Background: Prolonged Grief Disorder (PGD) affects a significant minority of bereaved individuals and is associated with persistent distress, comorbidity, and functional impairment. Access to evidence-based treatment remains limited. This study introduces and evaluates Internet Cognitive Therapy for Prolonged Grief (iCT-PG), a therapist-assisted digital intervention adapted from iCT-PTSD.Objective: To assess preliminary feasibility, acceptability, and clinical outcomes of iCT-PG, and to examine changes in key cognitive maintenance mechanisms of PGD (memory characteristics, negative appraisals, unhelpful coping strategies, and a sense of social disconnection).Methods: Eight adults assessed at interview to meet diagnostic criteria for PGD completed the 12-session iCT-PG programme remotely (e.g. browser, tablet, smartphone) over 14 weeks. The intervention targeted loss-related memory characteristics, negative grief appraisals, a sense of social disconnection, and unhelpful coping strategies, and used a personalised digital modular approach and therapist support through weekly calls and messages. Outcomes were assessed at pre-treatment, post-treatment, and 3-month follow-up using validated measures.Results: All participants completed treatment. Large reductions in PGD symptoms and comorbid symptoms of PTSD, depression, anxiety, and functional impairment were observed. At post-treatment, 87.5% (7/8) demonstrated both reliable improvement in PGD symptoms on the Reliable Change Index, and recovery below clinical cut-offs. There was no reliable deterioration on any measure. Process measures showed large pre-post treatment effect sizes (d = 1.29-1.64), with the strongest improvements in loss-related memory characteristics (d = 2.61). Therapeutic gains were maintained at 3-month follow-up. Average therapist time was approximately 10 h per participant.Conclusions: iCT-PG was feasible, well-accepted, and associated with substantial clinical improvement. The intervention successfully targeted mechanisms known to maintain PGD, supporting its theoretical foundation. Though uncontrolled and small in sample size, findings support further evaluation in larger trials to determine efficacy and scalability.

Importance:Rates of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are high among paramedics. Objective:To evaluate the efficacy of a cognitive resilience training program for reducing the development of PTSD and MDD among early career paramedics compared with psychoeducation and standard practice. Design, Setting, and Participants:This randomized clinical trial of paramedics training at 15 universities across England was conducted between October 2017 to October 2022 with 12-month follow-up. Data were analyzed from December 2023 to July 2025. Intervention:Participants were randomized to receive internet-delivered cognitive training in resilience (iCT-R), psychoeducation, or standard practice. iCT-R, a guided online intervention that utilizes cognitive therapy tools to target predictors of PTSD and MDD identified in prospective research with paramedics, consisted of 6 modules delivered over 6 weeks with 6-monthly top-up sessions delivered by email. Internet-delivered psychoeducation, a supported online psychoeducation intervention, consisted of 6 topics (1 topic per week) with 6-monthly top-up sessions delivered by email. Standard practice was training as usual. Main Outcomes and Measures:The primary outcome was rate of PTSD and MDD at 1-year follow-up, assessed by independent assessors blinded to intervention using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Secondary outcomes included measures of PTSD and depression symptom severity, resilience, rumination, anxiety, psychological distress, and well-being. Intent-to-treat analyses were conducted, with the primary outcome analyzed using mixed-effects logistic regression. Results:Of 570 student paramedics enrolled (372 female [65.3%]; mean [SD] age, 23.67 [6.88] years), 195 were randomized to iCT-R, 197 to psychoeducation, and 178 to standard practice. For participants randomized to iCT-R, the odds of meeting criteria for PTSD or MDD at 12 months were significantly lower compared with psychoeducation (odds ratio [OR], 0.20; 95% CI, 0.05-0.73) and standard practice (OR, 0.25; 95% CI, 0.07-0.97). Providing iCT-R training to 18 to 24 paramedic trainees (number needed to treat) would prevent 1 case of PTSD or MDD. Conclusions and Relevance:In this randomized clinical trial, participants receiving iCT-R were approximately 5 times less likely to develop PTSD or MDD at 1-year follow-up compared with psychoeducation and 4 times less likely when compared with standard practice. These findings suggest that iCT-R appears to decrease the likelihood of developing PTSD and MDD in early career paramedics. Trial Registration:isrctn.org Identifier: ISRCTN16493616.

