Dual-task interventions during the reactivation of aversive or traumatic memories, including bilateral alternating stimulation used in EMDR and certain concurrent visuospatial tasks, occupy an important place in contemporary debates on the modification of emotional memories. Their immediate effects on vividness, emotionality, and recall-related distress are relatively well documented, but their mechanistic interpretation remains debated. The literature still tends to bring together, and at times conflate, distinct levels of explanation: concurrent taxation of limited working memory resources, extinction, inhibitory learning, the orienting response, prediction error, and memory reconsolidation.The effects of dual tasks can only be understood rigorously if several levels of inference are distinguished. A reduction in vividness or distress constitutes an important immediate effect, but it does not, by itself, allow one to conclude that the traumatic memory has been durably transformed. Similarly, a decrease in emotional responding may reflect safety learning or contextual inhibition without necessarily implying modification of the original memory. Reconsolidation constitutes a strong mechanistic hypothesis, but it requires strict conditions of reactivation, novelty, prediction error, and restabilization, which are rarely established with certainty in ordinary clinical contexts.We therefore propose a critical clarification of the levels of inference involved in interpreting dual-task interventions. This clarification makes it possible to distinguish the immediate effect on the experience of recall, increased tolerance of contact with the memory, the clinical de-actualization of traumatic memory, and the more demanding hypothesis of memory updating. De-actualization does not refer here to a new mechanism, but to the central clinical issue long described in the trauma tradition: the shift from a memory experienced as a threatening presence in the present to a memory recognized as an event located in the past and capable of being integrated into autobiographical memory.This position leads to a reformulation of the clinical and methodological implications of the field. Clinically, it invites us not to reduce therapeutic change to the immediate decrease in subjective units of distress or image vividness, but to examine the durability of change, its generalization beyond the session, and the transformation of the autobiographical status of the memory. From a research perspective, it calls for protocols capable of separately measuring immediate working memory effects, safety learning, autobiographical contextualization, and the strict conditions required to infer possible reconsolidation. The aim is therefore not to add another explanatory mechanism, but to specify what dual tasks do, and do not, allow us to conclude.
Background Depression is a leading global public health concern, with trauma and trauma-related symptoms increasingly recognized as important contributors to its onset and maintenance. It remains unclear which specific post-traumatic and dissociative symptoms most strongly predict subsequent depressive symptoms. Objectives This longitudinal study addressed this gap by examining the predictive role of complex PTSD and dissociative symptoms on depressive symptoms over six months. Methods Participants were 293 female mental health service users recruited internationally. They completed surveys at baseline and six-month follow-up. Measures included the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, the International Trauma Questionnaire (ITQ) for ICD-11 complex PTSD symptoms, and the Multiscale Dissociation Inventory (MDI) for dissociative symptoms. Results Controlling for baseline depression, age, education, and location, hierarchical multiple regression analysis revealed that baseline re-experiencing symptoms (β = 0.135, p = .019) and depersonalization (β = 0.187, p = .034) significantly and positively predicted follow-up depressive symptoms. Nevertheless, baseline avoidance was negatively associated with depressive symptoms (β = -0.304, p = .043) at follow-up. Conclusions These findings suggest that the trauma model of depression requires more research and replication. Re-experiencing, depersonalization, and avoidance might be important symptom-level targets for preventing and treating depression, but future research should replicate these patterns in larger and more diverse samples, examine the mechanisms linking trauma-related symptoms to depressive trajectories, and evaluate whether trauma-focused interventions reduce depressive symptoms in individuals with prominent re-experiencing and depersonalization.
