International Psychoanalytic University Berlin

Individuals who do not disclose a potentially traumatic event (PTE) may receive no (or less) event-related social support after victimization. However, it is less clear whether non-disclosure increases the risk of post-event psychopathology. The present study aims to examine the effects of trauma non-disclosure or disclosure on post-event psychopathology in adult victims of PTEs in the general population of a western European country. In this prospective study, lack of emotional support along with anxiety and depression symptomatology (ADS) was assessed before participants (N = 1258) experienced a PTE (T1). Twelve months later (T2), following victimization between T1 and T2, PTSD symptoms (PTSS), ADS, and the extent of PTE-related social acknowledgment among disclosing participants were examined. Post-event psychopathology was then compared between non-disclosers (n = 98) and disclosers with high, fairly high, limited, or low levels of PTE-related social acknowledgment (n = 1160). Multivariable logistic regression analyses showed that non-disclosers had a higher prevalence of both PTSS and ADS at T2 than did disclosers with high and fairly high levels of PTE-related social acknowledgment. However, non-disclosers reported lower prevalence of PTSS than disclosers with low levels of PTE-related social acknowledgment. Among disclosers, the prevalence of PTSS and ADS at T2 increased when the level of PTE-related social acknowledgment decreased. Non-disclosure of trauma is not necessarily detrimental to mental health when compared to the effects of receiving low event-related social acknowledgment following disclosure. Rather than promoting disclosure in general, it would be more beneficial to recommend disclosure only when supportive relationships are present.

Background:Armed conflict and forced displacement are associated with elevated risks of anxiety, depression, and trauma. The ongoing war in Ukraine has exacerbated the need for mental health care while simultaneously disrupting access, underscoring the need for scalable and accessible interventions. Objective:This study examined user acceptance and changes in acute psychological distress among users of krisenchat Ukrainian (kcUA), a text-based digital counseling service. It explored patterns of distress levels, user satisfaction, and referral outcomes, comparing kcUA users (in Ukraine and in exile) with krisenchat Germany (kcDE) users. Methods:A pre-post observational study with a 4-week follow-up was conducted using feedback from 4436 help-seekers (2877 of kcDE and 1559 of kcUA) between July 2022 and April 2023. Surveys assessed mental health symptoms, user satisfaction, and local referral success at three time points: retrospectively assessed pre-consultation distress ("T0"), post-counseling (T1), and 4-week follow-up (T2). Results:All user groups reported significant reductions in symptoms of depression, anxiety, and stress immediately after counseling. At T2, kcUA users maintained symptom improvements, while kcDE users showed partial symptom rebound. User satisfaction and service acceptance were high across all groups (≥89% at T1). kcUA users more often reported war-related concerns and were more likely to recommend the service to others. Referral success was higher among kcDE users (46.6%) than kcUA users (34.9%). Conclusions:kcUA was associated with sustained reductions in psychological distress and was well accepted by kcUA users. Anonymous, scalable digital services may play a crucial role in supporting mental health during humanitarian crises.

Objective: Although rupture repair is a core process in psychotherapy, its mechanisms remain insufficiently understood. In this theory-building case study, we used an explanatory sequential mixed-method design to examine dyadic processes underlying successful versus unsuccessful withdrawal rupture repair. Method: We observer-rated rupture and repair across N = 81 video-recorded sessions of a successful psychodynamic psychotherapy. We applied Exponentially Weighted Moving Average control charting to identify two treatment phases with above-average success in rupture repair, and one phase with below-average repair. Sessions from these phases were analyzed using grounded theory coding informed by sensitizing concepts derived from a clinical discussion group. Results: The analysis yielded the core category of a collaborative working model of rupture repair. During the high-repair phases, therapist and patient tacitly established a shared interactional framework and a case-specific way of intuitively negotiating emotional intensity through multiple parameters. In the lower-repair phase, this collaborative working model could no longer be applied effectively, coinciding with changes in the treatment context that altered the transference-countertransference dynamics. Conclusion: The findings suggest that developing and sustaining a collaborative working model of rupture repair may be crucial for navigating impasses and highlight the importance of understanding the alliance as an emergent, dyadic process.

AIM:Longitudinal studies indicate that PTSD increases the risk of developing Diabetes Mellitus (DM). However, the extent to which pre-existing DM elevates the risk of PTSD and anxiety and depression symptomatology (ADS) following Potentially Traumatic Events (PTEs) remains largely unexplored. The present study aims to examine this risk. METHODS:Data were extracted from the Longitudinal Core Study on Health and the VICTIMS study conducted with the Dutch population-based LISS panel. First, adult respondents were selected who were exposed to PTEs in the past 12 months (between T2 and T3; n = 1339). A series of (stepwise) multivariate logistic regression analyses (MLRAs) were conducted with ADS and high PTSD-symptom levels (PTSS) at T3 as dependent variables. Physician-diagnosed pre-existing DM/hyperglycaemia at T1 (3 months before T2) and potential confounders, such as pre-existing anxiety and depression-symptomatology and lack of support at T2 were entered as predictors. Control MLRAs were conducted with physician-diagnosed cardiac or vascular disease problems instead of DM as predictor. RESULTS:By PTEs affected respondents with pre-existing DM (n = 62) compared to those without, were significantly more at risk of moderate-severe ADS (aOR = 2.26) and high PTSD symptom levels (aOR = 2.08) at T3. Pre-existing cardiac or vascular disease problems were not significantly associated with ADS and PTSS at T3. CONCLUSION:After PTEs adults with pre-existing DM are more at risk for PTSD and moderate-severe ADS than those without. Findings suggest that the relationship between DM on the one hand and PTSD and ADS on the other hand, is bi-directional.

Chronic depression associated with early trauma remains one of the most treatment-resistant conditions in mental healthcare. Clinical and empirical findings have increasingly suggested that patients with histories of early trauma may benefit differentially from intensive psychoanalytic treatments compared to symptom-focused or short-term psychotherapies. Our conceptual article aims to elucidate the mechanisms underlying sustained therapeutic change in psychoanalysis with chronically depressed, early traumatized patients by integrating clinical psychoanalytic theory, contemporary dream research, and interdisciplinary models of memory reconsolidation. Taking a longitudinal case from the LAC Depression Study as an illustration, this study examines a patient who underwent high-frequency psychoanalysis and demonstrated enduring structural change, which remained accessible for more than a decade after treatment termination. Clinical material from the original analysis and from a later crisis intervention illustrates how embodied memories of early traumatic experiences can be discovered and understood within the transference relationship and gradually transformed through repeated analytic working-through. Particular emphasis is placed on changes in dream processes as indicators of deep psychic reorganization. Using psychoanalytically informed dream research, including the Zurich Dream Process Coding System (ZDPCS), the analysis demonstrates a shift from early trauma-dominated nightmares characterized by helplessness and an absence of a helping object to a later dream reflecting increased affect regulation, symbolic capacity, involvement, and self-agency. These transformations are conceptualized as markers of structural change rather than mere symptom reduction. This article further argues that psychoanalytic processes resonate with contemporary neurobiological models of memory reconsolidation. When embodied memories of trauma are revived within a safe and emotionally attuned analytic relationship, they may enter a labile state that allows for enduring modification and reintegration. From this interdisciplinary perspective, psychoanalysis is uniquely positioned to foster sustained change in patients with chronic depression and early trauma by enabling the re-transcription and reconsolidation of traumatic embodied memories within the analytic relationship. This conceptual integration contributes to a more profound understanding of why psychoanalysis can produce lasting therapeutic effects in a patient population traditionally considered difficult to treat.