Conceptualizing traumatic stress and the structure of posttraumatic psychopathology through the lenses of RDoC and HiTOP

Hawn, Sage E.; Wolf, Erika J.; Neale, Zoë

doi:10.1016/j.cpr.2022.102177

Cited by 16 publications

(22 citation statements)

References 124 publications

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“…Another crucial finding was that after parametric assumptions were relaxed (i.e., the linear link function and Gaussian distribution of errors), a model with continuous variation in trajectories was preferred over latent class and growth mixture models. These findings are broadly consistent with a dimensional model of PTSD, which views affected individuals as experiencing extreme manifestations of what are otherwise typical and healthy expressions of natural human variation, in contrast to traditional taxonomic perspectives that emphasize discrete groups or classes of affected individuals [32]. As such, we found no evidence of discrete groups of symptom trajectories, consistent with the view that the common 4-class description of PTSD course [7] might be an artifact of fitting a parametric model to data that has substantial skew.…”

Section: Discussionsupporting

confidence: 81%

Long-Term Trajectories of Posttraumatic Stress Disorder Symptoms: A 20-Year Longitudinal Study of World Trade Center Responders

Mann,

Waszczuk,

Clouston

et al. 2024

Preprint

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Objective. The present study examined the 20-year course of posttraumatic stress disorder (PTSD) in World Trade Center (WTC) responders to address four questions: (1) How stable are symptoms of PTSD? (2) What is the average symptom trajectory? (3) How much do responders differ from the average trend? (4) How quickly do PTSD symptoms improve or worsen? Methods. Data include 81,298 observations from n = 12,822 responders, spanning from July 2002 to December 2022. Fourteen percent meet PTSD criteria. PTSD symptoms were measured using the PCL-17. Retest correlations were calculated to estimate stability, growth curve models to estimate individual trajectories, and Kaplan-Meier curves to estimate the rate of clinically significant change. Results. Retest correlations were high overall (range =.49, .84), lower in PTSD cases (range =.21, .78), and decreased as a function of time between assessments. The best-fitting growth model represented trajectories continuously rather than multiple classes. Symptom burden peaked in 2011 and declined modestly by 2022 (Cohen d = -0.28 and -0.59 in all responders and PTSD cases, respectively). Median time before clinically significant improvement in responders with PTSD was 8.88 years (95% CI = 8.01, 9.79). Conclusions. In the longest and largest study of PTSD symptoms tracked continuously since exposure, illness course was characterized to find that, while symptoms were highly stable in the short term, symptoms changed significantly over two decades. Most responders experienced clinical improvement after nine years, but 10% had poor course and should be the focus of public health efforts.

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Section: Discussionsupporting

confidence: 81%

Long-Term Trajectories of Posttraumatic Stress Disorder Symptoms: A 20-Year Longitudinal Study of World Trade Center Responders

Mann,

Waszczuk,

Clouston

et al. 2024

Preprint

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“…This will require integration of research into systems of care delivery. RDoC’s dimensional approach in PTSD supports the staging model, with a progression from subsyndromal to chronic and severe forms of PTSD [ 928 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review

Burback

Brémault‐Phillips

Nijdam

et al. 2024

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This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four decades, the scientific landscape has matured, with many interdisciplinary contributions to understanding its diagnosis, etiology, and epidemiology. Advances in genetics, neurobiology, stress pathophysiology, and brain imaging have made it apparent that chronic PTSD is a systemic disorder with high allostatic load. The current state of treatment yields a wide variety of pharmacological and psychotherapeutic approaches, of which many are evidence-based. However, the myriad challenges inherent in the disorder, such as individual and systemic barriers to treatment outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, and trauma-related guilt and shame often render treatment response suboptimal. These challenges are discussed as drivers for emerging novel treatment approaches, including early interventions in the Golden Hours, pharmacological and psychotherapeutic interventions, medication augmentation interventions, the use of psychedelics, as well as interventions targeting the brain and nervous system. All of this aims to improve symptom relief and clinical outcomes. Finally, a phase orientation to treatment is recognized as a tool to strategize treatment of the disorder, and position interventions in step with the progression of the pathophysiology. Revisions to guidelines and systems of care will be needed to incorporate innovative treatments as evidence emerges and they become mainstream. This generation is well-positioned to address the devastating and often chronic disabling impact of traumatic stress events through holistic, cutting-edge clinical efforts and interdisciplinary research.

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“…Prior functional magnetic resonance imaging (fMRI) studies have found an association of UCR with PTSD symptom severity (Dickie et al., 2008; Felmingham et al., 2010; Linnman et al., 2011; Mickleborough et al., 2011), but this is not yet established using physiological measures of UCR. Furthermore, in light of the clinical and biological heterogeneity of PTSD, it may be important to also examine UCR in relation to transdiagnostic phenotypes (Galatzer‐Levy & Bryant, 2013; Hawn et al., 2022). For example, the Research Domain Criteria (RDoC) (Insel et al., 2010) and the Hierarchical Taxonomy of Psychopathology (HiTOP) (Kotov et al., 2021) highlight transdiagnostic self‐report measures that may be related to conditioned defensive responding.…”

Section: Introductionmentioning

confidence: 99%

Unconditioned response to a naturally aversive stimulus is associated with sensitized defensive responding and self‐reported fearful traits in a PTSD sample

Lewis,

Bradford,

Akman

et al. 2023

Psychophysiology

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Unconditioned responding (UCR) to a naturally aversive stimulus is associated with defensive responding to a conditioned threat cue (CS+) and a conditioned safety cue (CS−) in trauma‐exposed individuals during fear acquisition. However, the relationships of UCR with defensive responses during extinction training, posttraumatic stress disorder (PTSD) symptom severity, and fearful traits in trauma‐exposed individuals are not known. In a sample of 100 trauma‐exposed adults with a continuum of PTSD severity, we recorded startle responses and skin conductance responses (SCR) during fear acquisition and extinction training using a 140 psi, 250‐ms air blast to the larynx as the unconditioned stimulus. We explored dimensional associations of two different measures of UCR (unconditioned startle and unconditioned SCR) with conditioned defensive responding to CS+ and CS−, conditioned fear (CS+ minus CS−), PTSD symptom severity, and a measure of fearful traits (composite of fear survey schedule, anxiety sensitivity index, and Connor‐Davidson resilience scale). Unconditioned startle was positively associated with startle potentiation to the threat cue and the safety cue across both learning phases (CS+ Acquisition, CS− Acquisition, CS+ Extinction Training, CS− Extinction Training) and with fearful traits. Unconditioned SCR was positively associated with SCR to the CS+ and CS− and SCR difference score during Acquisition. Neither type of UCR was associated with PTSD symptom severity. Our findings suggest that UCR, particularly unconditioned startle to a naturally aversive stimulus, may inform research on biomarkers and treatment targets for symptoms of pervasive and persistent fear in trauma‐exposed individuals.

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Conceptualizing traumatic stress and the structure of posttraumatic psychopathology through the lenses of RDoC and HiTOP

Cited by 16 publications

References 124 publications

Long-Term Trajectories of Posttraumatic Stress Disorder Symptoms: A 20-Year Longitudinal Study of World Trade Center Responders

Long-Term Trajectories of Posttraumatic Stress Disorder Symptoms: A 20-Year Longitudinal Study of World Trade Center Responders

Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review

Unconditioned response to a naturally aversive stimulus is associated with sensitized defensive responding and self‐reported fearful traits in a PTSD sample

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