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Innovations for Addressing Posttraumatic Stress and Co-occurring Conditions

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A special issue of Behavioral Sciences (ISSN 2076-328X). This special issue belongs to the section "Developmental Psychology".

Deadline for manuscript submissions: closed (31 March 2025) | Viewed by 7872

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Dr. Naomi Ennis

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Guest Editor

Carepoint Health, Mississauga, ON L5K 2N6, Canada
Interests: PTSD; cognitive behavioral therapy; trauma recovery; social support; interpersonal interactions

Dr. Candice M. Monson

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Guest Editor

Department of Psychology, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
Interests: trauma recovery; PTSD; intimate relationships; cognitive behavioral therapy; couple therapy; clinical trials

Special Issue Information

Dear Colleagues,

Posttraumatic stress disorder (PTSD) is associated with high rates of psychological comorbidities. Individuals with PTSD also present for treatment with factors that may interfere with their recovery, such as ongoing risks of re-exposure to trauma, substance use disorders, self-injury/suicidality, and interpersonal relationship distress. There is a need to better understand how cognitive behavioral therapies (CBT), considered the gold standard in PTSD treatment, can effectively and efficiently address these co-occurring concerns.

This Special Issue aims to identify papers on novel interventions or innovations in treatment that address PTSD and co-occurring concerns. Papers may present data on treatments that address PTSD and comorbidities such as substance use disorders, insomnia, personality disorders, eating disorders, severe mental illness, and depression. We also welcome papers on treatments and treatment innovations that address PTSD and clinically relevant issues such as support with return to work, chronic pain, racial trauma, dissociation, safety concerns, high risk of re-exposure to trauma, gender-based violence, interpersonal relationships and family distress, and traumatic brain injury/concussion, among others. We are in search of papers with both original data from treatment trials and basic science research that could have implications for treatments, as well as review papers. Of importance, these papers should describe the application of their findings to diverse populations and how diversity, equity, and inclusion are factored into treatment development or innovations.

Dr. Naomi Ennis
Dr. Candice M. Monson
Guest Editors

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Keywords

comorbidities
posttraumatic stress disorder
CBT
substance use disorders
personality disorders
insomnia
eating disorders
ongoing risk

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Published Papers (11 papers)

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24 pages, 1937 KiB

Open AccessArticle

Helping Opioid Use Disorder and PTSD with Exposure (HOPE): An Open-Label Pilot Study of a Trauma-Focused, Integrated Therapy for OUD/PTSD

by Tanya C. Saraiya, Sonali Singal, Krithika Prakash, Priya Johal, Sara Hameed, Sudie E. Back, Katherine L. Mills and Denise A. Hien

Behav. Sci. 2025, 15(7), 874; https://doi.org/10.3390/bs15070874 - 27 Jun 2025

Viewed by 162

Abstract

Opioid use disorder (OUD) and posttraumatic stress disorder (PTSD) frequently co-occur. However, there are no psychotherapy treatments intentionally designed for this comorbidity, nor designed to be augmented with medications for OUD. In this open-label pilot trial, we tested Helping Opioid Use Disorder and PTSD with Exposure (HOPE), a novel integrated, trauma-focused treatment for individuals (N = 6) with OUD/PTSD who were stabilized on medications for OUD. HOPE was delivered weekly for 10–12 sessions, and one follow-up visit was conducted ~1-month post-treatment. Primary outcomes included urine drug screens, the Timeline Followback, Desire for Drugs Questionnaire, Clinician-Administered PTSD Scale-5 (CAPS-5), and PTSD Checklist-5 (PCL-5). Boot-strapped linear mixed effect models and generalized estimating equations showed that PTSD symptoms (CAPS-5: B = −7.16, SE = 1.24, p < 0.01; PCL-5: B = −2.04, SE = 0.26, p < 0.01), desire for opioids (B = −0.56, SE = 0.15, p < 0.01), depression symptoms (B = −0.43, SE = 0.09, p < 0.01), and anxiety symptoms (B = −0.50, SE = 0.08, p < 0.01) decreased significantly over time. Client satisfaction increased throughout the study (B = 0.18, SE = 0.08, p = 0.02), and 83.3% of participants completed the therapy and follow-up visit. There were no significant changes in opioid or other substance use from baseline to follow-up. Although preliminary, results show high acceptability and feasibility of the HOPE therapy and demonstrate significant improvements in PTSD and associated symptoms with an integrated, trauma-focused treatment. Full article

(This article belongs to the Special Issue Innovations for Addressing Posttraumatic Stress and Co-occurring Conditions)

