Primary care clinics represent a promising, yet underutilized, setting for delivering health-focused prevention programming targeting adolescent substance use, sexual assault, and sexual risk behaviors; however, little is known about adolescents' prior exposure to such messaging. Therefore, the present study examined adolescents' prior prevention exposure, their perceptions of prevention content, and recommendations for future programs. Semi-structured qualitative interviews were conducted with 25 adolescents (ages 14-18; 56% female, 36% male, 8% gender fluid or Two-Spirit) recruited from primary care and community settings in the southeastern United States. Thematic analysis was used to examine youth exposure to and perspectives on prevention programming. Three core themes emerged: (1) prior exposure to prevention content across topics; (2) appraisal of strengths and limitations within previous programming; and (3) recommendations for what adolescents believe their same-aged peers should know. Participants reported a preference for technology-based programs, criticized interventions exclusively promoting abstinence and negative consequences, and emphasized needing additional information on sexual consent. Adolescents in primary care settings report inconsistent exposure to prior prevention, most centering abstinence and negative consequences, rather than inclusive harm-reduction approaches. Findings highlight a structural gap in exposure to comprehensive adolescent prevention programming and position pediatric primary care as a uniquely flexible and developmentally congruent setting for delivering integrated, harm-reduction-oriented prevention interventions. These findings also further support the development of scalable, technology-driven prevention tools that can be implemented within pediatric primary care settings to improve accessibility reach, engagement, and relevance.

Background: Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) frequently co-occur during adolescence and are associated with substantial functional impairment and elevated risk for chronic comorbidity. Despite strong evidence supporting integrated, trauma-focused treatments for adults with PTSD + SUD, the adolescent treatment literature remains limited.Objective: This review synthesizes current evidence on the integrated treatments for co-occurring PTSD + SUD problems among adolescents and youth, with emphasis on evaluating the strength of the evidence and identifying key directions for future research.Method: Targeted searches identified randomized controlled trials, open trials, pilot studies, and feasibility studies evaluating treatments for adolescents with PTSD + SUD problems. Studies were included if they reported PTSD and/or substance use outcomes. Findings from the adult PTSD + SUD literature were reviewed to inform developmentally appropriate adaptation for youth.Results: The adolescent evidence base is sparse. Risk Reduction Through Family Therapy (RRFT) is the only integrated treatment supported by multiple randomized controlled trials, demonstrating durable improvements in PTSD symptoms and substance use. Preliminary evidence also supports Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure for Adolescents (COPE-A). Across studies, trauma-focused treatment was not associated with increased substance use and was generally acceptable to adolescents. However, conclusions are constrained by small samples, heterogeneous interventions, and limited long-term and implementation data.Conclusions: Integrated, trauma-focused psychotherapies appear safe and promising for adolescents with co-occurring PTSD + SUD problems. Larger trials, mechanistic research, and implementation-focused studies are needed to inform best practices and expand access to effective care.

A growing body of research suggests sleep disturbances and depressive symptoms do not just co-occur but influence each other over time. While emerging evidence supports a bidirectional relationship, developmental pathways between sleep problems and depression remain understudied in youth. Rumination may serve as a potential modifiable cognitive mechanism linking these conditions. However, rumination’s role in these developmental pathways remains largely unexplored, particularly across childhood and adolescence. This study employed a cross-lagged panel model (CLPM) to investigate prospective associations among sleep, depression, and rumination and test mediation effects. Participants were 364 youth aged 8 to 16 participating in three yearly assessments. A distinct pattern emerged in which rumination predicted later depression, and depression predicted later insomnia. Insomnia did not significantly predict later depression and was not associated with rumination. Examination of indirect effects identified support for a mediational pathway from rumination to insomnia through depression. Although prior research has framed early insomnia symptoms as a risk factor for later depression, the present investigation highlights an alternative developmental pathway. Results suggest that depressive rumination contributes to later depression which in turn contributes to later insomnia among youth. These findings may inform prevention and early intervention efforts by identifying rumination as a potential target to mitigate risk for depression and insomnia.

