongside other factors such as older age and financial stress. Implications of these findings for service provision and policy are discussed.

This study aimed to ascertain frequency rates and predictors of six problematic online behaviors (POBs) in an Australian sample. Participants (N = 1626) completed instruments measuring problematic online gaming, cyberchondria, problematic cybersex, problematic online shopping, problematic use of social networking sites, problematic online gambling, anxiety, depression and attention deficit/hyperactivity disorder (ADHD). Each POB was presumed to be present based on the cut-off score on the corresponding instrument and at least one indicator of interference with functioning. Generalized linear model analyses were used to determine socio-demographic and psychopathological predictors of each POB. The most common POB was problematic online shopping (12.2%), followed by problematic online gambling (11.4%), problematic use of social networking sites (6.0%), problematic cybersex (5.3%), problematic online gaming (5.2%) and cyberchondria (4.6%). Age group 27-36 had the highest rates of POBs. The intensity of ADHD symptoms predicted all POBs, whereas younger age predicted all POBs except for problematic cybersex and online gambling. Female gender predicted lower scores on the measures of problematic online gaming and cybersex. These findings have implications for age- and gender-adapted education, prevention and treatment efforts and suggest that specific POBs should be investigated separately instead of lumping them together under the umbrella terms such as "Internet addiction".

Introduction: Nightmares are a re-experiencing symptom of Post-Traumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). They are intrusive, involuntary and have a significant impact on wellbeing, suggesting they have substantial clinical relevance. However, little is known about the phenomenological features of post-traumatic nightmares and how they are associated with the severity of PTSD and CPTSD symptoms. Method: Participants (N = 398) who identified that they had experienced a lifetime trauma completed various self-report questionnaires related to PTSD symptoms, CPTSD symptoms and nightmare characteristics. Participants also described their sensory experiences and rated the emotional intensity and vividness of their post-traumatic nightmares. Results: We found that elevated scores on various characteristics of nightmares including frequency of awakenings, nightmare severity, impact on wellbeing and the perceived realism of the nightmare were linked to more severe PTSD and CPTSD symptoms. Further, increased frequency, vividness, and emotional intensity of nightmares significantly predicted more severe PTSD symptoms but not CPTSD symptoms. Conclusions: Our study was largely exploratory and was the first to identify that specific nightmare features are related to PTSD and CPTSD symptom severity. However, although nightmare features of frequency, vividness and intensity appear to be related to CPTSD symptom severity, other variables may better predict CPTSD symptoms. Possible explanations for our findings, implications for treatment and directions for future research are discussed.

Body dysmorphic disorder (BDD) is characterised by a preoccupation with a perceived defect in appearance. This preoccupation results in the completion of repetitive/time consuming behaviours to reduce distress. While the disorder results in considerable distress and impairment, the prevalence of the disorder is largely unknown, as BDD has not been examined in large epidemiological studies. The aim of the current study was to provide an estimate of BDD prevalence in a variety of settings using a meta-analytic approach using only studies that have made a diagnosis using a structured diagnostic interview. Twenty-two studies met criteria (n = 7159) and the pooled point-prevalence estimate for BDD was 11.3% across all studies with high levels of heterogeneity (I2 = 95.81). The pooled point-prevalence estimate was 20.0% in cosmetic/dermatology settings, 7.4% in mental health settings, and 6.7% in 'other' settings (including students and professional ballet dancers). The risk of bias assessment indicated questionable methodological quality in some of the included studies. While this study provides an important improvement on the existing literature there is a need to include BDD in epidemiological studies in order to have a more accurate understanding of the prevalence rate of this mental health condition in the community.

Background: Efforts to understand the constellation of symptoms in obsessive-compulsive disorder (OCD) have typically relied on models where latent variable(s) are assumed to underlie all symptoms. In contrast, a network approach does not assume that there are underlying latent variables and allows for the possibility that clusters of symptoms may mutually reinforce each other. We aimed to determine whether obsessions and compulsions formed a coherent and mutually reinforcing network of symptoms. Method: 400 participants were recruited online and administered the Obsessive-Compulsive Inventory-Revised (OCI-R). A network analysis was computed using an Extended Bayesian Information Criterion estimator. Results: There were five communities of symptoms: 1. A mixed contamination and checking community, 2. An ordering/arranging community, 3. A superstitious/counting/repeating community, 4. A mixed hoarding and checking community, and 5. An intrusive thoughts community. In the accuracy check, edges displayed wide confidence intervals, indicating that edges’ strength could not be interpreted. Additional analyses at the level of OCI-R subscales indicated that checking was significantly more central than other subscales in the network. Conclusions: Obsessions and compulsions may be related in a mutually reinforcing way, thereby constituting OCD as a psychopathological entity. Prospective investigations are needed to ascertain the directionality of relationships in the network.

