There is no established guidance on how many days of posttraumatic stress disorder (PTSD) assessments are sufficient to capture reliable and stable estimates of intraindividual mean (iM) and variability (intraindividual standard deviations [iSD]) in intensive longitudinal studies. Thus, this study examined the reliability and short-term stability of daily PTSD symptoms measured using the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). Participants (N = 70, M = 30.44 years, SD = 12.78 72.9% female) completed the PC-PTSD-5 for 21 consecutive days before and after attending four intervention sessions. To examine reliability, generalizability coefficients assessing systematic consistency across days (Rc) and single-day reliability (R1F) were calculated. To examine short-term stability in each phase, we calculated reference iMs and iSDs from 21 days for the preintervention and postintervention phases. We used (a) correlation coefficients (stable: r > .80) and mean absolute differences (stable: < .25) to compare these reference estimates, with estimated values ranging from 2-21 days per participant, and (b) bias and agreement using Bland-Altman analyses. Results indicate that the PC-PTSD-5 yielded varying intraindividual variability estimates in the short term, Rcs = .45-.67, Rcs = .40-.55, but good single-day reliability, R1Fs = .72-.78, R1Fs = .77-.82. Assessing PTSD using the PC-PTSD-5 for 7-11 days could produce iM and iSD estimates comparable to 21 days. Overall, the PC-PTSD-5 was more reliable for capturing between-person differences than within-person fluctuations. Intensive longitudinal studies could use 7-11 days of daily PC-PTSD-5 assessments to capture stable estimates of average and variable PTSD symptoms.

Written exposure therapy (WET) is a brief, evidence-based treatment for posttraumatic stress disorder (PTSD) that has demonstrated effectiveness in a variety of settings, mostly within the United States. The pilot study described here examined the feasibility, acceptability, and effectiveness of WET in Azerbaijan, where access to evidence-based trauma-focused treatments is limited. Patients diagnosed with PTSD (N = 62) received five weekly sessions of WET delivered by trained clinicians. Self-report measures were used to assess PTSD and depressive symptoms, as well as maladaptive beliefs, at pre- and posttreatment. Working alliance was also assessed using the patient version of the Brief Revised Working Alliance Inventory (BR-WAI). Treatment dropout was low, with only four participants (6.4%) dropping out. Treatment outcome findings indicated that there were significant decreases in PTSD symptoms, d = 1.84; depressive symptoms, d = 1.43; and maladaptive beliefs, d = 0.85. At posttreatment, most (87.1%) participants showed a reliable reduction in PTSD symptoms, and 71.0% met the criteria for clinical recovery. Working alliance moderated PTSD symptom reductions, with stronger agreement on goals and tasks associated with larger reductions in PTSD symptoms, B = -0.18, p = .049. Exploratory analyses revealed that reductions in maladaptive trauma-related beliefs were significantly associated with reductions in PTSD symptoms, B = -0.46, p < .001. Overall, the findings suggest that WET is both feasible and acceptable to implement in Azerbaijan. Moreover, WET was effective, with large treatment effects observed. These findings support the broader implementation of WET in low-resource settings.

Response bias for sensitive questions in face-to-face interviewer-administered surveys is a common problem. Our objective was to evaluate the effectiveness of the nonverbal response card (NVRC) in soliciting responses to questions about lifetime trauma exposure and posttraumatic stress disorder (PTSD) symptoms. A sample of youths in Burkina Faso (N = 1,644, age range: 12-20 years) was randomized to answer sensitive questions, including on trauma exposure and PTSD, using either the standard verbal method or the NVRC, a laminated two-sided card that allows respondents to nonverbally answer questions without the interviewer knowing the actual response. We compared reported trauma exposure and PTSD prevalence, internal consistency, and convergent validity by response method. Compared with verbal respondents, NVRC respondents reported lifetime exposure to 18.0% more trauma types and were 2.8 times as likely to report three or four PTSD symptoms, with female trauma reports and male PTSD reports most affected. Measures of internal reliability and convergent validity were also higher for the NVRC method compared to verbal responses, trauma exposure (15 items): Cronbach's αs = .84 vs. .60, PTSD symptoms (four items): Cronbach's αs = .71 vs. .52. Due to the shame that is often associated with trauma and mental health disorders, standard interviewing approaches that rely on verbal responses are likely to underenumerate trauma exposure and PTSD, particularly among refugees who have low trust in formal authorities and institutions. The NVRC offers a low-tech, low-cost method that does not require literacy, is highly portable and robust, and offers enhanced privacy.