Background Outcome definitions such as response, remission, non-response, and treatment resistance are central to the evaluation of pharmacological trials in posttraumatic stress disorder (PTSD). Yet, definitional heterogeneity complicates evidence synthesis and clinical translation. Objective This methodological systematic review identified and classified how these outcome constructs have been defined and used in randomized controlled trials (RCTs) of pharmacological treatments for PTSD and examined variation in these definitions according to study characteristics, including publication period, intervention class, population type, instrument version, role within the trial, and treatment approach. Methods A systematic search was conducted without language restrictions in MEDLINE, CENTRAL, Embase, and PsycINFO, from inception to 1st August 2026, following a preregistered protocol (PROSPERO CRD420251074957). Eligible studies were RCTs evaluating pharmacological interventions for PTSD that reported at least one definition of treatment response, remission, non-response, or treatment resistance. At least two reviewers independently screened studies, extracted data and assessed Risk of Bias using the Cochrane RoB-1 tool. Results Definitions of response and remission varied considerably across the 111 included RCTs, with some variation reflecting changes in assessment instruments and diagnostic systems over time. The most frequently used response criterion was a CGI I/C rating of 1 or 2, indicating “very much improved” or “much improved”. A ≥30% reduction in CAPS score was repeatedly used across DSM-III-, DSM-IV-, and DSM-5-based CAPS versions, although alternative percentage thresholds, absolute score decreases, and composite definitions were common. Remission definitions differed more clearly by instrument generation: earlier CAPS generations predominantly used absolute CAPS endpoint thresholds, particularly scores around 20, whereas DSM-5 studies more often incorporated loss of PTSD diagnostic status. Treatment resistance or non-response was typically defined by prior treatment failure, but adequacy criteria, defined as minimum requirements regarding treatment type, dose, and duration of prior interventions, were rarely specified and varied substantially. After exclusion of studies using treatment-resistance only descriptively, adequacy criteria were specified more frequently, but heterogeneity in the number and type of required treatment failures persisted. Conclusions Definitions of response, remission, non-response and treatment resistance varied widely across pharmacological PTSD RCTs. This variability complicates comparisons across studies, may alter pooled responder estimates and contribute to between-study heterogeneity, hindering efforts to synthesize evidence. Standardized, consensus-based definitions are needed to improve the interpretability and comparability of future research and its relevance to clinical practice. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Background The ongoing war in Ukraine has substantially increased the need for treatment of trauma- and stress-related mental health problems, including among patients with heterogeneous and comorbid clinical presentations. Objective This study examined changes in PTSD symptoms, anxiety, and depression following participation in a multimodal inpatient rehabilitation program for stress- and trauma-related disorders. Methods A naturalistic pre–post observational study was conducted in an inpatient crisis center in Ukraine. The approximately four-week multimodal program combined individualized pharmacological treatment, a standardized 16-session group psychotherapy program, individual psychological consultations, and supplementary therapeutic activities. During the study period, 250 unique patients were admitted to the program, of whom 198 (79.2%) completed rehabilitation. The primary analysis included 159 participants with complete pre- and post-treatment assessment data. Outcomes were assessed using the PTSD Checklist for DSM-5 (PCL-5) and the Hospital Anxiety and Depression Scale (HADS). Results Significant reductions were observed across all primary outcomes. Mean PCL-5 scores decreased from 43.75 (SD = 15.54) at baseline to 27.07 (SD = 16.36) post-treatment, t(158) = 12.72, p < .001, d = 1.01. HADS anxiety scores decreased from 10.88 (SD = 4.12) to 7.22 (SD = 4.03), t(158) = 11.25, p < .001, d = 0.89, and HADS depression scores decreased from 9.27 (SD = 4.43) to 5.99 (SD = 4.08), t(158) = 10.16, p < .001, d = 0.81. Conclusions Participation in the multimodal inpatient rehabilitation program was associated with substantial reductions in PTSD symptoms, anxiety, and depression. These findings suggest that structured multimodal inpatient rehabilitation may be a feasible treatment approach for heterogeneous clinical populations in resource-constrained wartime settings. Given the uncontrolled naturalistic design and the concurrent use of pharmacological and multiple psychosocial interventions, the observed symptom changes cannot be causally attributed to the program as a whole or to any individual treatment component.
Sexual assault disclosures often elicit negative and positive reactions, which may relate respectively to posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth. Clarifying how these reactions shape victims’ adjustment over time is essential for improving clinical and social practices. Aim This study examined cross‑sectional and longitudinal associations between negative social reactions and PTSD symptoms, and between positive social reactions and PTG. Method A community sample of 97 participants who disclosed a sexual assault completed the Social Reactions Questionnaire, the PTSD Checklist for DSM‑5, and the Posttraumatic Growth Inventory at three assessments spaced six months apart. Cross‑lagged panel models tested associations. Results Negative reactions were associated with PTSD symptoms cross‑sectionally but did not predict them longitudinally. Positive reactions were linked to PTG cross‑sectionally and preliminary results suggest that this link may also emerge over time. Conclusion Findings show no prospective effect of negative reactions on PTSD but indicate that positive reactions may precede PTG, highlighting the need to promote positive reactions.