Early (before age 6) potentially traumatic events (PTEs) may interact with hypothalamic-pituitary-adrenal (HPA) axis functioning to shape outcomes involving externalizing problems and anxiety. However, directions of effects remain unclear. This study examined associations between aspects of HPA axis reactivity, anxiety, and externalizing problems over two years by early PTE exposure history, while statistically capturing the co-occurrence of symptom domains. Youth (N = 189; Mage = 10.96 years, SD = 2.51, Range = 8-15; 52.4% female, 47.1% male; 50.3% White, 35.4% Black/African American, 6.4% Other; 7.4% Hispanic/Latine) were included if they had early PTE exposure (n = 107) or had never experienced a PTE (n = 82). HPA axis reactivity to social stress was calculated using area under the curve with respect to ground (AUCg) and increase (AUCi). For youth with early PTE exposure, higher AUCg was concurrently associated with more externalizing symptoms and greater predominance of externalizing over anxiety. Blunted AUCi predicted increasing predominance of externalizing for the early PTE group, but elevated AUCi predicted increases in anxiety for the no PTE group. Findings highlight distinct roles of overall and reactive HPA axis functioning in shaping outcomes following early trauma.

People living with Human immunodeficiency virus (HIV; PLHIV) have high rates of post-traumatic stress disorder (PTSD), which contributes to poor health outcomes. Avoidant behavior, a hallmark feature and overlapping symptom of PTSD and HIV stigma, may undermine antiretroviral therapy (ART) adherence. Few studies have evaluated PTSD treatment effects on HIV outcomes. Cognitive Processing Therapy (CPT), an evidence-based PTSD treatment, can be adapted to address internalized stigma and adherence by reducing avoidance. In alignment with the U = U (Undetectable = Untransmissible) campaign, this pilot randomized controlled trial (RCT) tested feasibility of integrating CPT with an adherence intervention (Life-steps; CPT-L) in a Ryan White clinic. Forty-one adults with HIV, PTSD, and suboptimal HIV care (e.g., missed appointments, detectable viral load) were recruited from a South Carolina Ryan White clinic. Participants were randomized 1:1 to CPT-L (n = 20) or Life-steps only (n = 21). Outcomes included PTSD symptoms, HIV stigma, quality of life, viral load, and appointment engagement, assessed at baseline, post-intervention, and 3-month follow-up. Analyses used linear regression/ANOVA, with viral load detection examined via Fisher’s exact test. CPT-L participants showed significantly greater reductions in PTSD symptoms (Δ = 11.55, SE = 4.32, p = .01) and HIV stigma (Δ = 22.63, SE = 7.33, p = .006) compared with Life-steps only. Preliminary trends also indicated improved HIV care indicators, including appointment attendance, ART adherence, and viral suppression. Integrating CPT with adherence counseling reduced PTSD symptoms and HIV stigma, and showed potential to improve HIV outcomes. This innovative approach may advance U = U goals by increasing viral suppression among PLHIV with PTSD.