INTRODUCTION:Prolonged grief disorder (PGD) is a condition marked by sustained separation distress. Although cognitive models suggest that memory processes are critical in PGD, the specific characteristics of loss-related memories have received limited longitudinal attention. This study examined how loss-related memory characteristics and prolonged grief symptoms (PGS) influence each other over the first 18 months of bereavement. METHOD:A community sample of 275 bereaved adults (79% women, Mage = 46.4) completed assessments of PGS and the Oxford Grief-Memory Characteristics Scale at three time points (0-6, 6-12, and 12-18 months post-loss). Panel graphical vector autoregressive (GVAR) models decomposed contemporaneous and temporal within person associations over time. RESULTS:Memory characteristics emerged as the most influential variables over time. Memories high in re-experiencing qualities predicted increasing difficulty accepting the death and a greater range of memory triggers over time, which predicted subsequent difficulty moving forward. Predominantly negative memories were associated with subsequent heightened yearning, while visceral consequences of memories predicted later loneliness, and disconnection from memories of the past self-predicted role confusion. Re-experiencing qualities and the PGS emotional numbness had a bidirectional link. Contemporaneous networks showed dense connections among memory characteristics and symptoms within the same time point. CONCLUSION:Overall, the findings demonstrate that loss-related memory processes are predictors of later change in PGS during the first 18-month post-bereavement. This highlights maladaptive memory characteristics as promising mechanistic targets for intervention and supports therapeutic approaches that directly address how memories of loss are encoded, retrieved, and interpreted.

This randomized clinical trial evaluates the efficacy of a cognitive resilience training program for reducing the development of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) compared with psychoeducation and standard practice among early career paramedics in England. QuestionIs training that targets modifiable risk factors for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) in paramedics associated with lower rates of these disorders at 1-year follow-up compared with psychoeducation and standard practice?FindingsIn this randomized clinical trial of 570 student paramedics, participants who received internet-delivered cognitive training in resilience (iCT-R) over 6 weeks had a statistically significant reduction in and significantly lower odds of developing PTSD and MDD diagnoses at follow-up.MeaningThese findings suggest that iCT-R reduces the likelihood of developing common psychiatric disorders associated with paramedic training and work. ImportanceRates of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are high among paramedics.ObjectiveTo evaluate the efficacy of a cognitive resilience training program for reducing the development of PTSD and MDD among early career paramedics compared with psychoeducation and standard practice.Design, Setting, and ParticipantsThis randomized clinical trial of paramedics training at 15 universities across England was conducted between October 2017 to October 2022 with 12-month follow-up. Data were analyzed from December 2023 to July 2025.InterventionParticipants were randomized to receive internet-delivered cognitive training in resilience (iCT-R), psychoeducation, or standard practice. iCT-R, a guided online intervention that utilizes cognitive therapy tools to target predictors of PTSD and MDD identified in prospective research with paramedics, consisted of 6 modules delivered over 6 weeks with 6-monthly top-up sessions delivered by email. Internet-delivered psychoeducation, a supported online psychoeducation intervention, consisted of 6 topics (1 topic per week) with 6-monthly top-up sessions delivered by email. Standard practice was training as usual.Main Outcomes and MeasuresThe primary outcome was rate of PTSD and MDD at 1-year follow-up, assessed by independent assessors blinded to intervention using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Secondary outcomes included measures of PTSD and depression symptom severity, resilience, rumination, anxiety, psychological distress, and well-being. Intent-to-treat analyses were conducted, with the primary outcome analyzed using mixed-effects logistic regression.ResultsOf 570 student paramedics enrolled (372 female [65.3%]; mean [SD] age, 23.67 [6.88] years), 195 were randomized to iCT-R, 197 to psychoeducation, and 178 to standard practice. For participants randomized to iCT-R, the odds of meeting criteria for PTSD or MDD at 12 months were significantly lower compared with psychoeducation (odds ratio [OR], 0.20; 95% CI, 0.05-0.73) and standard practice (OR, 0.25; 95% CI, 0.07-0.97). Providing iCT-R training to 18 to 24 paramedic trainees (number needed to treat) would prevent 1 case of PTSD or MDD.Conclusions and RelevanceIn this randomized clinical trial, participants receiving iCT-R were approximately 5 times less likely to develop PTSD or MDD at 1-year follow-up compared with psychoeducation and 4 times less likely when compared with standard practice. These findings suggest that iCT-R appears to decrease the likelihood of developing PTSD and MDD in early career paramedics.Trial Registrationisrctn.org Identifier: ISRCTN16493616