Introduction: Meta-analytic reviews suggest similar outcomes across trauma-focused psychotherapies for adults with post-traumatic stress disorder (PTSD). However, this conclusion may be premature due to suboptimal statistical-review methodologies. Network meta-analysis (NMA) allows a detailed rank-ordering of the efficacy of established psychotherapy interventions derived from indirect evidence as well as results from direct head-to-head comparisons. Objective: We sought to determine the efficacy and attrition rates of psychotherapy interventions for PTSD by applying NMA. Methods: We searched EMBASE, PsychINFO, PTSDPubs and PubMed for randomised controlled trials that compared psychotherapies either head-to-head or against controls for adults with PTSD. A frequentist NMA was used to compare direct and indirect effects to determine the efficacy and attrition rates of psychotherapy interventions. Results: Of the 5649 papers identified, 82 trials comprising of 5838 patients were included. The network comprised 17 psychotherapies and four control conditions. Network estimates indicated superior efficacy of meta-cognitive therapy and cognitive processing therapy over other psychotherapies (ESs between = 0.26 and 2.32). Written exposure therapy and narrative exposure therapy were associated with lower risk of drop out when considered alongside other psychotherapies. Confidence in the network meta-analytic estimates was considered moderate for both outcomes. Conclusions: In broad terms, therapeutic commensurability was evident. Nevertheless, with additional studies and larger sample sizes, meta-cognitive and written exposure therapies could indeed differentiate themselves from other approaches as having favourable efficacy and acceptability respectively. These findings may inform clinical decision-making, as well as guide future research for PTSD.

BACKGROUND: This research examined the mental health of a cohort of asylum-seeking children, adolescents and their primary caregiver affected by insecure residency while living in the community, compared to refugees and immigrants. METHODS: The project investigated the prevalence of psychosocial problems among Iranian and Afghani asylum seeker, refugee and immigrant children and adolescents, and their caregivers who arrived in Australia from 2010. In total, n=196 children and adolescents aged 5-18 years, and their primary caregiver were asked about family visa status, country of origin, level of education, parent symptoms of posttraumatic stress disorder (Harvard Trauma Questionnaire) and child wellbeing (Strengths and Difficulties Questionnaire). An additional n=362 Farsi and Dari speaking children, recruited through the Building a New Life in Australia (BNLA) study, a national comparison sample of families with permanent refugee visas, were included. FINDINGS: Asylum seeker children and adolescents displayed significantly more psychosocial problems compared to those with full refugee protection and immigrant background within the current sample and when benchmarked against a national sample of Farsi-Dari speaking refugee children. Higher parental posttraumatic stress disorder symptoms was associated with poorer child and adolescent psychosocial functioning. This effect was more marked in families with insecure residency. INTERPRETATION: Insecure visa status is associated with higher rates of children's mental health problems and a stronger association with parental PTSD symptoms compared to children with secure residency. This raises important questions about Australia's restrictive immigration policies. FUNDING: This project was supported by an Australian Rotary Health Research Fund / Mental Health of Young Australians Research Grant and by the Australian Research Council (DP160104378).

Shame is a common trauma response that is associated with the development and maintenance of PTSD. Phenomenological descriptions of shame indicate that shame arises from internal, stable and global causal attributions (negative attributions) for the precipitating event. The current study investigated whether negative attributions would be associated with higher levels of shame and PTSD, and whether shame would mediate the relationship between causal attributions and PTSD. As negative attributions may reflect a common transdiagnostic process in both depression and PTSD, it also examined whether depression would moderate this relationship. Eighty-seven participants meeting criteria for a Criterion A stressor were administered a structured PTSD diagnostic interview and a series of self-report measures. Findings indicate that shame mediated the relationship between internal, stable and global trauma-related causal attributions and PTSD symptoms. Further, depression did not moderate this relationship, indicating that negative causal attributions are associated with shame and PTSD independent of depression. Results provide empirical support for the cognitive concomitants of trauma-related shame, which raise the possibility that addressing negative attributions through cognitive therapeutic methods may be pertinent in reducing trauma-related shame. Future prospective data is needed to establish cognitive antecedents to shame.