Background:Despite high PTSD prevalence and related detrimental health outcomes for persons with HIV (PWH) there are no established integrated interventions addressing co-occurring HIV and PTSD. Negative reinforcement conceptual models posit that avoidant behavior (a hallmark symptom of PTSD) demonstrated by PWH with co-occurring PTSD can contribute to poor antiretroviral therapy (ART) adherence. However, research evaluating the impact of evidence-based treatment for PTSD among HIV positive populations on HIV outcomes is scarce. The Cognitive Processing Therapy (CPT) protocol is an evidence-based PTSD treatment that can address internalized stigma with tailored modifications and improve ART adherence and subsequent viral suppression through reduction of avoidant coping. Methods:This is the first pilot RCT to test feasibility of an integrated evidence-based PTSD treatment, cognitive processing therapy (CPT) with an adherence intervention (Life-steps) delivered in a Ryan White clinic to improve PTSD symptoms and HIV care. Participants were 41 adults with HIV, co-occurring PTSD, and areas of improvement in HIV care (e.g., missed appointments, less than 90% ART adherence, detectable viral load). Those meeting eligibility criteria were enrolled and randomized to the CPT-L intervention (n = 20) or the control condition of Life-steps only (n = 21). Outcome measures including PTSD symptoms, HIV stigma, quality of life, viral load, and engagement in care appointments were collected at baseline, post-intervention and at a 3-month follow-up visit. Results:Data from the feasibility trial demonstrated significantly greater reductions in PTSD symptoms (Δ = 11.55, SE = 4.32, Cohen's d = 1.03, p = .01) and HIV stigma (Δ = 22.63, SE = 7.33, p = 0.006, Cohen's d = 1.37) in participants randomized to CPT-L compared to Lifesteps-only. Preliminary data also indicate promising findings in HIV care (e.g., improved appointment rates, overperformance on viral load and ART adherence) for individuals in the CPT-L group. Conclusions:The research extends PTSD treatment approaches as a paradigm to integrate adherence counseling and improve ART adherence. This is an innovative use of established behavioral interventions and supports the U = U (Undetectable = Un-transmissible) campaign, potentially helping prevent the transmission of HIV through increasing viral suppression rates in a people living with HIV and PTSD.The study was registered with clinicaltrials.gov, identifier NCT05275842.

BackgroundIndividuals with co-occurring posttraumatic stress disorder (PTSD) and HIV are at high-risk for negative HIV-related outcomes, including low adherence to antiretroviral therapy, faster disease progression, more hospitalizations, and almost twice the rate of death. Despite high rates of PTSD in persons with HIV (PWH) and poor HIV-related health outcomes associated with PTSD, an effective evidence-based treatment for PTSD symptoms in PWH does not exist. ObjectiveThis study aimed to describe the adaptation and theater testing of an evidence-based intervention designed for people with co-occurring PTSD and HIV. MethodsThe Assessment, Decision, Adaptation, Production, Topical experts-integration, Training, and Testing (ADAPT-ITT) framework guided the formative process used to modify an evidence-based PTSD treatment (cognitive processing therapy; CPT) to meet the unique needs of PWH experiencing PTSD. With the integration of Life-Steps for Medication Adherence (Life-Steps), the adapted protocol (CPT-Life-Steps for integration of adherence; CPT-L) targeted HIV-related stigma and HIV medication adherence within a trauma-informed framework. Theater testing was completed with 7 participants to evaluate acceptability of CPT-L for PWH. The qualitative data (N=54 recordings) used to evaluate and adapt CPT-L emerged from individual interviews conducted with participants after each therapy session as well as exit interviews conducted at posttreatment data collection. ResultsAfter challenging stigma-related appraisals, participants expressed feeling less constrained by maladaptive thoughts. These shifts translated to increased self-efficacy with both HIV-related care and mental health. ConclusionsThese results indicate that trauma-informed work with PWH should consider the impact of HIV on trauma-related stuck points, intersecting identities (including living with HIV), and challenging internalized stigma. Findings provide evidence that CPT-L is acceptable and effective in addressing internalized HIV stigma that impacts PTSD symptom maintenance and HIV treatment engagement. Trial RegistrationClinicalTrials.gov; NCT05275842; https://clinicaltrials.gov/study/NCT05275842?id=NCT05275842&rank=1 International Registered Report Identifier (IRRID)RR2-10.1016/j.conctc.2023.101150

Polyvictimization, exposure to multiple potentially traumatic events (PTEs), is prevalent and has profound mental health implications. Investigating the patterns and impact of co-occurring PTEs during childhood is essential to design and deliver tailored clinical services. This study included a diverse community sample of 326 youth (ages 7-16). Latent class analysis (LCA) of DSM-5 posttraumatic stress disorder (PTSD) criterion A events was conducted to identify PTE classes. Classes were further characterized using race-related, peer, and dating victimization, and psychopathology symptoms (PTSD, anxiety, depression). Three classes emerged: (1) low trauma, (2) interpersonal and community violence (IPV/CV), and (3) emotional abuse, neglect, and interpersonal violence in familial relationships (EA/N/IPVFam). Demographics, total PTEs, age at first exposure, race-related events, PTSD, anxiety, and depression symptoms varied across classes, indicating functional significance of identified profiles. Results underscore the importance of considering PTE profiles and person-centered approaches to understand and address trauma-related sequelae in youth.

