Trauma Recovery: A Heroic Journey

BACKGROUND Worldwide, exposure to potentially traumatic events is extremely common and many will develop posttraumatic stress disorder (PTSD) along with other disorders. Unfortunately, considerable barriers to treatment exist. One promising approach to overcoming treatment barriers are digital mental health interventions (DMHIs). Yet, engagement with DMHIs is a concern and theoretically based research in this area is sparse and often inconclusive. OBJECTIVE The focus of this study was on the complex issue of DMHI engagement. Based on the social cognitive theoretical (SCT), the conceptualization of engagement and a theoretically based model of predictors and outcomes were investigated using a DMHI for trauma recovery. METHODS A 6-week longitudinal study with a national sample of trauma survivors was performed that measured engagement, predictors of engagement, and mediational pathways to symptom reduction while using a trauma recovery DMHI (NT1 = 915, NT2 = 350, NT3 = 168, NT4 = 101). RESULTS Confirmatory factor analysis of the engagement latent construct of duration, frequency, interest, attention, and affect produced an acceptable model fit, (χ² = 8.35, df = 2, P = .015, CFI = .973, RMSEA = .059, 90% CI = [.022, .103]. Using the latent construct, the longitudinal theoretical model demonstrated adequate model fit, CFI = .929, RMSEA = .052, 90% CI [.040, .064] and indicated that engagement self-efficacy (β = .35, P < .001) and outcome expectations (β = .37, P < .001) were significant predictors of engagement (R2 = 39%). The relationship between engagement and outcomes was mediated by both activation self-efficacy (β = .80, P < .001), and trauma coping self-efficacy (β = .40, P < .001), which predicted a reduction in PTSD symptoms (β = -.20, P = .017). CONCLUSIONS The results of this study may provide a solid foundation toward formalizing the nascent science of engagement. The engagement conceptualization consisted of general measures of attention, interest, affect, and usage that could be applied to other applications. The longitudinal research model supported two theoretically based predictors of engagement, engagement self-efficacy and outcome expectancies. Two task specific self-efficacies, activation and coping, proved to be significant mediators between engagement and symptom reduction. Taken together, this model can be applied to other DMHIs to understand engagement as well as predictors and mechanisms of action. Ultimately, this could help improve the design and development of engaging and effective trauma recovery DMHIs.

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Post-trauma behavioral phenotype predicts vulnerability to fear relapse after extinction

10.1101/2021.09.25.461769 ◽

2021 ◽

Author(s):

Fanny Demars ◽

Ralitsa Todorova ◽

Gabriel Makdah ◽

Antonin Forestier ◽

Marie-Odile Krebs ◽

...

Keyword(s):

Wide Spectrum ◽

Psychiatric Patients ◽

Transcriptional Profiling ◽

Behavioral Assessment ◽

Trauma Recovery ◽

Genome Wide ◽

Differential Vulnerability ◽

Response Profiles ◽

Automated Pipeline ◽

Post Therapy

Current treatments for trauma-related disorders remain ineffective for many patients. Here, we modeled interindividual differences in post-therapy fear relapse with a novel ethologically relevant trauma recovery paradigm. After traumatic fear conditioning, rats underwent fear extinction while foraging in a large enriched arena, permitting the expression of a wide spectrum of behaviors, assessed by an automated pipeline. This multidimensional behavioral assessment revealed that post-conditioning fear response profiles clustered into two groups, respectively characterized by active vs. passive fear responses. After trauma, some animals expressed fear by freezing, while others darted, as if fleeing from danger. Remarkably, belonging to the darters or freezers group predicted differential vulnerability to fear relapse after extinction. Moreover, genome-wide transcriptional profiling revealed that these groups differentially regulated specific sets of genes, some of which have previously been implicated in anxiety and trauma-related disorders. Our results suggest that post-trauma behavioral phenotypes and the associated epigenetic landscapes can serve as markers of fear relapse susceptibility, and thus may be instrumental for future development of more effective treatments for psychiatric patients.

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