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14 pages, 725 KiB

Open AccessArticle

Examining Trauma Cognitions as a Mechanism of the BRITE Intervention for Female-Identifying Individuals with PTSD Symptoms and Alcohol Misuse

by Elizabeth A. Lehinger, Molly Joseph, Antoine Lebeaut, Scott Graupensperger, Debra Kaysen and Michele A. Bedard-Gilligan

Behav. Sci. 2025, 15(7), 872; https://doi.org/10.3390/bs15070872 - 26 Jun 2025

Viewed by 137

Abstract

Trauma cognitions have been widely supported as a mechanism of change in post-traumatic stress disorder (PTSD) treatment. Less is known about the mediating role of trauma cognitions in early interventions addressing PTSD symptoms and co-occurring conditions such as alcohol misuse. This study was a secondary analysis of data collected as part of a pilot randomized clinical trial of a single session intervention and four coaching calls (BRITE), adapted from Cognitive Processing Therapy for survivors of a sexual assault that occurred in the past 10 weeks. Fifty-seven adult female-identifying individuals with symptoms of PTSD and alcohol misuse randomized to either intervention or symptom monitoring completed the assessments of PTSD severity, alcohol use, and trauma cognitions at intake, post-intervention, and 3-month follow-up. Mixed-effects models showed trauma cognitions improved significantly in the BRITE condition but did not change in the symptom monitoring condition (b = −1.53, p < 0.001, B = −1.05). Mediation analyses indicated that change in total trauma cognitions and self-blame cognitions did not have a significant indirect effect on the association between condition and PTSD symptoms and average drinks on drinking days, and the proportion mediated was small for PTSD symptoms and average drinks. Preliminary findings indicate reductions in negative trauma cognitions for the BRITE condition, but this is likely one of several factors that play a role in changes in PTSD symptoms and alcohol use in the early recovery period following sexual assault. Full article

(This article belongs to the Special Issue Innovations for Addressing Posttraumatic Stress and Co-occurring Conditions)

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21 pages, 1004 KiB

Open AccessArticle

Examining Longitudinal Risk and Strengths-Based Factors Associated with Depression Symptoms Among Sexual Minority Men in Canada

by Yusuf Ghauri, Graham W. Berlin, Shayna Skakoon-Sparling, Adhm Zahran, David J. Brennan, Barry D. Adam and Trevor A. Hart

Behav. Sci. 2025, 15(7), 839; https://doi.org/10.3390/bs15070839 - 21 Jun 2025

Viewed by 330

Abstract

Sexual minority men (SMM) experience anti-SMM stressors and have elevated rates of mental health issues compared to heterosexual men, such as depression. Importantly, strengths-based factors may directly increase wellbeing and provide a buffer against the detrimental effects of such stressors. In the present study, we integrated risk and strengths-based models to examine predictors of depression symptoms in a sample of 465 Canadian SMM across three time points using multilevel modeling. Higher scores on a measure of childhood physical abuse at baseline, and greater within-person (i.e., deviation from individual’s average) and between-person (i.e., deviation from group average) internalized homonegativity and heterosexist discrimination were associated with higher depression scores. Higher within- and between-person scores on measures of self-esteem, social support, and hope were associated with lower depression scores. Social support buffered the effects of between-person heterosexist discrimination on depression symptoms: at mean and high levels of social support, heterosexist discrimination was not associated with depression symptoms. This is the first study to disaggregate between-person and within-person effects of both risk factors and strengths-based factors among SMM, which has critical importance for the development of tailored individual-level interventions that target internalized homonegativity, hope, social support, and self-esteem to alleviate symptoms of depression among SMM. Full article

(This article belongs to the Special Issue Innovations for Addressing Posttraumatic Stress and Co-occurring Conditions)

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8 pages, 210 KiB

Open AccessArticle

Furthering Our Understanding of Post-Traumatic Mental Health Conditions and Intimate Relationship Outcomes in Veterans of the Wars in Afghanistan and Iraq