Healthcare workers are at increased risk of posttraumatic stress disorder (PTSD), depression and generalised anxiety disorder. Evidence-based interventions tailored to this workforce are limited. We developed and evaluated a telephone-based cognitive therapy coaching intervention targeting PTSD and depression. One hundred three healthcare workers seeking support during the COVID-19 pandemic completed measures at baseline, after three-week symptom monitoring, following six-week coaching, and at three-month follow-up. Sixty-five participants met criteria for probable PTSD (PCL-5 ≥ 32) or probable depression (PHQ-9 ≥ 10), and 38 experienced subthreshold symptoms. For PTSD (PCL-5) and depression (PHQ-9), reliable recovery rates increased substantially from symptom monitoring (PTSD: 14.6

Background: Journalists are frequently exposed to traumatic images and events, which may contribute to poor mental health, especially in those starting in the profession. Evidence-based preventative tools are needed to reduce the effects of exposure to these occupational stressors. Previous research demonstrates that the strategy journalists most commonly apply to traumatic images is suppression.Objective: This experiment investigated whether stimulus discrimination, a technique used in cognitive therapy for PTSD (CT-PTSD; Ehlers et al., 2005. Cognitive therapy for post-traumatic stress disorder: development and evaluation. Behaviour Research and Therapy, 43(4), 413-431) for reducing intrusive trauma memories, is more effective than memory suppression.Methods: Student journalists were randomly allocated to one session of online training in stimulus discrimination (N = 34; Mage = 23.65, SD = 4.18; 24 female) or suppression (N = 34; Mage = 24.26, SD = 4.55; 24 female) before exposure to analogue trauma film clips. Participants then completed daily diaries of intrusive memories of the film clips for one week and completed PTSD symptom measures at one-week follow-up.Results: Compared to participants trained in memory suppression, those trained in stimulus discrimination reported significantly fewer intrusive memories, less distress associated with intrusions and lower PTSD symptom severity at follow-up. There were no training-specific effects associated with depression or resilience at follow-up.Conclusions: The study found that student journalists can be trained in stimulus discrimination and that this CT-PTSD tool significantly reduced intrusive memories and associated PTSD symptoms after post-training exposure to traumatic images.

To mark 15 years of the European Journal of Psychotraumatology, editors reviewed the past 15-year years of research on trauma exposure and its consequences, as well as developments in (early) psychological, pharmacological and complementary interventions. In all sections of this paper, we provide perspectives on sex/gender aspects, life course trends, and cross-cultural/global and systemic societal contexts. Globally, the majority of people experience stressful events that may be characterized as traumatic. However, definitions of what is traumatic are not necessarily straightforward or universal. Traumatic events may have a wide range of transdiagnostic mental and physical health consequences, not limited to posttraumatic stress disorder (PTSD). Research on genetic, molecular, and neurobiological influences show promise for further understanding underlying risk and resilience for trauma-related consequences. Symptom presentation, prevalence, and course, in response to traumatic experiences, differ depending on individuals’ age and developmental phase, sex/gender, sociocultural and environmental contexts, and systemic socio-political forces. Early interventions have the potential to prevent acute posttraumatic stress reactions from escalating to a PTSD diagnosis whether delivered in the golden hours or weeks after trauma. However, research on prevention is still scarce compared to treatment research where several evidence-based psychological, pharmacological and complementary/ integrative interventions exist, and novel forms of delivery have become available. Here, we focus on how best to address the range of negative health outcomes following trauma, how to serve individuals across the age spectrum, including the very young and old, and include considerations of sex/gender, ethnicity, and culture in diverse contexts, beyond Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries. We conclude with providing directions for future research aimed at improving the well-being of all people impacted by trauma around the world. The 15 years EJPT webinar provides a 90-minute summary of this paper and can be downloaded here [http://bit.ly/4jdtx6k].

Background: Bullying can be associated with emotional and social difficulties, but not all individuals experience enduring negative effects.Objective: This study aimed to explore beliefs about bullying, self, and other people among young adults who were bullied that may be associated with ongoing anxiety and distress related to those experiences.Method: Semi-structured interviews with 20 people, aged 18-29 years, who had experienced bullying were analysed using thematic analysis. The sample was split, by current symptoms of social anxiety and post-traumatic stress related to bullying, into a lower symptoms group (n = 12) and a higher symptoms group (n = 8).Results: Participants reported multiple types of bullying, including online. Four superordinate themes were identified in negative beliefs related to bullying experiences: personal deficiency (i.e. victimization was due to own low value or undesirable traits), social threat (i.e. wariness of others due to their negative motives or traits), acceptance is fragile (i.e. being accepted by others is transient and requires effort), and minimizing (i.e. downplaying severity and impact of past experiences). These were evident in both groups but were more frequently endorsed in the higher symptoms group.Conclusion: Negative appraisals related to bullying can persist into young adulthood and may influence social interactions and mental health. Interventions targeting these beliefs could mitigate negative outcomes and bolster resilience among individuals affected by bullying. Further research should explore these themes to inform effective therapeutic strategies for young adults who have been bullied.

