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Psychological assessment is commonly conducted using either self-report measures or clinical interviews; the former are quick and easy to administer, and the latter are more time-consuming and require training. Self-report measures have been criticized for producing higher estimates of symptom and disorder presence relative to clinical interviews, with the assumption being that self-report measures are prone to Type 1 error. Here, we introduce the use of "clinical checks" within an existing self-report measure. These are brief supplementary questions intended to clarify and confirm initial responses, similar to what occurs in a clinical interview. Clinical checks were developed for the items of the International Grief Questionnaire (IGQ), a self-report measure of ICD-11 prolonged grief disorder (PGD). Data were collected as part of a community survey of mental health in Ukraine. Individual symptom endorsements for the IGQ significantly decreased with the use of clinical checks, and the percentage of the sample that met the ICD-11 diagnostic requirements for PGD fell from 13.6% to 10.2%, representing a 24.8% reduction in cases. The value and potential broader application of clinical checks are discussed., (© 2024 The Author(s). Journal of Traumatic Stress published by Wiley Periodicals LLC on behalf of International Society for Traumatic Stress Studies.)

Epidemiological studies show 30% to 50% of all patients in community mental health teams have personality disorders. These are normally comorbid with other psychiatric disorders, often as Galenic syndromes, and are seldom identified. In the Boston (UK) Personality Project all patients under a community health service in Boston in Lincolnshire will be asked to agree to have their personality status assessed using scales recording the new ICD-11 classification, together with clinical ratings, social function and satisfaction. A control group of 100 patients from an adjacent service of similar demographics (Spalding) will also have similar ratings but no personality assessments. Changes in clinical status, social function and service satisfaction will be made after 6 and 12 months in both groups. The patients in the Boston group will be offered matched interventions using a stepped care approach for both the severity of disorder and its domain structure. These interventions will include shorter versions of existing psychological treatments, environmental therapies including nidotherapy, adaptive and acceptance models, drug reduction and social prescribing. Full costs of psychiatric care will be measured in both groups. The main hypothesis is that greater awareness of personality function will lead to better clinical outcomes and satisfaction., (© 2022 John Wiley & Sons, Ltd.)

Objective: We retrospectively evaluated the effectiveness of trauma-focused psychotherapy (TF-P) versus stabilization and waiting in a civilian cohort of patients with an 11th version of the international classification of disease (ICD-11) diagnosis of complex post-traumatic stress disorder (CPTSD)., Methods: We identified patients with CPTSD treated at a specialist trauma service over a 3-year period by triangulating evidence from self-report questionnaires, file review, and expert-clinician opinion. Patients completed a phase-based treatment: stabilization consisting of symptom management and establishing safety, followed by waiting for treatment (phase 1); individual TF-P in the form of trauma-focused cognitive behavioral therapy (TF-CBT), or eye movement desensitization and reprocessing (EMDR) or TF-CBT plus EMDR (phase 2). Our primary outcome was PTSD symptoms during phase 2 versus phase 1. Secondary outcomes included depressive symptoms, functional impairment, and a proxy CPTSD measure. Exploratory analysis compared outcomes between treatments. Adverse outcomes were recorded., Results: Fifty-nine patients were included. Compared to receiving only phase 1, patients completing TF-P showed statistically significant reductions in PTSD [ t (58) = -3.99, p  < 0.001], depressive symptoms [ t (58) = -4.41, p  < 0.001], functional impairment [ t (58) = -2.26, p  = 0.028], and proxy scores for CPTSD [ t (58) = 4.69, p  < 0.001]. There were no significant differences in outcomes between different treatments offered during phase 2. Baseline depressive symptoms were associated with higher PTSD symptoms and functional impairment., Conclusions: This study suggests that TF-P effectively improves symptoms of CPTSD. However, prospective research with validated measurements is necessary to evaluate current and new treatments and identify personal markers of treatment effectiveness for CPTSD.

Purpose: Hip precautions are routinely provided in the UK, despite evidence suggesting that they are no longer needed. A change in practice was introduced into an orthopaedic service whereby the provision of routine hip precautions was discontinued for selected individuals receiving a primary total hip replacement. The change involved implementing a new regime of "no precautions" which was facilitated using a number of key strategies. The aim of this study was to explore the experiences of clinicians associated with the change in practice., Material and Methods: Individual semi-structured interviews were conducted with clinicians who had experience of delivering both hip precautions and no hip precaution regimes. Data were analysed thematically., Results: Ten orthopaedic staff (two senior occupational therapists, one occupational therapy support worker, three senior physiotherapists, two surgeons, and two senior nurses) were interviewed. Three main themes were identified: changes experienced, perceptions of the new regime, and challenges experienced., Conclusion: Several barriers and facilitators to the successful changeover were identified. Successful strategies in changing practice included assigning "Hip Champions", staff education and targeted training. It is proposed that holding multidisciplinary education and training would be the ideal model.Implications for rehabilitationKey strategies for changing practice were educating staff and providing targeted training.Multidisciplinary training might prevent discrepancies in the advice given to patients.Appointing "Hip Champions" provided clear role models and enabled new clinical behaviours to be enforced.

