Abstract Nigeria faces multiple overlapping violent conflicts; however, there are few validated mental health screening instruments for these conflict‐affected populations. This study validated the PTSD Checklist for DSM‐5 (PCL‐5), Patient Health Questionnaire–9 (PHQ‐9), and Generalized Anxiety Disorder–7 (GAD‐7) among 205 conflict‐affected people in two internally displaced persons camps in Abuja, Nigeria. Measures were translated into Hausa and Pidgin English and culturally adapted; psychiatrists also administered structured clinical diagnostic interviews. All instruments showed excellent reliability, McDonald's ωs = .866–. 915, Cronbach's αs = .864–.915. Confirmatory factor analysis favored a six‐factor anhedonia model for the PCL‐5 per incremental fit indices, whereas the Bayesian information criterion favored more parsimonious four‐factor models. Neither the single‐factor nor two‐factor PHQ‐9 models provided adequate fit, and the GAD‐7 fit a unidimensional structure poorly. The PCL‐5 showed fair criterion validity, AUC = .706, and performed best at a threshold of 38 points or higher (sensitivity: 56.3%, specificity: 76.5%), outperforming the international standard of 33. The PHQ‐9 demonstrated poor criterion validity, AUC = .697. At a 10‐point score threshold, sensitivity (69.7%), specificity (68.8%), and negative predictive value (82.6%) supported limited use as a first‐stage screener with clinical case confirmation. The GAD‐7 demonstrated even lower criterion validity, AUC = .576. Within this population, estimated PTSD (50.2%), depression (32.4%), and anxiety (44.9%) prevalences were high, with comorbid presentations in 40.5% of participants. Population‐specific score thresholds improved PCL‐5 diagnostic accuracy, and the PCL‐5 and PHQ‐9 can support screening in this population; the GAD‐7 requires further evaluation or supplementation.
Abstract Humanitarian responses to war‐related trauma frequently prioritize scalable psychosocial activities or medication‐adjacent services, while clinically governed psychotherapy remains uncommon in settings shaped by ongoing state violence. When psychotherapy is introduced, it is often without the conditions that make care safe and clinically coherent: stable privacy, continuity, supervised decision‐making, culturally grounded formulation, and enforceable boundary governance. Further, in crises, cultural adaptation may be reduced to literal, decontextualized translation rather than interpretation as part of clinical work. This manuscript provides a program description of Healing for Gaza, a hybrid remote and field‐based care model developed to extend access to clinically governed psychotherapy and psychiatric care for Palestinians from Gaza amid protracted violence and displacement. The model integrates trauma‐informed psychotherapy, psychiatric services, periodic field missions for in‐person and community interventions, and a structured training curriculum emphasizing both learning about care for trauma in this setting and countering clinical assumptions anchored in stable settings. In addition, this paper offers an operational account of how Healing for Gaza delivers psychotherapy as a governed clinical process: centralizing triage and coordination; providing clinic‐managed communication channels to protect confidentiality in a system reliant on telehealth care; ensuring interpreters and clinicians are trained, consistently assigned, and integrated into supervision; applying workforce safeguards, including structured supervision and debriefing, reflective practices, caseload caps, and access to psychotherapy; and using a mixed‐methods monitoring, evaluation, accountability, and learning framework oriented toward clinical quality and emerging risks. The manuscript concludes with principles that may guide adaptation of this architecture in other humanitarian contexts.