The validity of the constructs of problematic Internet or smartphone use and Internet or smartphone addiction has been extensively debated. The spectrum hypothesis posits that problematic online behaviors (POBs) may be conceptualized within a spectrum of related yet distinct entities. To date, the hypothesis has received preliminary support, and further robust empirical studies are still needed. The present study tested the spectrum hypothesis of POBs in an Australian community sample (n = 1,617) using a network analysis approach. Psychometrically validated self-report instruments were used to assess six types of POBs: problematic online gaming, cyberchondria, problematic cybersex, problematic online shopping, problematic use of social networking sites, and problematic online gambling. A tetrachoric correlation matrix was computed to explore relationships between online activities and a network analysis was used to analyze relationships between POBs. Correlations between online activities were positive and significant, but of small magnitude (0.051 ≤ r ≤ 0.236). The community detection analysis identified six distinct communities, corresponding to each POB, with strong relationships between items within each POB and weaker relationships between POBs. These findings provide further empirical support for the spectrum hypothesis, suggesting that POBs occur as distinct entities and with little overlap.

BACKGROUND: Theoretical models of self-conscious emotions indicate that shame is elicited through internal, stable, and global causal attributions of the precipitating event. The current study aimed to investigate whether these negative attributions are related to trauma-related shame and PTSD symptom severity. METHOD: A total of 658 participants aged 18 to 89 (M = 33.42; SD = 12.17) with a history of trauma exposure completed a range of self-report measures assessing trauma exposure, negative trauma-related attributions, shame, and PTSD symptoms. RESULTS: Higher levels of internal, stable, and global trauma-related attributions were significantly associated with shame and PTSD. Shame mediated the association between trauma-related attributions and PTSD symptom severity, even after controlling for the effects of number of trauma exposures, worst index trauma and depression. CONCLUSIONS: The present results suggest that negative attributions are a critical cognitive component related to shame and in turn, PTSD symptom severity. Future research should aim to replicate these findings in a clinical sample and extend these findings using prospective designs.

Abstract Intrusive autobiographical memories are a prominent feature of depression implicated in the onset and course of the disorder. Current cognitive behavioural treatment of depression does not specify techniques to address intrusive memories. Imagery rescripting has been demonstrated to be effective in the treatment of trauma-related intrusive memories. This paper illustrates the application of imagery rescripting as a stand-alone treatment for two patients experiencing a current major depressive episode. The two cases are described in detail and follow-up data are reported. Both patients experienced clinically significant and reliable change in their depression scores and no longer met criteria for a current major depressive episode at post-assessment, with gains maintained at 3-month follow-up. Implications are discussed for the theoretical mechanisms of change of this intervention as well as methods to overcome common treatment obstacles that arise in depression. Key learning aims (1) To learn how intrusive autobiographical memories are implicated in the onset and maintenance of depression. (2) To learn the limitations that may present clinically when applying verbal-linguistic techniques such as cognitive restructuring to intrusive memories. (3) To learn when imagery rescripting may be required to treat intrusive memories and how to implement this technique to overcome traditional treatment obstacles in depression.

Cognitive interventions involving visuospatial tasks, such as the game "Tetris" have demonstrated efficacy in reducing the frequency of intrusive memories. However, it remains unclear whether these tasks also reduce the perceived intensity and distress of these memories. We investigated whether either of two visuospatial tasks: a Tetris intervention or Digital Corsi task, following the viewing of an analog trauma (film) resulted in decreased intensity and distress for intrusive memories over the following week, when compared to a control condition. Participants (n = 110) were randomly assigned to task conditions after viewing the film. Linear mixed models indicated no between-group differences for reductions in intensity or distress over the course of the week. These findings highlight an important boundary to the benefits of such visuospatial tasks, in that while they may be associated with reductions in intrusion memory frequency, individuals may nonetheless continue to experience distress when intrusions do occur.