Screening, brief intervention, and referral to treatment (SBIRT) is a widely used public health approach for delivering early intervention for substance misuse. SBIRT adaptations that incorporate content on interpersonal violence and posttraumatic stress disorder (PTSD) symptoms may be warranted, as experiences of interpersonal violence are prevalent and associated with greater substance misuse; however, more research is needed to refine the delivery of PTSD-substance use content within the SBIRT model. This study examined clinical data collected as part of a web-based SBIRT developed for co-occurring substance misuse and PTSD symptoms after interpersonal violence to characterize the clinical symptoms and responses of adults presenting to agencies serving intimate partner and sexual violence survivors. The respondents (N = 52) completed self-report measures during the SBIRT tool to personalize the recommendations, as well as motivational enhancement exercises. Descriptive statistics were conducted. The results underscored high rates of probable PTSD, substance use, and trauma-related motives for substance use. The respondents were ready to change their substance use on average after receiving personalized feedback. Many expressed values related to trauma recovery and self-empowerment, perceived these values as useful for substance use reduction, and set goals to seek mental health services or reduce their drinking quantity. The findings point to several clinical targets for integrated PTSD-substance misuse interventions for interpersonal violence survivors.

Alcohol and cannabis are the first and second most used substances among adolescents. Adolescence is a period of considerable development, making the adolescent brain particularly vulnerable to negative effects of alcohol and cannabis use. Developing and testing interventions that target both alcohol and cannabis use during adolescence are vital to decreasing costly consequences. Biases in cognitive processing of drug-related stimuli play an important role in the development and maintenance of problematic substance use. The Approach-Avoidance Task (AAT) is a computerized program, effective in assessing implicit approach biases for both alcohol and cannabis, in which participants make approach or avoidance movements in response to an irrelevant feature of an image presented on a screen (e.g., push when in portrait, pull when in landscape). A modified version of the AAT is also used as an approach bias modification (ApBM) intervention, to retrain participants’ implicit biases toward or away from stimuli by presenting the target stimuli predominantly in one format (e.g., push or pull). Despite research demonstrating the effectiveness of AAT interventions to reduce problematic alcohol and cannabis use, there is a dearth of research examining this intervention among adolescents. This protocol paper describes a NIDA-funded randomized control trial (RCT) to evaluate an integrated mobile ApBM intervention to target co-occurring alcohol and cannabis use among treatment-seeking adolescents. Outcomes will be measured from pre-treatment through a three-month follow-up. The sampling procedures, assessment protocol, description of the intervention, and planned statistical approaches to evaluating outcomes are detailed. Clinical and research implications of this work are also discussed.

BackgroundChildhood trauma has been associated with lower positive affect (van Veen et al., 2013). Rumination has been linked to more intense and longer lasting periods of negative emotion (Brosschot et al., 2005) and poorer affective states (Moberly & Watkins, 2008). However, few studies have tested mechanisms that could help elucidate the relationship between traumatic event exposure and affective dysregulation, particularly in youth.ObjectiveConsidering the transdiagnostic nature of rumination and affect dysregulation across depressive and posttraumatic stress symptomatology, the present study examined a rumination pathway between lifetime experiences of potentially traumatic events (PTEs) and past-week state positive affect in a community sample of youth residing in a large, urban city in the U.S.MethodA sample of 3rd (n = 72), 6th (n = 82), and 9th (n = 76) graders (N = 230; Mage = 11.49 years, SDage = 2.43; 52.6% female; 44.3% White, 41.3% Black or African American; 14.4% Multiracial, Hispanic/Latino, or Native American) completed self-report measures and a clinical interview at a baseline lab visit.ResultsResults revealed that rumination significantly mediated the relationship between PTEs and past-week state positive affect. Conclusion: Findings suggest that the relationship between PTEs and state positive affect is explained by rumination. Among youth who have experienced PTEs and experience dysregulated positive affect, rumination may be a modifiable treatment target that could alleviate affect dysregulation.