by Camara A. T. Azubuike, Alexander O. Crenshaw and Candice M. Monson

Behav. Sci. 2025, 15(6), 719; https://doi.org/10.3390/bs15060719 - 23 May 2025

Viewed by 425

Abstract

Objective: Although there has been substantial research on post-traumatic stress disorder and its commonly comorbid conditions, the unique associations among these mental health symptoms and relationship adjustment have not been investigated. The purpose of this paper is to extend understanding of the associations among PTSD and relationship adjustment for female and male veterans, as well as to account for the impact of comorbid symptoms of depression and problematic alcohol use in a large sample. Method: Participants were 2325 (n = 1122 men and 1203 women) veterans of the wars in Iraq and Afghanistan from a larger study exploring wartime experiences and post-deployment adjustment. Chi-square analyses and regressions tested the associations among mental health symptoms (PTSD symptom severity, depressive symptoms, and problematic alcohol use) and relationship status and adjustment. Results: For both men and women, those with probable PTSD were less likely to be in an intimate relationship than those without probable PTSD, and those in intimate relationships had lower PTSD symptom severity compared with those not in intimate relationships. However, when accounting for PTSD, depression, and problematic alcohol use simultaneously, only depression emerged as a significant negative predictor of relationship adjustment. Conclusions: Shared variance among these common post-traumatic mental health conditions comorbidities may be most responsible for PTSD’s negative association with relationship adjustment. Unique remaining variance of depression is also negatively associated with relationship adjustment. Treatment implications of these findings for individual and couple therapy post-trauma are provided. Full article

(This article belongs to the Special Issue Innovations for Addressing Posttraumatic Stress and Co-occurring Conditions)

10 pages, 263 KiB

Open AccessArticle

An Initial Examination of Couple Therapy for PTSD Outcomes Among Black/African American Adults: Findings from an Uncontrolled Trial with Military Dyads

by Steffany J. Fredman, Alyssa A. Gamaldo, August I. C. Jenkins, Yunying Le, Jacqueline A. Mogle, Candice M. Monson, Charlene E. Gamaldo, Roland J. Thorpe, Jr., Brittany N. Hall-Clark, Tabatha H. Blount, Brooke A. Fina, Orfeu M. Buxton, Christopher G. Engeland, Galena K. Rhoades, Scott M. Stanley, Alexandra Macdonald, Katherine A. Dondanville, Daniel J. Taylor, Kristi E. Pruiksma, Brett T. Litz, Stacey Young-McCaughan, Jeffrey S. Yarvis, Terence M. Keane and Alan L. Peterson Show full author list Hide full author list

Behav. Sci. 2025, 15(4), 537; https://doi.org/10.3390/bs15040537 - 16 Apr 2025

Viewed by 779

Abstract

Black/African American individuals experience high rates of posttraumatic stress disorder (PTSD), which is frequently chronic and undertreated in this population. Intimate relationships are a salient resource for Black/African American adults’ psychological well-being. To help advance health equity, this study serves as an initial, proof-of-concept investigation of patient outcomes among Black/African American adults who received a disorder-specific couple therapy for PTSD. Participants were a subsample of seven Black/African American adults (mean age = 40.56 years, SD = 10.18; 85.7% male) who participated in an uncontrolled trial of an abbreviated, intensive, multi-couple group version of cognitive-behavioral conjoint therapy for PTSD with 24 military dyads. Treatment was delivered over 2 days in a weekend retreat format. Assessments were administered at baseline, 1 month post-retreat, and 3 months post-retreat. There were large and significant decreases in patients’ PTSD symptoms based on clinicians’ and patients’ ratings (ds −1.37 and −1.36, respectively) by the 3-month follow-up relative to baseline. There were also large and significant decreases in patients’ depressive, anxiety, and anger symptoms (ds −1.39 to −1.93) and a large, marginally significant decrease in patients’ insomnia (d = −0.85; p = 0.083). Patients reported a medium, non-significant increase in relationship satisfaction (d = 0.68; p = 0.146) and a large, marginally significant increase in joint dyadic coping (d = 0.90; p = 0.069). Findings offer preliminary evidence that treating PTSD within a couple context is a relevant strategy to reduce PTSD and comorbid symptoms among partnered Black/African American adults and a promising approach to enhance relationships. Full article

(This article belongs to the Special Issue Innovations for Addressing Posttraumatic Stress and Co-occurring Conditions)

9 pages, 210 KiB

Open AccessArticle

Examining Virtual Delivery of Strength at Home for Intimate Partner Violence Perpetration

by Casey T. Taft, Justin K. Benzer, Megan Kopitsky and Suzannah K. Creech

Behav. Sci. 2024, 14(12), 1127; https://doi.org/10.3390/bs14121127 - 25 Nov 2024

Viewed by 998

Abstract

This study examined the effectiveness of the virtual delivery of the Strength at Home (SAH) intervention program for intimate partner violence in a sample of 605 military veterans across 69 Veterans Affairs (VA) Medical Centers through a national implementation of the program. Outcome measures included physical IPV, psychological IPV, coercive control behaviors, post-traumatic stress disorder (PTSD) symptoms, and alcohol misuse. Significant pre-intervention to post-intervention reductions were found for all the outcomes, with similar effect size estimates relative to a prior investigation of in-person-delivered SAH through the same national VA implementation. Study findings suggest that the virtual delivery of SAH may be as effective as in-person delivery which has important implications for program access and impact. Full article