Cyberchondria refers to excessive and repeated online health-related searching, which is associated with increased distress and anxiety. The Cyberchondria Severity Scale (CSS) is the most widely used measure for assessment of cyberchondria, and its shortened version (CSS-12) has recently been developed. The aim of the present study was to develop the Spanish version of the CSS-12 and test its psychometric properties. A community sample of 432 Spanish-speaking adults (67.6% women; mean age = 36.00 ± 15.22 years) completed the Spanish translation of CSS-12 along with measures of health anxiety, obsessive-compulsive, anxiety and depressive symptoms. The Spanish version of the CSS-12 comprises a general cyberchondria factor and four specific factors (‘excessiveness’, ‘compulsion’, ‘distress’, and ‘reassurance’). Multi-group confirmatory factor analysis indicated measurement invariance across gender groups. Internal consistency values for the total score and subscales were good to excellent. The CSS-12 showed strong correlations with health anxiety, and moderate to low correlations with anxiety, obsessive-compulsive and depressive symptoms, supporting the convergent and divergent validity of the CSS-12, respectively. In conclusion, these results show that the CSS-12 is a valid and reliable tool for measuring cyberchondria in both genders in the general Spanish population.

Greater recognition of diversity in psychological responses to traumatic events has led to increased exploration of posttrauma symptom typologies and risk factors for more "complex" presentations. OBJECTIVES: We sought to identify unique PTSD symptom profiles associated with the experience of physical and sexual abuse and to determine whether exposure in childhood, type of abuse, frequency of abuse and familial support were associated with profiles indicating increased symptom complexity. METHOD: We analyzed data from 6,769 American adults (M = 43.93 years, SD = 15.35, 70.9% female) from the National Epidemiologic Survey on Alcohol and Related Conditions-III who reported histories of physical or sexual abuse. Latent Class Analysis was used to identify distinct profiles of the twenty PTSD symptoms outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Abuse in childhood, type of abuse, frequency of childhood abuse, emotional support in childhood and a range of demographic variables were compared across classes. RESULTS: Five classes were educed: High All (19.6%), Threat (14.4%), Dysphoric (13.7%), Moderate Threat (29.4%) and Low Symptom (22.9%). Contrary to our hypotheses, trauma exposure in childhood did not predict class membership while type of abuse did. The High All and Dysphoric classes had greater frequency of childhood abuse, lower support in childhood, and a history of sexual abuse when compared to their less complex, predominantly fear-based counterparts (Threat and Moderate Threat classes, respectively). CONCLUSIONS: These constellations of DSM-5 PTSD symptoms may be a proxy for increased "complexity" and may indicate a need for alternative or additional therapeutic interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Background: Despite growing support for the distinction between posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as separate diagnoses within the ICD-11 psychiatric taxonomy, the prevalence and treatment implications of CPTSD among current and ex-serving military members have not been established. Objective: The study aims were to a) establish the prevalence of provisional ICD-11 CPTSD diagnosis relative to PTSD in an Australian sample of treatment-seeking current and ex-serving military members, and b) examine the implications of CPTSD diagnosis for intake profile and treatment response. Methods: The study analysed data collected routinely from Australian-accredited treatment programmes for military-related PTSD. Participants were 480 current and ex-serving military members in this programmes who received a provisional ICD-11 diagnosis of PTSD or CPTSD at intake using proxy measures. Measures of PTSD symptoms, disturbances in self-organisation, psychological distress, mental health and social relationships were considered at treatment intake, discharge, and 3-month follow-up. Results: Among participants with a provisional ICD-11 diagnosis, 78.2% were classified as having CPTSD, while 21.8% were classified as having PTSD. When compared to ICD-11 PTSD, participants with CPTSD reported greater symptom severity and psychological distress at intake, and lower scores on relationship and mental health dimensions of the quality of life measure. These relative differences persisted at each post-treatment assessment. Decreases in PTSD symptoms between intake and discharge were similar across PTSD (d RM = -0.81) and CPTSD (d RM = -0.76) groups, and there were no significant post-treatment differences between groups when controlling for initial scores. Conclusions: CPTSD is common among treatment-seeking current and ex-serving military members, and is associated with initially higher levels of psychiatric severity, which persist over time. Participants with CPTS