Trauma exposure and alcohol use often co-occur. Unveiling predictors of drinking behavior, including among those with varying levels of trauma exposure, can inform behavioral health prevention and treatment efforts in at-risk populations. The current study examined associations between depressive symptoms, avoidant coping, gender, and alcohol use among emerging adults with and without trauma exposure and posttraumatic stress disorder (PTSD). Participants were 238 emerging adults between the ages of 21 and 30 years (M = 24.75; SD = 2.61) in one of three groups: trauma-exposed with PTSD (n = 70); trauma-exposed with no PTSD (n = 83); or a no trauma (control) group (n = 85). Demographics, parental alcohol problems, depressive symptoms, and avoidant coping were examined as predictors of drinks per drinking day. Chi-square, t-test, bivariate, and group path analysis were conducted. Among participants, men consumed greater amounts of alcohol than women across all three groups. Group assignment based on trauma history and PTSD significantly moderated the association between avoidant coping and alcohol use such that avoidant coping had a significant effect on alcohol use among participants in the trauma-exposed and PTSD groups. There was also a significant group × gender × avoidant coping interaction such that, among participants in the control group, men had attenuated alcohol use at low levels of avoidant coping and increased at high levels of avoidant coping. No effects of race were observed. Results highlight the importance of avoidant coping as a risk factor for problematic drinking, unveiling a specific intervention target for reducing co-occurring PTSD and problematic alcohol use.

The increased risk for psychopathology associated with interpersonal violence exposure (IPV, e.g., physical abuse, sexual assault) is partially mediated by neurobiological alterations in threat-related processes. Evidence supports parsing neural circuitry related to transient and sustained threat, as they appear to be separable processes with distinct neurobiological underpinnings. Although childhood is a sensitive period for neurodevelopment, most prior work has been conducted in adult samples. Further, it is unknown how IPV exposure may impact transient-sustained threat neural interactions. The current study tested the moderating role of IPV exposure on sustained vmPFC-transient amygdala co-activation during an fMRI task during which threat and neutral cues were predictably or unpredictably presented. Analyses were conducted in a sample of 212 community-recruited youth (M/SDage = 11.77/2.44 years old; 51.9% male; 56.1% White/Caucasian). IPV-exposed youth evidenced a positive sustained vmPFC-transient amygdala co-activation, while youth with no IPV exposure did not show this association. Consistent with theoretical models, effects were specific to unpredictable, negative trials and to exposure to IPV (i.e., unrelated to non-IPV traumatic experiences). Although preliminary, these findings provide novel insight into how childhood IPV exposure may alter neural circuity involved in specific facets of threat processing.