(This article belongs to the Special Issue Innovations for Addressing Posttraumatic Stress and Co-occurring Conditions)

14 pages, 233 KiB

Open AccessArticle

Intensive Treatment of Chronic Pain and PTSD: The PATRIOT Program

by John D. Otis, Jonathan S. Comer, Terence M. Keane, Erica Checko (Scioli) and Donna B. Pincus

Behav. Sci. 2024, 14(11), 1103; https://doi.org/10.3390/bs14111103 - 16 Nov 2024

Cited by 5 | Viewed by 1854

Abstract

Military combat can result in the need for comprehensive care related to both physical and psychological trauma, most commonly chronic pain and post-traumatic stress disorder (PTSD). These conditions tend to co-occur and result in high levels of distress and interference in everyday life. Thus, it is imperative to develop effective, time-efficient treatments for these conditions before they become chronic and resistant to change. We developed and pilot-tested the Pain and Trauma Intensive Outpatient Treatment (PATRIOT) Program, a brief, intensive (3 weeks, six sessions) integrated chronic pain and PTSD treatment. An overview and session-by-session outline of the PATRIOT Program is provided, followed by results from the first pilot evaluation of the PATRIOT Program’s feasibility, acceptability, and preliminary efficacy in a sample of eight participating Veterans with comorbid chronic pain and PTSD. There were no treatment dropouts. At post-treatment, there were significant reductions in PTSD symptoms based on the Clinician-Administered Assessment of PTSD (CAPS). Pain and catastrophic thinking also decreased from pre- to post-treatment. With continued investigations and support, the PATRIOT Program may offer a brief, cost-effective, and more easily accessible treatment option for individuals who could benefit from learning skills to manage pain and PTSD more effectively. Full article

(This article belongs to the Special Issue Innovations for Addressing Posttraumatic Stress and Co-occurring Conditions)

14 pages, 296 KiB

Open AccessArticle

Optimizing Allocation to Telehealth and In-Person Prolonged Exposure for Women Veterans with Military Sexual Trauma: A Precision Medicine Approach

by Evangelia Argyriou, Daniel F. Gros, Melba A. Hernandez Tejada, Wendy A. Muzzy and Ron Acierno

Behav. Sci. 2024, 14(11), 993; https://doi.org/10.3390/bs14110993 - 24 Oct 2024

Cited by 1 | Viewed by 1469

Abstract

Military sexual trauma-related post-traumatic stress disorder (PTSD) is highly prevalent and costly among women veterans, making the need for effective and accessible treatment of critical importance. Access to care is a key mechanism of mental health disparities and might affect differential response to treatment. The goal of this study was to estimate an individualized treatment rule based on readily available individual characteristics related to access to care to optimize allocation to in-person vs. telehealth delivery of prolonged exposure for PTSD in military sexual trauma survivors. The following variables were used as prescriptive factors: age, race, disability status, socioeconomic status, rural vs. urban status, and baseline PTSD level. The rule was estimated using a machine-learning approach, Outcome Weighted Learning. The estimated optimal rule outperformed a one-size-fits-all rule where everyone is universally assigned to telehealth; it led to markedly lower mean PTSD levels following 6 months from treatment (

V

d_opt −

V

_Telehealth = −14.55, 95% CI: −27.24, −1.86). However, the rule did not significantly discriminate for in-person therapy (

V

d_opt −

V

_In-person = −11.86, 95% CI: −25.83, 2.12). Upon further validation with larger and more diverse samples, such a rule may be applied in practice settings to aid clinical decision-making and personalization of treatment assignment. Full article

(This article belongs to the Special Issue Innovations for Addressing Posttraumatic Stress and Co-occurring Conditions)

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23 pages, 505 KiB

Open AccessCase Report

Written Exposure Therapy for PTSD Integrated with Cognitive Behavioral Coping Skills for Cannabis Use Disorder After Recent Sexual Assault: A Case Series

by Christine K. Hahn, Selime R. Salim, Emily L. Tilstra-Ferrell, Kathleen T. Brady, Brian P. Marx, Barbara O. Rothbaum, Michael E. Saladin, Constance Guille, Amanda K. Gilmore and Sudie E. Back