Experiencing psychological trauma during childhood and/or adolescence is associated with an increased risk of psychosis in adulthood. However, we lack a clear knowledge of how developmental trauma induces vulnerability to psychotic symptoms. Understanding the psychological processes involved in this association is crucial to the development of preventive interventions and improved treatments. We sought to systematically review the literature and combine findings using meta-analytic techniques to establish the potential roles of psychological processes in the associations between developmental trauma and specific psychotic experiences (i.e., hallucinations, delusions and paranoia). Twenty-two studies met our inclusion criteria. We found mediating roles of dissociation, emotional dysregulation and post-traumatic stress disorder (PTSD) symptoms (avoidance, numbing and hyperarousal) between developmental trauma and hallucinations. There was also evidence of a mediating role of negative schemata, i.e. mental constructs of meanings, between developmental trauma and delusions as well as paranoia. Many studies to date have been of poor quality, and the field is limited by mostly cross-sectional research. Our findings suggest that there may be distinct psy-chological pathways from developmental trauma to psychotic phenomena in adulthood. Clinicians should carefully ask people with psychosis about their history of developmental trauma, and screen patients with such a history for dissociation, emotional dysregulation and PTSD symptoms. Well conducted research with prospective designs, including neurocognitive assessment, is required in order to fully understand the biopsychosocial mechanisms underlying the association between developmental trauma and psychosis., (© 2021 World Psychiatric Association.)

Individuals with posttraumatic stress symptoms (PTSS) report difficulties engaging with positive autobiographical memories. Extending this line of research, we examined daily-level concurrent and lagged associations between PTSS severity and positive memory characteristics (vividness, coherence, accessibility, time perspective, sensory details, visual perspective, emotional intensity, sharing, distancing, and valence). The sample included 88 trauma survivors (M age = 39.89 years, 59.1% female) who completed seven daily measures of PTSS and positive memory characteristics. Multilevel models examined concurrent and lagged associations between PTSS severity and positive memory characteristics. The results indicated that days with higher PTSS severity were associated with less accessibility, β = -.21, p < .001; less visual perspective, β = -0.13, p = .034; and lower positive valence of the memory, β = -.19, p = .003, as well as more emotional intensity associated with, β = .13, p = .041, and more distancing from, β = .21, p < .001, the memory. Supplemental lagged analyses indicated that higher previous-day PTSS severity was associated with more next-day distancing from, β = .15, p = .042, and sensory details of, β = .17, p = .016, the memory. Findings suggest that individuals with more severe PTSS have difficulties accessing positively valenced memories from a first-person perspective, are more distant from the recalled positive memory, and report more emotional intensity when retrieving the memory. Thus, improving access to and reducing distance from positive autobiographical memories, as well as addressing emotional intensity surrounding the retrieval of these memories, may be potential clinical targets for PTSS interventions., (© 2024 International Society for Traumatic Stress Studies.)

Trauma and post-traumatic stress are involved in the aetiology and maintenance of voice-hearing. It has been proposed that trauma-focused therapy (TFT) might affect voice-hearing, but previous studies are limited and remain undecided., Objectives: We aimed to investigate the effect of TFT on voice-hearing in people with PTSD and psychosis using experience sampling method (ESM). A secondary aim was to explore how changes in voice-hearing are related to changes in PTSD., Design: This is an adjunct longitudinal ESM study of a sub-group of participants (N = 39) from a randomised controlled trial that compared TFT to a waiting-list control group., Methods: Voice-hearing participants filled in 10 daily voice-hearing-related questionnaires for six consecutive days at baseline and post-treatment at pseudo-random times during the day. PTSD symptom severity was assessed at baseline and post-treatment. Multilevel linear regression was used to test the effect of TFT on voice-hearing and to analyse the relationship between changes in voice-hearing and changes in PTSD., Results: The intention-to-treat analysis showed a significant interaction effect between time and treatment condition (p < .00001) with a small effect size (dppc2 = -0.27), indicating a larger decrease in voice-hearing in the TFT group than in the waiting-list control group. Also, a significant association was observed between changes in PTSD symptoms and changes in voice-hearing (p < .00001)., Conclusions: Our findings tentatively suggest that, even when voices are not targeted directly, TFT for PTSD can alleviate distressing voices., (© 2024 The Author(s). Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of The British Psychological Society.)