Background Attachment style is widely recognized as influential in shaping responses to bereavement and prolonged grief disorder (PGD). Although theorized extensively, empirical clarity regarding how attachment styles specifically impact PGD symptoms and therapeutic implications remains limited. This study aimed to identify cognitive-behavioral mechanisms linking attachment styles to PGD symptoms.Methods Data were collected from a community sample of 695 bereaved adults. Network analysis explored interactions between attachment styles (anxious and avoidant) and various cognitive-behavioral factors associated with PGD, including appraisals, memory characteristics, maladaptive coping strategies, and a sense of social disconnection.Results The findings reveal attachment styles as peripheral within the network, suggesting that their direct influence on PGD symptoms may be less central than previously theorized. However, anxious attachment correlated positively with injustice rumination and altered social self, while avoidant attachment was positively associated with perceived loss of future and relationships and preferences for solitude, and negatively associated with proximity-seeking behaviors and fear of losing connection to the deceased. Cognitive-behavioral factors, particularly memory characteristics and social disconnection, held central positions within the network, mediating relationships between attachment styles and PGD.Conclusions Attachment styles indirectly influence PGD through cognitive-behavioral pathways rather than exerting strong direct effects. By bridging the gap between attachment theory and cognitive-behavioral approaches to grief, this study offers a more nuanced understanding of its relationship with PGD and points toward potential new avenues for future interventions aimed at addressing attachment-related challenges in bereaved individuals.

BACKGROUND:Stress leads to neurobiological changes, and failure to regulate these can contribute to chronic psychiatric issues. Despite considerable research, the relationship between neural alterations in acute stress and coping with chronic stress is unclear. This longitudinal study examined whole-brain network dynamics following induced acute stress and their role in predicting chronic stress vulnerability. METHODS:Sixty military pre-deployment soldiers underwent a lab-induced stress task where subjective stress and resting-state functional magnetic resonance imaging were acquired repeatedly (before stress, after stress, and at recovery, 90 min later). Baseline depression and post-traumatic stress symptoms were assessed, and again a year later during military deployment. We used the Leading Eigenvector Dynamic Analysis framework to characterize changes in whole-brain dynamics over time. Time spent in each state was compared across acute stress conditions and correlated with psychological outcomes. RESULTS:Findings reveal significant changes at the network level from acute stress to recovery, where the frontoparietal and subcortical states decreased in dominance in favor of the default mode network, sensorimotor, and visual states. A significant normalization of the frontoparietal state activity was related to successful psychological recovery. Immediately after induced stress, a significant increase in the lifetimes of the frontoparietal state was associated with higher depression symptoms (r = 0.49, p < .02) and this association was also observed a year later following combat exposure (r = 0.49, p < .009). CONCLUSIONS:This study revealed how acute stress-related neural alterations predict chronic stress vulnerability. Successful recovery from acute stress involves reducing cognitive-emotional states and enhancing self-awareness and sensory-perceptual states. Elevated frontoparietal activity is suggested as a neural marker of vulnerability to chronic stress.

Behavioural experiments are experiential exercises used in Cognitive Behavioural Therapy to drive cognitive change by testing patients' idiosyncratic, emotionally linked beliefs. In this paper, we provide clinical guidance on how to deliver effective behavioural experiments that maximise cognitive change based on lessons learnt over the last 30 years from our work using Cognitive Therapy to treat Panic Disorder (CT-PD), Social Anxiety Disorder (CT-SAD) and Post-Traumatic Stress Disorder (CT-PTSD). We describe key steps for setting up and carrying out powerful experiments, including common blocks and barriers patients and therapists come across when using them.