Behav. Sci. 2025, 15(7), 877; https://doi.org/10.3390/bs15070877 - 27 Jun 2025

Viewed by 146

Abstract

Background/Objectives: The co-occurrence of posttraumatic stress disorder (PTSD) and cannabis use disorder (CUD) symptoms is common following sexual assault, particularly among emerging adult women. CUD is associated with more severe PTSD symptoms and other mental health comorbidities including depression, suicidality, and emotion dysregulation. Addressing these issues concurrently soon after sexual assault could help decrease the risk for downstream negative health outcomes. Integrated trauma-focused interventions for PTSD and co-occurring substance use disorders have been shown to decrease PTSD severity and substance use. Yet, existing protocols are lengthy and have rarely been applied following recent trauma exposure or specifically to address CUD symptoms. Methods: This case series describes the application of Written Exposure Therapy (WET) for PTSD adapted to integrate cognitive-behavioral skills training for substance use among women following recent sexual assault. The adapted integrated intervention, Skills Training and Exposure for PTSD and Substance Misuse (STEPS), was delivered to three emerging adult women (age range = 19–25) who experienced recent sexual assault (weeks since assault range = 1–12 weeks). Results: This case series describes the novel intervention and examines clinical outcomes post-treatment and at the 1-month follow-up. Past-week PTSD symptoms (based on a clinical interview) and past-month cannabis use decreased among all participations after receiving STEPS. Conclusions: Preliminary findings from the case series provide new knowledge and insights regarding the application of STEPS following recent sexual assault among individuals with co-occurring PTSD and CUD. Therapeutic strategies for addressing PTSD and CUD concurrently and implications for future clinical research are discussed. Full article

(This article belongs to the Special Issue Innovations for Addressing Posttraumatic Stress and Co-occurring Conditions)

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19 pages, 499 KiB

Open AccessStudy Protocol

Treating Racial Trauma: The Methodology of a Randomized Controlled Trial of the Healing Racial Trauma Protocol

by Muna Osman, Sophia Gran-Ruaz, Lucia Rios Maia da Silva and Monnica T. Williams

Behav. Sci. 2025, 15(7), 856; https://doi.org/10.3390/bs15070856 - 25 Jun 2025

Viewed by 189

Abstract

Cumulative experiences of racism lead to stress and trauma. Racial trauma is associated with compromised functioning across psychological, social, and physical health domains. This is further complicated by any comorbidity with other mental health conditions. Many clinicians are not trained in identifying, diagnosing, and treating racial trauma. Given the pervasive nature of racism, limited clinician knowledge and experiences, as well as the impact of this condition, there is an urgent need for novel, culturally safe, and effective treatment. The newly developed Healing Racial Trauma Protocol (HRTP) shows significant promise. We explore the methodological considerations for a randomized controlled trial comparing the efficacy of the HRTP for racialized individuals suffering from racial trauma and to a control condition of treatment as usual, in reducing the severity of racial trauma and depression symptoms, as well as improved functioning. Ethical, pragmatic, and methodological considerations in trial design, research population, and treatment protocol are explored. Full article

(This article belongs to the Special Issue Innovations for Addressing Posttraumatic Stress and Co-occurring Conditions)

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12 pages, 604 KiB

Open AccessPerspective

Overcoming Implementation Barriers of Concurrent Treatment for Eating Disorders and Posttraumatic Stress Disorder: Two Novel and Feasible Approaches

by Kathryn Trottier, Sara Bartel and Aaron Keshen

Behav. Sci. 2025, 15(6), 749; https://doi.org/10.3390/bs15060749 - 30 May 2025

Viewed by 432

Abstract

Eating disorders (EDs) and posttraumatic stress disorder (PTSD) frequently co-occur and share a functional relationship. Evidence suggests benefits of integrated and/or concurrent treatment; however, implementation is hindered by clinician training burden and the challenges of delivering two treatments simultaneously. This paper explores two novel and feasible approaches to addressing ED-PTSD. The first is a clinician-guided cognitive behavioural workbook intervention delivered concurrently with ED treatment. It involves psychoeducation, addresses dissociation, and encourages approach (versus avoidance) practices. The second involves combining Written Exposure Therapy (WET) with ED treatment at both outpatient and day hospital levels of care. Both interventions have a low training burden and are feasible in routine clinical practice, making concurrent approaches available to those who need them. Full article

(This article belongs to the Special Issue Innovations for Addressing Posttraumatic Stress and Co-occurring Conditions)

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