Many trauma-affected voice hearers report comorbid posttraumatic stress and voices (auditory verbal hallucinations) that are directly (voices repeat phrases spoken by perpetrators) or indirectly (voice content and trauma are thematically similar) related to their trauma. Models of PTSD and positive symptoms of psychosis are insufficient in explaining the comorbidity between PTSD and voices, and interventions based on these models have limited effectiveness in treating voices. This study presents a model that generates novel research into the factors underlying trauma-related voices that may inform effective interventions. Maintaining factors from existing models of PTSD and positive symptoms were combined into an integrative model of trauma-related voices. Theorised relationships between factors were used to identify possible differential pathways to direct and indirect voices. An integrative, trauma-related voices (TRV) model was developed that identifies multiple causal pathways to trauma-related voices. A future research agenda is proposed to test novel hypotheses based on the integrative model. The TRV model is a practical tool for complex case conceptualisation and generates novel hypotheses that may inform more effective treatments. Future studies are needed to test elements of the TRV model and should recruit transdiagnostic samples with diverse posttraumatic stress and voice hearing symptoms., (© 2024 John Wiley & Sons Ltd.)

Over recent decades, serious games have become a promising intervention approach for addressing psychological problems by providing users with computerized, engaging, and interactive experiences. An innovative serious game, Traveler, has been developed specifically as an intervention tool for managing posttraumatic responses immediately after trauma. The game incorporates the principle of visuospatial interference, the core elements of Tetris, such as spatial displacement and mental rotation, and the critical phases of eye movement desensitization and reprocessing. To test the intervention efficacy and feasibility of Traveler, we conducted a randomized controlled trial involving 105 young adults. Participants were randomly assigned into three groups: a wait-list control group, a group undergoing five-session written exposure therapy, or a group engaging in one session of Traveler gameplay. Outcome measures included intrusive memories (i.e. vividness of traumatic images, disgust at traumatic images, flashback frequency, and flashback impact) and posttraumatic growth measured by the Posttraumatic Growth Inventory. Traveler significantly outperformed the control and written exposure therapy groups in reducing intrusive memories and enhancing posttraumatic growth, with effects persisting at a 30-day follow-up. Thus, Traveler offers a promising brief and early intervention technique for addressing posttraumatic responses. Yet, its clinical applicability requires further investigation., (© 2024 International Association of Applied Psychology.)

Objectives: Research in adults suggests that intrusive memories and intrusive thoughts (often referred to as intrusive cognitions) are common in members of the general population and are often seen in clinical disorders. However, little is known about the experience of intrusive cognitions in adolescents, particularly in adolescents with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). The present study sought to gather fundamental data on these phenomena (i.e., frequency, characteristics and appraisals of intrusive cognitions) in adolescents with MDD and PTSD., Methods: Adolescents aged 11-18 with MDD (n = 11), PTSD (n = 13) and a non-clinical control group (n = 25) completed structured interviews concerning their intrusive memories and thoughts., Results: Intrusive thoughts were common in all three groups but were particularly frequently experienced in the MDD group. Intrusive memories were expectedly very common in the PTSD group but also experienced by over half of the adolescents with MDD. Both clinical groups reported more negative emotions in response to their intrusive thoughts or memories and appraised these cognitions more negatively than the non-clinical group., Conclusion: Intrusive memories and thoughts are common experiences in adolescents with MDD and PTSD. Emotions and appraisals relating to these cognitions may be targets for psychological intervention in this age group. However, small sample sizes limit the conclusions that can be drawn. Replication is needed with larger numbers of clinical participants., (© 2024 The Author(s). British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Objectives: Treatments for borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD) are less effective for patients with co-occurring symptoms of both disorders, who are considered to have complex PTSD (cPTSD), compared with patients with either condition alone. Evidence suggests that co-occurrence of symptoms indicates greater impairment in mentalizing. This study examines evidence for targeting mentalizing when treating individuals with co-occurring symptoms, irrespective of their exposure to developmental trauma and, for the first time, investigates the mediational role of mentalizing in the associations between BPD symptomatology and cPTSD., Design: We identified in a routine clinical service a group of patients with BPD, with or without co-occurring symptoms of PTSD. We hypothesized that patients with co-occurring symptoms and a history of childhood maltreatment will show more severe clinical profiles and greater mentalizing problems, which in turn lead to symptoms consistent with cPTSD., Method: Clinical profiles of 72 patients with BPD (43 with and 29 without co-occurring symptoms of PTSD; mean age in both groups 28 years, 79% and 83% female, respectively) were identified using the Structured Clinical Interview for DSM-IV Axis II Disorders. Patients completed self-report measures of BPD and PTSD symptoms, well-being, dissociation and reflective functioning. Childhood trauma histories were evaluated., Results: Compared with patients with BPD-only, those with co-occurring BPD and PTSD showed greater severity in terms of BPD and dissociative symptoms, met a broader range of BPD diagnostic criteria, had a greater sense of personal worthlessness and self-evaluated their well-being as considerably diminished. This group was also more inclined to recall increased instances of childhood sexual abuse. In a mediation analysis, mentalizing acted as a partial mediator for the relationship between BPD severity and cPTSD, as well as between dissociative symptoms and cPTSD. Interestingly, mentalizing did not mediate the relationship between childhood sexual abuse and cPTSD., Conclusions: Overall, the correlational findings are consistent with an intended focus on mentalizing to treat cPTSD symptoms in individuals who also meet criteria for a diagnosis of BPD., (© 2023 The Authors. Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of The British Psychological Society.)