Alexithymia involves difficulties in identifying, describing, and symbolically processing emotional states. Previous research has shown that childhood maltreatment is associated with alexithymia, but the psychological processes underlying this relationship remain only partially understood. The present study explores the mediating role of defence styles in the association between childhood maltreatment and alexithymia. The study was carried out on 402 Italian participants (Mage = 36.56, SD = 12.89, age range 19-78 years; 309 females), who completed the Childhood Trauma Questionnaire–Short Form, the Toronto Alexithymia Scale, and the Defence Style Questionnaire-40. Results indicated that childhood maltreatment was positively associated with the immature defence styles, which, in turn, was positively associated with alexithymia. The total indirect effect was significant, and the specific indirect effect through immature defence styles was significant. Conversely, mature and neurotic defence styles did not show significant indirect effects. The direct association between childhood maltreatment and alexithymia was not significant. The study provides evidence on the role of defence styles in alexithymia among individuals reporting childhood maltreatment. Limitations and future research directions are also discussed.
Background : Childhood trauma and dissociative experiences are recognized as significant factors in the development of severe personality pathology. However, limited research has systematically compared these phenomena across different personality spectra within non-clinical populations. The present study aimed to compare dissociative experiences and childhood trauma among individuals exhibiting prominent borderline, paranoid, and schizotypal personality traits within a non-clinical sample. Method: A total of 263 participants were selected from a larger screened sample of 1084 university students and categorized into four groups (Borderline: n = 71, Paranoid: n = 64, Schizotypal: n = 68, Normative Comparison: n = 60) based on their dominant personality trait profile or assignment to a low-trait normative comparison group. Participants completed the Dissociative Experiences Scale (DES) and the Childhood Trauma Questionnaire (CTQ). Multivariate analyses of variance (MANCOVA) were conducted to examine group differences. Results: The findings revealed a significant hierarchical pattern across the three personality spectra. Individuals with prominent borderline traits reported the highest levels of both dissociative experiences and childhood trauma, followed by those with schizotypal traits, and then those with paranoid traits. All three high-trait groups scored significantly higher than the normative comparison group on all measures. Conclusion: These findings are consistent with the hypothesis that there are qualitative differences in the nature of core personality impairment, predominant trauma patterns, and the potential role of defense mechanisms across these three personality spectra. These findings suggest the potential importance of spectrum-based approaches in understanding the developmental pathways of severe personality pathology and may have implications for early identification and targeted, trauma-informed interventions. However, due to the cross-sectional design, these interpretations remain speculative and require longitudinal validation.
The International Trauma Interview (ITI) can guide clinicians in assessing posttraumatic stress disorder (PTSD) and complex PTSD. Emerging evidence supports the ITI’s validity, but its clinical utility in routine practice remains underexplored. The aim of this study was to investigate clinician-rated utility of the ITI across three specialised PTSD clinics treating different trauma-affected populations. We collected qualitative focus group data across all clinics. Systematic quantitative data on interview duration and clinician-rated response validity for 100 interviews were collected at two clinics only. Thematic analysis with mixed-methods integration showed that from a clinician perspective, 1) the ITI’s appropriateness for clinical practice is anchored in its thoroughness, 2) time constraints challenge its accessibility, 3) client- and wording-related factors influence its practicability, and 4) its acceptability among clinicians is predominantly positive. Overall, the ITI holds valuable potential for clinical practice, but considering how to compensate for the time-consuming implementation is vital for future clinical use. To enhance the clinical utility of the ITI, we discuss its utility beyond diagnostics, adopting a more flexible interview format, examining wording and translations to enhance validity and flow, ensuring adequate clinician training, and exploring clients’ perceptions of the ITI. In conclusion, our study revealed both advantages and challenges influencing clinicians’ perceptions of the clinical utility of the ITI. We recommend further research on the ITI’s clinical utility to support its thoughtful integration into routine trauma-focused practice.