A wide range of biological, cognitive, affective, and behavioral risk factors have been studied in relation to posttraumatic stress disorder. Previous work has often isolated a single risk factor or a small number of risk factors, making it is difficult to know which may be the most important to study or target in interventions. We used a supervised machine learning technique, elastic net, to test the associations between posttraumatic stress symptoms (PTSS) and several self-reported risk factors at the full-scale, subscale, and item levels in a large online sample (N = 1,186) of individuals who endorsed experiencing a DSM-5 Criterion A traumatic event, allowing for a broader and more granular understanding of the associations between transdiagnostic risk factors and PTSS. In our full-scale model, posttraumatic cognitions, β = .28; anxiety sensitivity, β = .21; and posttraumatic maladaptive beliefs, β = .18, explained the largest amount of variance in PTSS. At the subscale level, heightened threat perceptions of harm, β = .30; negative cognitions about the self, β = .23; and cognitive sensitivity, β = .14, explained the largest amount of variance in PTSS. Meanwhile, at the item level, not feeling safe, not knowing oneself, and self-blame for a traumatic event had the highest importance ratings. The identified variables may be important targets in future longitudinal and treatment research.

Potentially traumatic events (PTEs) and stressful life events (SLEs) are recognized as environmental risk factors for diverse psychiatric disorders, including obsessive compulsive disorder (OCD) and social anxiety disorder (SAD). However, research has predominantly focused on the presence and quantity of PTE/SLE exposure rather than specific event types or associated emotions. This study aimed to investigate the role of PTEs/SLEs in the onset of OCD and SAD. We recruited patients diagnosed with OCD (n = 38) or SAD (n = 25) and contrasted their responses to the Childhood Trauma Questionnaire-Short Form (CTQ-SF) and the newly developed Obsessive-Compulsive Related Disorders Stressful and Traumatic Events Scale (OTraS), which was built to measure events related to OCD and related disorders. Data analysis was performed using Mann-Whitney tests. Childhood trauma severity did not differ between groups; however, OTraS responses demonstrated that participants with OCD reported exposure to a significantly higher number of PTEs/SLEs, r = .25, p = .044, especially those related to loss and deprivation, than those with SAD, r = .36; p = .004. Importantly, this difference remained significant after controlling for the presence of hoarding disorder, p = .012. Our findings indicate that PTEs/SLEs, particularly those that were loss- and deprivation-related, are more common before OCD onset than SAD onset. Further research is needed to explore whether different PTE/SLE types are transdiagnostically relevant for the whole spectrum of OCD- and anxiety-related disorders or may shape specific disorder development in at-risk individuals.

In my view, randomized controlled trials for posttraumatic stress disorder (PTSD) have reached a point of diminishing returns: There is equipoise among bona fide manualized short-term psychotherapies, dropout is pervasive, most patients do not make clinically significant gains, and no efficient pathway exists for discovering how to personalize care or prevent nonresponse. Progress now depends on leveraging real-world clinical experiences and outcomes as engines of learning. Observational outcome data are indispensable for this purpose but are often misinterpreted as generalizable evidence of effectiveness. In response to Lancaster et al. (2025), this commentary outlines principles and checklist items for transparent, hypothesis-generating reporting that can transform routine clinical data from descriptive snapshots of performance into a scalable foundation for discovery, quality improvement, and advancement in PTSD care.