Background: Drop-out is an important barrier in treating post-traumatic stress disorder (PTSD) with consequences that negatively impact clients, clinicians and mental health services as a whole. Anger is a common experience in people with PTSD and is more prevalent in military veterans. To date, no research has examined if anger may predict drop-out in military veterans or first responders. Aims: The present study aimed to determine the variables that predict drop-out among individuals receiving residential treatment for PTSD. Method: Ninety-five military veterans and first responders completed pre-treatment measures of PTSD symptom severity, depression, anxiety, anger, and demographic variables. Logistic regression analyses were used to determine if these variables predicted drop-out from treatment or patterns of attendance. Results: Female gender was predictive of drop-out. However, when analysed by occupation female gender was predictive of drop-out among first responders and younger age was predictive of drop-out in military participants. Anger, depression, anxiety and PTSD symptom severity were not predictive of drop-out in any of the analyses. No variables were found to predict attendance patterns (consistent or inconsistent) or early versus late drop-out from the programme. Conclusion: These results suggest that although anger is a relevant issue for treating PTSD, other factors may be more pertinent to drop-out, particularly in this sample. In contrast with other findings, female gender was predictive of drop-out in this study. This may indicate that in this sample, there are unique characteristics and possible interacting variables that warrant exploration in future research.

AbstractVisuospatial cognitive tasks that influence memory reconsolidation may be of benefit in reducing intrusive memories for traumatic events when used as an adjunct to trauma-focused psychotherapy. We conducted a feasibility assessment of a protocol that involved the use of a visuospatial cognitive task, the Tetris intervention, alongside routine exposure-based treatment for posttraumatic stress disorder (PTSD). Participants were inpatients attending for PTSD treatment at a psychiatric hospital. The Tetris intervention was administered on three occasions when imaginal exposure had formed part of the treatment session. Using a phone app, participants also monitored intrusive memories over a 3-week period. Feasibility outcomes were fully met for the demand, implementation, practicality and adaptability criteria. Only a single criterion was not met for each of the acceptability and implementation criteria. Limited-efficacy testing outcomes are also discussed. Overall, the findings from our feasibility study indicated viability of the protocol, which involved implementation of the Tetris intervention alongside routine exposure-based treatment for PTSD, in a clinical inpatient setting.

Background: Despite growing support for the distinction between posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as separate diagnoses within the ICD-11 psychiatric taxonomy, the prevalence and treatment implications of CPTSD among current and ex-serving military members have not been established. Objective: The study aims were to a) establish the prevalence of provisional ICD-11 CPTSD diagnosis relative to PTSD in an Australian sample of treatment-seeking current and ex-serving military members, and b) examine the implications of CPTSD diagnosis for intake profile and treatment response. Methods: The study analysed data collected routinely from Australian-accredited treatment programmes for military-related PTSD. Participants were 480 current and ex-serving military members in this programmes who received a provisional ICD-11 diagnosis of PTSD or CPTSD at intake using proxy measures. Measures of PTSD symptoms, disturbances in self-organisation, psychological distress, mental health and social relationships were considered at treatment intake, discharge, and 3-month follow-up. Results: Among participants with a provisional ICD-11 diagnosis, 78.2% were classified as having CPTSD, while 21.8% were classified as having PTSD. When compared to ICD-11 PTSD, participants with CPTSD reported greater symptom severity and psychological distress at intake, and lower scores on relationship and mental health dimensions of the quality of life measure. These relative differences persisted at each post-treatment assessment. Decreases in PTSD symptoms between intake and discharge were similar across PTSD (dRM = −0.81) and CPTSD (dRM = −0.76) groups, and there were no significant post-treatment differences between groups when controlling for initial scores. Conclusions: CPTSD is common among treatment-seeking current and ex-serving military members, and is associated with initially higher levels of psychiatric severity, which persist over time. Participants with CPTSD we

Cyberchondria is a clinical entity of excessive and repetitive online health-related searches, associated with health anxiety, obsessive-compulsive symptoms and intolerance of uncertainty. Its relationships with depressive and somatic symptoms have not yet received much attention. The purpose of this study was to examine the individual and comparative effects of several psychopathology constructs on the severity of cyberchondria. Through an online platform, participants (N = 749) completed specific self-report measures assessing the severity of cyberchondria, anxiety, intolerance of uncertainty, depressive, somatic, and obsessive-compulsive symptoms. Standard and hierarchical multiple regression analyses were used to assess how well the independent variables influenced the levels of cyberchondria, before and after controlling for age, education, and sex. When measures of all constructs were included in the analysis, all were significant predictors of cyberchondria levels, except for anxiety. Health anxiety made the strongest contribution. When age, education and sex were controlled for, all measures except for anxiety were also significant predictors of cyberchondria severity. Our study confirms that health anxiety, obsessive-compulsive symptoms and intolerance of uncertainty are all associated with cyberchondria severity, with health anxiety making the strongest unique contribution. Depression and somatic symptoms also predicted cyberchondria severity. These findings have important implications for research and clinical practice.