BackgroundYouth who experience traumatic events are at a substantially higher risk of engaging in substance use and sexual risk behaviors and problems (eg, HIV acquisition) than their non–trauma-exposed counterparts. Evidence-based substance use and risky sexual behavior prevention may reduce the risk of these outcomes. Trauma-focused mental health treatment provides a window of opportunity for the implementation of such preventive work with these youth. However, overburdened clinicians face challenges in adding prevention content while implementing evidence-based treatments. Mobile health (mHealth) tools can help reduce this burden in delivering prevention curricula. Trauma-Informed Prevention for Substance Use and Risky Sexual Behavior (TIPS) is an mHealth app that was developed to aid trauma-focused cognitive behavioral therapy (TF-CBT) clinicians in the implementation of an evidence-based risk behavior prevention curriculum. ObjectiveThe goal of this paper is to describe the rationale for and development of the TIPS app and present the results of a mixed methods approach for the initial evaluation of its usability. MethodsParticipants included clinicians (n=11), adolescents (n=11), and caregivers (n=10) who completed qualitative interviews and an adapted version of the Website Analysis and Measurement Inventory. ResultsIn total, 4 overarching themes emerged from the participants’ answers to the qualitative interview questions, demonstrating a generally positive response to the app. The themes were (1) strength of app content, (2) suggestions about app content, (3) esthetics and usability, and (4) benefits to the patient and session implementation. Clinicians, adolescents, and caregivers all agreed that the content was very relevant to adolescents and used examples and language that adolescents could relate to. All 3 groups also discussed that the content was comprehensive and addressed issues often faced by adolescents. All 3 groups of users made suggestions about the esthetics, which mostly comprised suggestions to change the font, color, or pictures within the app. Of all the groups, adolescents were most positive about the esthetics and usability of the app. Results from the Website Analysis and Measurement Inventory further illustrated the users’ favorable reaction to the TIPS app, with 100% (11/11) of clinicians, 100% (10/10) of caregivers, and most adolescents (7/11, 64%) selecting strongly agree or somewhat agree to the following statement: “This app has much that is of interest to me.” Adolescents generally found the app easier to use than did caregivers and clinicians. ConclusionsThe TIPS app shows promise as an mHealth tool for TF-CBT clinicians to integrate evidence-based substance use, risky sexual behavior, and HIV prevention during treatment. Future research, including a randomized controlled trial comparing TF-CBT implementation with and without the inclusion of the app, is necessary to evaluate the feasibility and efficacy of the app in reducing the risk of substance use and risky sexual behavior among trauma-exposed adolescents. Trial RegistrationClinicalTrials.gov NCT03710720; https://clinicaltrials.gov/study/NCT03710720

Trauma exposure and drinking motives (e.g., social, enhancement, coping) are both associated with increased alcohol use and related problems. Studies have frequently investigated this relationship by examining drinking motives, such as drinking to cope with negative affect, in isolation, yet few studies have examined motives simultaneously in trauma-exposed populations. It is also unclear whether the relationship between drinking motives and alcohol use outcomes differs as a function of population characteristics (e.g., gender, trauma type). Using latent profile analysis, we aimed to (a) identify latent profiles characterized by drinking motives, assessed with the Drinking Motives Questionnaire (DMQ), in two samples: primarily male veterans with combat trauma (N = 174) and civilians with interpersonal trauma (N = 152), and (b) determine whether associations with alcohol use outcomes of consumption and binge drinking (BD) would differ by sample. A three-class solution was replicated across both samples: profiles characterized by moderate Social scores and low Enhancement and Coping scores (low ENH/COP), moderate scores across all domains (medium DMQ), and elevated scores across all domains (high DMQ). In both samples, profile membership was differentially associated with consumption and BD. Findings suggest patterns of drinking motives may be similar across different trauma-exposed populations, but associations with alcohol outcomes likely differ in meaningful ways. Results can help inform targeted interventions at different treatment settings, such as community health centers or VA hospitals.