We thank Litz (2025) for his thoughtful commentary and shared commitment to improving posttraumatic stress disorder care through the transparent use of observational outcome data. The proposed reporting checklist offers a timely framework for enhancing interpretive clarity and hypothesis generation. Our study incorporated many of these elements and was designed as a descriptive, noncomparative analysis aligned with learning health system goals. We acknowledge the importance of careful framing to avoid overinterpretation and support the broader call for standardized reporting practices. Measurement-based care remains central to Cohen Veterans Network's approach, and we welcome continued dialogue to advance responsible data use and iterative quality improvement across systems.

In September 2017, Category 4 Hurricane Maria devastated Puerto Rico (PR). This cross-sectional study evaluated the long-term mental health outcomes among women who were pregnant during or became pregnant shortly after (i.e., within 3 months) hurricane exposure. The HELiOS Study cohort recruited 187 mother-child dyads. Mothers reported prenatal hurricane-related experiences (threat, injury, property loss) and completed assessments of posttraumatic stress disorder (PTSD), perceived stress, and depressive symptoms. Maternal probable depression (19.5%), probable PTSD (21.4%), and moderate-to-severe stress (66.1%) were prevalent 12-54 months postpartum. Linear regression models showed that property damage/loss predicted depressive, B = 0.290, p = .007, and PTSD symptoms, B = 0.893, p = .001, and injury predicted higher depressive, B = 0.546, p = .039, and PTSD symptoms, B = 1.979, p = .003. Prehurricane depression also predicted higher depressive, B = 1.927, p = .035, and PTSD symptoms, B = 4.628, p = .046, whereas total trauma count was associated with PTSD symptoms, B = 1.905, p = .003, and perceived stress, B = 0.803, p = .007. Mothers interviewed closer to the hurricane were more likely to report PTSD symptoms, B = 5.001, p = .021. Married, B = -10.706, p = .038, and cohabitating women, B = -10.948, p = .035, reported lower perceived stress. Hurricane-related experiences during pregnancy can have negative long-term effects on maternal mental health. Single mothers and pregnant women with a history of trauma exposure and/or depression may have a heightened risk of adverse postdisaster mental health outcomes.

The theme of the 2024 International Society for Traumatic Stress Studies (ISTSS) 40th Annual Meeting was "From Bench to Bedside and Beyond: Advancing Translational Science in Traumatic Stress Studies." The current editorial highlights the breadth and depth of scholarly contributions to the meeting, which represent timely and evidence-based work across the translational science spectrum-bench, bedside, and beyond. Some key themes emerged across the featured articles, including the importance of adopting lifespan and intergenerational perspectives when examining trauma and its consequences, unique ethical complexities for trauma-exposed populations, and the value of multisystem collaborations and professional support. Further, articles in this issue span foundational and basic science, clinical applications, implementation strategies, and public health and policy. This editorial reflects the conference's scientific dialogue and serves as a call to action for continued work in translational traumatic stress science.

Self-inflicted injury is a known risk factor for suicide. Previous studies have reported associations between posttraumatic stress disorder (PTSD) and self-inflicted injury; however, this association has not been widely studied among disaster-exposed populations. Among 50,386 enrollees in the World Trade Center Health Registry, a cohort of individuals exposed to the September 11, 2001, attacks in New York City (9/11), we examined longitudinal associations between probable 9/11-related PTSD and hospitalizations and emergency department (ED) visits for self-inflicted injuries that occurred between study enrollment (2003-2004) and 2015. Time-dependent Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals (CIs) for associations of time-varying probable 9/11-related PTSD and self-inflicted injury, adjusting for sociodemographic and pre-9/11 mental health symptoms. At study enrollment, 11.0% of enrollees had probable PTSD. Over a median follow-up period of 11.2 years, a total of 171 hospitalizations/ED visits for self-inflicted injury occurred among 146 enrollees. When comparing individuals with probable PTSD to those without probable PTSD, the multivariable-adjusted hazard ratio for self-inflicted injury was 2.45, 95% CI [1.63, 3.66]. Evidence of effect modification by age group was not observed. Our findings suggest that surveillance for PTSD among disaster-exposed populations may help identify individuals at high risk of self-inflicted injury who could benefit from targeted interventions.