Background: Cyberchondria denotes excessive and repeated online health-related searches associated with an increase in health anxiety. Such searches persist in those with cyberchondria, despite the negative consequences, resembling a pattern of compulsive Internet use. Objectives: The aim of the present study was to assess compulsive health-related Internet use in relation to cyberchondria while controlling for related variables. Method: Adult participants (N = 749) were recruited from an online platform. They completed questionnaires assessing the severity of cyberchondria (via the Cyberchondria Severity Scale [CSS]), compulsive Internet use adapted for online health-related seeking (via the adapted Compulsive Internet Use Scale [CIUS]), and levels of intolerance of uncertainty and anxiety, as well as depressive, somatic, and obsessive-compulsive symptoms. A logistic regression analysis was carried out to identify predictors of scores above a cutoff value on the CIUS, indicating compulsive health-related Internet use. Results: The regression output showed that only the CSS total score and sex made a unique, statistically significant contribution to the model, leading to the correct classification of 78.6% of the cases. Of the CSS subscales, compulsion and distress were the most strongly associated with compulsive health-related Internet use. Conclusions: The finding that the adapted CIUS scores are associated with cyberchondria indicates that cyberchondria has a compulsive component, at least in terms of health-related Internet use. It also suggests that compulsive health-related Internet use persists despite the distress associated with this activity. Males may engage in cyberchondria more compulsively than females. These findings have implications for research and clinical practice.

Mothers with insecure attachment styles may have increased difficulty establishing secure attachment with their infant and may experience emotion regulation difficulties in the postpartum period. This study aimed to examine the mediating effect of emotion dysregulation (ED) on the relation-ship between maternal insecure attachment style and self-reported attachment to infant in women admitted to a mother-baby unit.

Background and objectives: Rumination following an event, particularly in an abstract as opposed to concrete processing mode, is associated with increased intrusive memory frequency. However, the temporal trajectory of intrusive memories following abstract and concrete rumination remains unclear. We examined the association between processing mode and the frequency of intrusive memories over a 6-h time period following a negative mood induction. Methods: One hundred and sixteen community participants watched a video sequence designed to induce negative mood. Participants were then randomised into condition (abstract, concrete or distraction) and completed a verbally mediated task designed to induce the respective processing mode. Participants then completed hourly ratings of rumination and intrusive memories about the video after leaving the laboratory. Results: Negative mood and intrusive memories were reliably induced. There were no differences in the frequency of intrusive memories between the abstract and concrete conditions. In contrast, participants in the distraction condition reported significantly more sensory intrusive memories than either ruminative condition. Three classes were found among participants following the video (intrusion free, rapid remitters, slow remitters). Condition was not predictive of class membership. Limitations: It cannot be ruled out that the differences between rumination and distraction conditions were due to task differences. Conclusions: In contrast to previous findings, our results suggest that any form of rumination about an event (whether in an abstract or concrete mode) may temporarily result in fewer intrusive memories in comparison to distraction. Processing mode does not appear to predict particular trajectories of intrusions following a mood induction.

The aim of this study was to identify whether parenting style during a child's toddler years predicts the course of the child's internalising symptoms throughout early to middle childhood. The current study uses data from waves 1 to 7 (acquired biennially) of the infant cohort (N = 4494) of Growing up in Australia: the Longitudinal Study of Australian Children (LSAC), a population-based longitudinal study. Latent class growth analysis identified four distinct longitudinal trajectories of internalizing symptoms: Low stable (66% of the children), High increasing (7%), Low increasing (17%) and High decreasing (10%). Multinomial logistic regression indicated that low self-efficacy and socioeconomic disadvantage during the toddler years were significant predictors of unfavourable (i.e., increasing) trajectories of internalizing symptoms across later childhood. Parenting hostility was a significant predictor of the low increasing trajectory. Additionally, male children were more likely than females to follow unfavourable trajectories. However, low parenting warmth was not predictive of increasing symptoms across time. Our findings highlight the importance of parenting factors in a child's early years, particularly the potentially detrimental outcomes associated with parental hostility and low self-efficacy.