This study analyzed epidemiological data that straddled the Wang Fuk Court fire disaster in Tai Po, Hong Kong Special Administrative Region. A random sample of Hong Kong residents aged 18–64 years was included (pre-disaster n = 634, post-disaster n = 311). The two samples did not differ in the four demographic variables. The post-disaster sample reported significantly higher levels of depressive, dissociative, and psychotic-like symptoms, as well as poorer sleep quality, compared to the pre-disaster sample, with small effect sizes (Cohen’s d = 0.144 to 0.231; all p < .05), in unadjusted analyses. The differences remained statistically significant for dissociative and psychotic-like symptoms in the adjusted analyses and after applying for Bonferroni correction. The Tai Po fire was associated with small increases in selected mental health indicators among respondents surveyed after the fire. Urban disasters may have mental health impacts that extend beyond the directly affected individuals to the broader community.
Cet article propose de mobiliser la théorie de la dissonance cognitive (TDC, Festinger, 1957) comme cadre heuristique à visée analogique pour éclairer certains mécanismes sociocognitifs du psychotraumatisme. Sans pour autant assimiler ces deux corpus l’un à l’autre, nous proposons que l’exposition à un événement traumatogène, en ce qu’elle invalide des croyances fondamentales relatives au soi, aux autres et au monde (Janoff-Bulman, 1989), peut être utilement conceptualisée comme générateur de dissonance. Dans ce cadre, les stratégies de réduction de la dissonance peuvent être analysées comme des réponses adaptatives ou pathogènes, selon leur nature et leur persistance. Cette analogie conceptuelle est illustrée par une vignette clinique dans laquelle le cadre de la TDC a été mobilisé à des fins de psychoéducation. La démarche semble avoir contribué, de façon circonscrite, à une réduction des ruminations de la patiente, sans que nous puissions, à ce stade, en généraliser les effets à d’autres dimensions cliniques. Les limites de cette proposition sont discutées et l’article conclut en faveur d’une approche intégrative susceptible d’enrichir la pratique clinique, la psychoéducation et la formation des professionnels.
The October 7, 2023 attacks in Israel created an unprecedented mental health crisis marked by mass trauma, grief, and displacement. Traditional psychotherapy models - designed for stable, individual-focused settings - were challenged by the scope, intensity, and diversity of needs emerging in the aftermath. Drawing on existing literature and extensive clinical experience during the ensuing war, this paper proposes a comprehensive, integrative model of psychotherapy guided by two intersecting axes: mind-body and individual-system. This model conceptualizes war-related distress as existing along continua that encompass psychological and physical injury, and extend from the individual to familial and community systems. It highlights the importance of flexible, interdisciplinary, and modular interventions that address comorbidity, ambiguous loss, secondary trauma, and identity reconstruction following injury and disability. Clinical examples drawn from real-world therapy with war survivors illustrate how these axes inform assessment, formulation, and treatment -integrating approaches from cognitive-behavioral, narrative, psychodynamic, systemic, and rehabilitation psychology. The model underscores the need for mental health care that dynamically adapts to the interplay between trauma, grief, physical injury, and collective distress. Ultimately, this two-axes framework offers clinicians a theoretically-grounded yet practical approach to psychotherapy in contexts of ongoing war, emphasizing flexibility, integration, and collaboration across mind-body and system levels to promote resilience and healing amid prolonged crisis.
Background Somatoform dissociation is the somatic manifestation of dissociation. It refers to physical symptoms that resemble somatic diseases or the effect of substance use but cannot be explained by any organic disorder. Identifying the dissociative nature of a somatic symptom and its frequently hidden history of trauma can be challenging. Since no psychometric instrument is currently available in Hungary to screen for this phenomenon, the adaptation and preliminary psychometric analysis of a reliable measurement is essential. Objective The present study aimed to examine and adapt the psychometric properties of the Hungarian version of the Somatoform Dissociation Questionnaire (SDQ-20) while also investigating the prevalence of somatoform dissociation among psychiatric patients and its association with childhood trauma. Method A cross-sectional study was conducted with 112 heterogeneous adult psychiatric patients aged 18–65 years (M = 38.36; SD = 13.51) at the Department of Psychiatry and Psychotherapy of the University of Debrecen Clinical Centre. Participants were selected via convenience sampling and completed a battery of questionnaire that included the Hungarian adaptation of the SDQ-20, the Dissociative Experiences Scale (DES), the Adverse Childhood Experiences (ACE) Questionnaire and the Patient Health Questionnaire-15 (PHQ-15) Somatic Symptom Severity Scale. Results The Hungarian version of the SDQ-20 showed excellent internal consistency (Cronbach’s α = 0.831; McDonald's ω = 0.84). A significant, positive correlation was observed between SDQ-20 and DES (ρ = 0.521; p < 0.001). Furthermore, childhood traumatization showed a stronger association with the SDQ-20 (ρ = 0.356; p < 0.001) than with the PHQ-15 (ρ = 0.213; p < 0.05). The study established the cut-off score of our sample at 29.5, revealing that 24.1 % of the participants exhibited a somatoform dissociative tendency. Adverse childhood experiences were highly frequent, with 41.1 % of the total sample and 63.0 % of those with somatoform dissociation reporting four or more ACEs. Binary logistic regression significantly associated physical abuse with higher odds of reporting both psychoform and somatoform dissociation. Conclusion Given the preliminary evidence regarding the psychometric properties of the Hungarian version, the SDQ-20 can be considered a reliable tool for screening somatoform dissociative symptoms in psychiatric settings. Our findings suggest the importance of screening for somatoform dissociation and considering its association with adverse childhood experiences among psychiatric patients to facilitate the identification of patients who would benefit from trauma-focused interventions. Further studies using larger samples, structured clinical interviews, test-retest designs, and independent clinical criteria are needed to establish structural validity, diagnostic thresholds, and clinical utility.