Despite growing interest in understanding mental health issues among burn survivors, limited research has explored potential factors explaining these challenges. This study explored the role of emotion reactivity, emotion regulation, and burn wound severity in depressive, anxiety, and posttraumatic stress disorder (PTSD) symptoms among burn survivors. Participants were severe burn survivors (N = 146, M = 42.11 years) hospitalized at the National Burn Hospital in Vietnam who completed a battery of self-report measures. Results from hierarchical linear regression indicated that heightened emotion reactivity was associated with higher depressive, B = 0.16, β = .58; anxiety, B = 0.15, β = .56; and PTSD symptoms, B = 0.17, β = .52, among participants. Emotion regulation strategies, such as cognitive reappraisal and expressive suppression, did not moderate the association between emotion reactivity and mental health outcomes. Furthermore, no significant association between total burn surface area and psychological symptoms was found, though deeper burns were linked to increased symptom levels. Specifically, survivors with mixed second- and third-degree burns reported higher levels of depressive, B = 1.93, β = .32, and anxiety symptoms, B = 2.10, β = .36, compared to those with second-degree burns only. Future research should further explore factors that moderate the associations among emotion reactivity, burn severity, and mental health, particularly those that influence the effectiveness of emotion regulation strategies. In addition to identifying factors that contribute to mental health problems, these findings could inform health care policies that emphasize pain management and emotional support for burn survivors.

Disgust in posttraumatic stress disorder (PTSD) has been relatively underexamined compared to other emotions, although it may be relevant to war-related PTSD given potential exposure to both physical contaminants and moral violations. The present study examined the prevalence of disgust, mental contamination, and compulsive behaviors among veterans seeking PTSD treatment. Participants were 289 military veterans (79.2% male; M = 43.82, SD = 13.61) referred for treatment at a U.S. Department of Veterans Affairs PTSD specialty clinic. Veterans completed measures of PTSD symptoms; trauma-related disgust toward others and themselves; feelings of dirtiness in response to thoughts, images, or memories of the trauma (i.e., trauma-cued mental contamination); compulsive behaviors; and time spent washing, cleaning, and/or avoiding feeling dirty. Combat was the most common index trauma (69.9%). Nearly three quarters (74.0%) of veterans endorsed at least moderate disgust toward others, and 61.2% endorsed at least moderate disgust toward oneself; about half (54.4%) endorsed at least moderate mental contamination, and 45.0% endorsed washing, cleaning, and/or avoiding feeling dirty at least 1 hr per day. Disgust toward others, disgust toward oneself, and mental contamination were significantly correlated with PTSD symptoms, rs = .41-.57, ps < .001. Multiple regression analysis indicated that all three predictors were associated with PTSD symptoms, F(3, 274) = 79.68, p < .001, R = .47, with disgust toward oneself the strongest predictor, β = .30, p < .001. The present study suggests a notable prevalence of disgust, contamination, and time spent avoiding feeling dirty among veterans seeking PTSD treatment.

Trauma-focused psychotherapy is the front-line treatment option for posttraumatic stress disorder (PTSD); however, approximately two thirds of veterans who initiate such evidence-based psychotherapy (EBP) for PTSD discontinue treatment before completing an adequate number of therapy sessions. We examined the association between whole health (WH) care, comprising WH services (e.g., health and wellness coaching, wellness groups) and complementary and integrative health (CIH) therapies, and EBP completion for PTSD. We completed a national retrospective database analysis of Veterans Health Administration administrative records for veterans with PTSD who initiated an EBP in Fiscal Years 2018-2022 and estimated multiple logistic regression models assessing the association between WH care use and EBP completion (i.e., completing eight EBP sessions within 14 weeks). We identified 100,177 veterans with PTSD who initiated EBP (34.8% completed EBP). Of these veterans, 9,824 (9.8%) had used WH services, and 3,396 (3.6%) had used CIH therapies. When controlling for demographic and health-related variables, WH care use was associated with increased odds of EBP completion. The strongest associations were between the use of WH services both before EBP initiation and concurrent with EBP use, OR = 1.39, 95% CI [1.28, 1.51], and the use of CIH therapies concurrent with EBP use, OR = 1.38, 95% CI [1.20, 1.60], or both before EBP initiation and concurrent with EBP use, OR = 1.30, 95% CI [1.17, 1.45]. The results suggest that parallel use of WH care may bolster patient completion of EBP for PTSD, a critical component of the effectiveness of these psychotherapies.