BACKGROUND:This single-blind, superiority randomised controlled trial will evaluate the efficacy of cognitive therapy (CT) coaching for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) for health and social care workers in the UK compared to a waitlist condition. METHODS:The trial will include two parallel conditions (intervention and waitlist) using a 1:1 allocation ratio. Assessors of treatment outcome will be blinded to trial condition. Ninety-two participants who meet criteria for PTSD or MDD will be randomly allocated to the intervention or waitlist condition, minimising for key clinical characteristics. Participants allocated to waitlist will be offered the SHAPE intervention afterwards. The intervention will be tailored CT coaching for PTSD and MDD called SHAPE. The primary assessment point is 8 weeks post-random allocation. Further assessment points are 4 weeks post-random allocation and 6 months after receiving the intervention to measure the long-term effects of SHAPE. The primary outcome is SCID-5 diagnosed PTSD and MDD at 8 weeks post-random allocation. The PTSD Checklist for DSM-5 (PCL-5) and the Patient Health Questionnaire (PHQ-9) will be used as secondary measures of PTSD and MDD to assess for symptom severity. Other secondary measures will assess for posttraumatic cognitions, responses to intrusive memories, resilience, wellbeing, and symptom severity for generalised anxiety disorder and insomnia. Health economic analyses will compare the two conditions on quality of life at 8 weeks post-random allocation and compare productivity loss, resource use, and health problems at pre- and post-intervention for everyone who received SHAPE. Patient and provider experience of the SHAPE intervention will be assessed by semi-structured interviews at post-intervention. DISCUSSION:This trial will be the first to evaluate the efficacy of CT coaching for PTSD and MDD for UK health and social care workers compared to a waitlist control. Since PTSD symptoms can improve naturally over time, comparison to a waitlist condition allows intervention effects to be distinguished from the effects of time alone. Findings from this trial will inform adaptations that may make the intervention more precise and effective. TRIAL REGISTRATION:ISRCTN57105098. Registered prospectively on February 21, 2023.

Background Effective face‐to‐face treatments for Post‐Traumatic Stress Disorder (PTSD) are available, but most young people with PTSD do not receive effective treatment. Therapist‐supported online Cognitive Therapy has the potential to improve accessibility of effective treatment. This early‐stage trial gathered data on the feasibility, acceptability, and initial signal of clinical efficacy of a novel online Cognitive Therapy program for young people with PTSD. Methods A two‐arm, parallel‐groups, single‐blind, early‐stage feasibility RCT compared online Cognitive Therapy to a waitlList condition. Participants were N = 31 adolescents (12–17 years‐old) with a diagnosis of PTSD, randomised in a 1:1 ratio using minimisation. Thresholds for progression to a larger trial were set a priori for recruitment rate, data completeness, and the initial signal of clinical efficacy. The primary clinical outcome was PTSD diagnosis at 16 weeks post‐randomisation. Secondary clinical outcomes were continuous measures of PTSD, depression, and anxiety at 16 weeks; and at 38 weeks in the online Cognitive Therapy arm. Results All pre‐determined feasibility thresholds for progression to a larger trial were met. We recruited to target at a rate of 1–2 participants/month. No patient dropped out of therapy; 94% of all participants were retained at 16 weeks. At 16‐weeks, the intention‐to‐treat (ITT) effect adjusted odds ratio was 0.20 (95% CI, 0.02, 1.42), indicating that the odds of meeting PTSD caseness after online therapy were 80% lower than after the waitlist (10/16 participants met PTSD caseness after therapy compared to 11/13 after WL). Effect‐size estimates for all secondary clinical outcomes were large‐moderate; improvements were sustained 38 weeks after online Cognitive Therapy. Conclusions Therapist‐supported online Cognitive Therapy for PTSD is acceptable to young people and has potential for meaningful and sustained clinical effects. A larger trial appears feasible to deliver. Further work is needed to refine the intervention and its delivery and to evaluate it in a larger confirmatory trial.