Abstract This systematic review and network meta‐analysis evaluated and ranked psychosocial interventions for reducing posttraumatic stress disorder (PTSD), depression, and anxiety among adults exposed to mass casualty events (MCEs). English‐ and Spanish‐language databases were searched for randomized and nonrandomized trials comparing interventions with inactive (e.g., waitlist) or active (e.g., treatment‐as‐usual) controls. Primary outcomes were posttreatment symptoms of PTSD, depression, and anxiety. Risk of bias was assessed (Cochrane Risk of Bias 2, ROBINS‐I), and random‐effects network meta‐analyses were conducted using standardized mean differences (SMDs), with ranking based on P‐scores. Primary analyses excluded studies with a high or serious risk of bias. Fifty‐four studies ( N = 10,721) across 25 countries met the inclusion criteria. Compared with inactive controls, large effects for PTSD were observed for early eye movement desensitization and reprocessing (E‐EMDR), SMD = 2.48; exposure therapy, SMD = 1.60; and cognitive behavioral therapy (CBT), SMD = 1.40, with E‐EMDR and CBT remaining significant versus active controls, SMDs = 2.36 and 1.28, respectively. For depression, exposure therapy, SMD = 1.36; interpersonal psychotherapy, SMD = 1.15; mind–body practices, SMD = 1.01; CBT, SMD = 0.85; and integrative therapies, SMD = 0.67, outperformed inactive controls, with exposure therapy, mind–body practices, and CBT remaining significant versus active controls. For anxiety, exposure therapy, CBT, and integrative therapies outperformed both control types, with less precise estimates. Exposure and CBT ranked highly across outcomes; E‐EMDR ranked highest for PTSD. The findings support prioritizing trauma‐focused interventions following MCEs while highlighting the need for additional comparative and long‐term research.
Abstract At the 41st Annual Meeting of the International Society for Traumatic Stress Studies, held in Baltimore, Maryland, on September 17–20, 2025, researchers and practitioners worldwide convened to examine issues central to the theme, “Frontiers in Traumatic Stress: Global Perspectives and Creative Solutions.” The meeting highlighted global and local complexities in trauma assessment, intervention, and policy and showcased innovative research and practice across diverse contexts. This editorial spotlights papers drawn from presentations at the meeting that illuminate key innovations, emerging developments, and evidence‐based practices across the field. The featured work spans topics including the recognition of chronic trauma exposure across global settings; promises and challenges posed by advances in digital technologies and artificial intelligence; progress in trauma‐informed assessment, diagnosis, and intervention; and community‐based approaches addressing the impacts of systemic trauma. This issue presents a curated sample of the meeting's compelling presentations to illuminate the depth and breadth of contemporary trauma innovations and to chart directions for future research, clinical practice, and policy that more holistically support improved outcomes for affected individuals and the prevention of trauma‐related psychopathology following exposure.
Abstract Written exposure therapy (WET) is an evidence‐based, trauma‐focused psychotherapy for posttraumatic stress disorder (PTSD) that has been tested with several trauma‐exposed samples. Although many individuals who receive WET and other trauma‐focused psychotherapies experience a significant reduction in PTSD symptoms, there remains room for improvement given that a meaningful proportion of individuals continue to meet the diagnostic criteria following treatment. Adjunctive interventions that can be easily combined with trauma‐focused psychotherapies for PTSD may improve treatment outcomes. Transcranial direct current stimulation (tDCS) is a noninvasive neurostimulation intervention that has demonstrated preliminary evidence of reducing PTSD symptoms. In this study, we combined WET with tDCS to treat PTSD in a pilot randomized clinical trial. Participants ( N = 25) received five WET sessions and were randomized to active or sham tDCS targeting the dorsolateral prefrontal cortex. Results showed no statistically significant group differences in PTSD symptom reductions at 1‐month follow‐up, as assessed using the Clinician‐Administered PTSD Scale for DSM‐5 or PTSD Checklist for DSM‐ 5 (PCL‐5), p s = .573–.619, and both treatment groups demonstrated significant PTSD improvements, p s < .001, at the final assessment point. However, there was a significant two‐way interaction for the PCL‐5, p = .010. Deconstruction of this interaction showed that WET with tDCS had an accelerated effect, with larger PTSD symptom reductions occurring earlier in treatment relative to WET with sham tDCS. The findings highlight the potential of tDCS to accelerate PTSD outcomes when combined with WET and support conducting larger randomized clinical trials.