OBJECTIVE For more than two decades, federal agencies have sought to address a persistent lack of inclusion of Black, Latinx, Asian, and indigenous peoples in randomized controlled trials (RCTs), often with an underlying hypothesis that such efforts will increase diversity across clinically-relevant dimensions. We examined racial/ethnic and clinical diversity, including racial/ethnic differences in prior service access and symptom dimensions, in an RCT focusing on trauma-related mental health and substance use among adolescents. METHOD Participants were 140 adolescents in an RCT of Reducing Risk through Family Therapy. Recruitment followed several recommendations for enhancing diversity. Structured interviews examined trauma exposure, posttraumatic stress disorder (PTSD) and depression symptoms, substance use, service utilization, and demographics. RESULTS Non-Latinx (NL) Black youth were more likely to receive mental health services for the first time and have greater trauma exposure, but less likely to report symptoms of depression (ps < .05) relative to NL White youth. Relevant caregiver differences included that NL Black caregivers were more likely to be unemployed and looking for work (p < .05) despite having similar levels of education relative to NL White caregivers (p > .05). CONCLUSION Results suggest that efforts to expand racial/ethnic diversity in an RCT of combined substance use and trauma-focused mental health may also expand other clinical dimensions. Many of these differences reflect multiple dimensions of racism experienced by NL Black families that clinicians must attend to. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Despite high rates of Post-Traumatic Stress Disorder (PTSD) in persons living with HIV (PLWH) and poor HIV-related health outcomes associated with PTSD, an effective evidence-based treatment for PTSD symptoms in PLWH does not exist. Negative reinforcement conceptual models posit that avoidant behavior (hallmark symptom of PTSD) demonstrated by PLWH with co-occurring PTSD can contribute to poor antiretroviral therapy (ART) adherence. However, research evaluating the impact of evidence-based treatment for PTSD among HIV infected populations on HIV outcomes is scarce. The Cognitive Processing Therapy (CPT) protocol is an evidence-based PTSD treatment that may address internalized stigma with targeted modifications and improve ART adherence and subsequent viral suppression through reduction of avoidant coping. This study will be the first pilot open-label randomized control trial (RCT) to test feasibility of an integrated evidence-based PTSD treatment (CPT) with an adherence intervention (Lifesteps) delivered in a Ryan White clinic to improve PTSD symptoms, adherence to ART, and retention in HIV care. Primary aims are to (1) conduct theater testing of the CPT and Lifesteps research protocol and evaluate acceptability (n = 12) and (2) deliver a modified CPT protocol (CPT-Lifesteps, or CPT-L) in 60 PLWH/PTSD exploring impact of CPT-L on PTSD symptoms and HIV outcomes compared to a Lifesteps + Standard of Care condition. This innovative research extends PTSD treatment approaches as a paradigm to reduce barriers to ART adherence. Findings of this innovative study are significant because they support the Undetectable = Untransmittable (U[bond, double bond]U) campaign and can help prevent the transmission of HIV infection through increased viral suppression.

The ability to anticipate and process predictable unpleasant events, while also regulating emotional reactivity, is an adaptive skill. The current article and a companion in this issue test for potential changes in predictable event processing across the childhood-to-adolescence transition, a key developmental period for biological systems that support cognitive/emotional abilities. While the companion article focuses on emotion regulation and peripheral attention modulation in predictable unpleasant contexts, the current paper presents neurophysiological markers of predictable event processing itself. 315 third-, sixth-, or ninth-grade individuals saw 5-s cues predicting "scary," "every day," or uncertain image content; in this paper, cue- and picture-locked event-related potentials (ERPs) are analyzed. During the cue, early ERP positivities were increased and later slow-wave negativities were reduced when predicted content was scary as compared with mundane. After picture onset, a picture processing-related positivity was then increased for scary compared with everyday images regardless of predictability. Cue-interval data suggest enhanced processing of scary cues and reduced anticipatory processing of scary images-opposite to adults. After event onset, meanwhile, emotional ERP enhancement regardless of predictability is similar to adults and suggests that even preadolescent individuals maintain preferential engagement with unpleasant events when they are predictable.

The ability to anticipate and process predictable unpleasant events, while also regulating emotional reactivity, is an adaptive skill. The current article and a companion in this issue test for potential changes in predictable event processing across the childhood-to-adolescence transition, a key developmental period for biological systems that support cognitive/ emotional abilities. While the companion article focuses on neurophysiology of predictable event processing itself, the present article examines peripheral emotional response regulation and attention modulation that coincides with event processing. A total of 315 third-, sixth-, or ninth-grade individuals saw 5-s cues predicting "scary," "every day," or uncertain pictures, and here, blink reflexes and brain event-related potentials (ERPs) elicited by peripheral noise probes are analyzed. During the cue, blink reflexes and probe ERP (P200) amplitudes were increased when the cue predicted scary, compared to everyday, content. After picture onset, reflex enhancement by scary content then disappeared for predictable images, whereas ERP modulation was similar regardless of predictability. Patterns are similar to those in adults and suggest (1) sustained defensive response priming and enhancement of peripheral attention during aversive anticipation, and (2) an ability, even in pre-adolescents, to downregulate defensive priming while maintaining attentional modulation once an awaited predictable aversive event occurs.