We previously found that feeding rats with broccoli or cauliflower leads to the formation of characteristic DNA adducts in the liver, intestine and various other tissues. We identified the critical substances in the plants as 1-methoxy-3-indolylmethyl (1-MIM) glucosinolate and its degradation product 1-MIM-OH. DNA adduct formation and the mutagenicity of 1-MIM-OH in cell models were drastically enhanced when human sulfotransferase (SULT) 1A1 was expressed. The aim of this study was to clarify the role of SULT1A1 in DNA adduct formation by 1-MIM-OH in mouse tissues in vivo. Furthermore, we compared the endogenous mouse Sult1a1 and transgenic human SULT1A1 in the activation of 1-MIM-OH using genetically modified mouse strains. We orally treated male wild-type (wt) and Sult1a1-knockout (ko) mice, as well as corresponding lines carrying the human SULT1A1-SULT1A2 gene cluster (tg and ko-tg), with 1-MIM-OH. N2-(1-MIM)-dG and N6-(1-MIM)-dA adducts in DNA were analysed using isotope-dilution UPLC-MS/MS. In the liver, caecum and colon adducts were abundant in mice expressing mouse and/or human SULT1A1, but were drastically reduced in ko mice (1.2–10.6% of wt). In the kidney and small intestine, adduct levels were high in mice carrying human SULT1A1-SULT1A2 genes, but low in wt and ko mice (1.8–6.3% of tg-ko). In bone marrow, adduct levels were very low, independently of the SULT1A1 status. In the stomach, they were high in all four lines. Thus, adduct formation was primarily controlled by SULT1A1 in five out of seven tissues studied, with a strong impact of differences in the tissue distribution of mouse and human SULT1A1. The behaviour of 1-MIM-OH in these models (levels and tissue distribution of DNA adducts; impact of SULTs) was similar to that of methyleugenol, classified as “probably carcinogenic to humans”. Thus, there is a need to test 1-MIM-OH for carcinogenicity in animal models and to study its adduct formation in humans consuming brassicaceous foodstuff.

Research indicates that post-bereavement coping strategies can be adaptive or maladaptive. Understanding which strategies lead to poorer outcomes is an important clinical and theoretical question with the potential to guide intervention. The Oxford Grief - Coping Strategies scale was developed from interviews with bereaved people with and without prolonged grief disorder (PGD) to assess the frequency of maladaptive cognitive and behavioural strategies after bereavement. Factorial and psychometric validity were assessed using exploratory and confirmatory factor analysis (N = 676). A three-wave cross-lagged panel model (N = 275) was used to assess the predictive validity of the tool in explaining symptoms of PGD. Results supported a four-factor solution (Avoidance, Proximity Seeking, Loss Rumination, Injustice Rumination) with good psychometric properties. The OG-CS predicted prospective symptoms of PGD in the short-term (6-12 months) and long term (12-18 months), controlling for baseline symptoms and autocorrelations. Subscale analyses demonstrated that the use of coping strategies predicted ICD-11 PGD in both the short-term and the long-term. However, avoidance was not predictive of outcomes early in the grieving process. At 6-12 months, avoidance predicted PGD at 12-18 months.

Although psychological treatments are broadly recognized as evidence-based interventions for various mental disorders, challenges remain. For example, a substantial proportion of patients receiving such treatments do not fully recover, and many obstacles hinder the dissemination, implementation, and training of psychological treatments. These problems require those in our field to rethink some of our basic models of mental disorders and their treatments, and question how research and practice in clinical psychology should progress. To answer these questions, a group of experts of clinical psychology convened at a Think-Tank in Marburg, Germany, in August 2022 to review the evidence and analyze barriers for current and future developments. After this event, an overview of the current state-of-the-art was drafted and suggestions for improvements and specific recommendations for research and practice were integrated. Recommendations arising from our meeting cover further improving psychological interventions through translational approaches, improving clinical research methodology, bridging the gap between more nomothetic (group-oriented) studies and idiographic (person-centered) decisions, using network approaches in addition to selecting single mechanisms to embrace the complexity of clinical reality, making use of scalable digital options for assessments and interventions, improving the training and education of future psychotherapists, and accepting the societal responsibilities that clinical psychology has in improving national and global health care. The objective of the Marburg Declaration is to stimulate a significant change regarding our understanding of mental disorders and their treatments, with the aim to trigger a new era of evidence-based psychological interventions.

Abstract This chapter describes how post-traumatic stress disorder (PTSD) is diagnosed, contrasting traditional “broad” formulations with a “narrow” formulation focusing on core symptoms introduced in ICD-11. The ICD-11 distinction between PTSD and complex PTSD is also described. Next, the chapter presents the two signature changes consisting of vivid re-experiencing of the traumatic event in the present coupled with impaired voluntary recall of the event. Other aspects of memory affected in PTSD that are unrelated to the traumatic event are also described. Three prominent controversies are discussed: whether traumatic memories are “special,” whether traumatic events can be forgotten, and whether there is evidence for delayed-onset PTSD. Contemporary theories of PTSD are then described, all of which identify deficits in memory for context as central to the disorder. Finally, the chapter discusses likely mechanisms involved in psychological therapy for PTSD: habituation/extinction, updating/reconsolidation, and metacognitive change.