Background Posttraumatic stress disorder (PTSD) develops in only a minority of trauma-exposed individuals and follows markedly divergent post-trauma courses. Explaining this distribution requires a framework that integrates non-transition, transition, persistence, clinical expression, and recovery rather than treating any single mechanism or phenotype as sufficient. Objective To synthesize established and contemporary trauma literatures into a multilevel account that treats PTSD as a conditional transition outcome rather than as the product of a single mechanism, circuit, or biomarker. Method This integrative theoretical review draws on trauma psychology, emotional-processing and cognitive models, fear-extinction research, resilience and trajectory studies, network approaches, stress physiology, and biological psychiatry. Findings are organized across three analytic levels — landscape (transition and non-transition), network (maintenance after entry), and constellation (phenotypic and measurement-level representations) — with a transverse biological substrate axis. Results The synthesis positions non-transition as the explanatory baseline; treats transition as configurational rather than determined by exposure alone; describes maintenance as plural, supported by partially separable behavioral and neurobiological processes; and treats recovery and relapse as asymmetric rather than simple reversals of pathogenesis. Diagnostic systems, the PTSD–complex PTSD distinction, trajectory classes, subtype axes such as the dissociative subtype, and demographic patterns provide clinically meaningful phenotypic and measurement-level representations that the framework must accommodate, while their correspondence to specific causal processes requires independent evidence. Conclusions The framework separates the problems of transition, maintenance, clinical expression, and exit, and specifies how biological evidence can inform each without being reduced to a single biomarker or pathway. Its principal value is to define longitudinal and translational tests that could move PTSD theory from cataloguing heterogeneity toward explaining it, while individual-level prediction remains a separate validation task.
Background Globally, 123.2 million people are forcibly displaced, having often faced violence, persecution, or instability. These populations show noticeably higher rates of PTSD and other mental health issues than host communities. Although clinical guidelines recommend trauma-focused therapies as first-line treatments for PTSD, their use with exiled populations remains contested. Objective This systematic review aims to identify the brief individual psychological interventions currently implemented for psychotrauma in exiled populations, including refugees and asylum seekers. Method Adhering to PRISMA guidelines and the PICO framework, we screened RCTs involving adult refugees, asylum seekers, or forcibly displaced people with psychotrauma. Eligible interventions were brief (4-12 sessions), individually delivered, trauma-focused, or transdiagnostic therapies, selected for their adaptability to displaced populations and alignment with WHO recommendations. The primary outcome of interest was PTSD. Fifteen articles met these criteria. Results RCTs identified a range of brief interventions implemented to reduce PTSD symptoms among refugee and asylum-seeking populations. Although efficacy varied, evidence suggested particularly promising results for EMDR, NET, VBC, and PM+. Support for CBT-based approaches was more limited. Cultural adaptation and community engagement emerged as key factors for enhancing acceptability, sustaining participation, and reducing attrition. Conclusion These findings indicate that brief psychological interventions, including trauma-focused therapies, can be feasibly implemented among exiled populations and are associated with meaningful reductions in post-traumatic stress symptoms. They also highlight the need for culturally adapted approaches and further high-quality research to strengthen the evidence base for psychotrauma care in forcibly displaced adults.