This report was originally a presentation at the 2024 International Society of Traumatic Stress Studies Annual Meeting (Boston, MA, United States) that describes the integration of a trauma-informed approach into a law enforcement-based critical incident review process conducted by the U.S. Department of Justice's Office of Community Oriented Policing Services in response to a 2022 school shooting in Uvalde, Texas. The report focuses on how the review team of nine law enforcement subject matter experts and six Department of Justice staff members used a trauma-informed approach to ensure they would do no harm to the victims, family members, responders, and others as a result of their review process. The team conducted 260 interviews over 54 days and reviewed 14,000 pieces of data. The team followed trauma-informed principles to protect victims and families and to avoid overexposing themselves and risking secondary traumatic stress. The use of a trauma-informed lens had not been part of prior critical incident reviews, which focused almost exclusively on the facts of the actions of law enforcement and lessons learned. Data were obtained from victim and responder agency interviews, law enforcement reports, and audio and video materials of the incident. The resulting findings indicate that although the law enforcement response to the shooting is considered a failure, the trauma-informed approach used in the review helped support victims, responders, community members, and the team conducting the review.

There is a need to improve psychological interventions for first responders and veterans with posttraumatic stress disorder (PTSD). We conducted an open trial integrating explicit case formulation (CF) within cognitive processing therapy (CPT) in a sample primarily composed of first responders (N = 29). Participants attended weekly CPT sessions with explicit CF, where CF guided deviations (if required) from standard CPT delivery (CPT-CF). PTSD diagnosis and self-reported PTSD symptoms, depressive symptoms, and quality of life utility scores were key variables assessed at pretreatment, posttreatment, and 3-month follow-up for all participants. Of the 28 participants who started therapy, 23 completed treatment. Intent-to-treat analyses indicated significant reductions and sizeable effects at posttreatment for clinician-rated and self-reported PTSD outcomes, g = 2.48-2.50, and self-reported depressive symptoms, g = 1.37, and quality of life, g = 0.99. Effects for secondary variables ranged from small (alcohol misuse: g = 0.32) to large (sleep, g = 0.71; anger, g = 0.74; unhelpful trauma beliefs: g = 1.11). Clinical gains were maintained at 3-month follow-up. Among the 23 participants available at follow-up, 82.6% (n = 19) met good end-state functioning for PTSD, and none met the criteria for PTSD. Seven participants had moderate-to-major deviations from CPT during treatment but largely demonstrated similar outcomes to those who did not. The study replicates prior CPT-CF work among civilians, finding it to be acceptable to participants and not diluting positive outcomes of standard CPT. Future research requires randomized trials and an expansion of this approach with other trauma populations.

Treating posttraumatic stress disorder (PTSD) in military-affiliated populations, including veterans, active duty service members, and their families, remains a significant challenge in the mental health field. Most research on PTSD treatment outcomes has been conducted in controlled trials or within VA and military settings, limiting its generalizability to other clinical environments. This study examined treatment outcomes for 2,717 military-affiliated clients receiving treatment for PTSD within a community mental health network. Treatments included cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR), or prolonged exposure (PE), with outcomes measured using the PTSD Checklist for DSM-5 (PCL-5) throughout treatment. Clients who attended at least four sessions showed substantial symptom reductions for CPT (ΔM = 19.3), d = 0.98; EMDR (ΔM = 16.6), d = 0.86; and PE (ΔM = 17.4), d = 0.87, all of which exceeded improvements seen with other treatments (ΔM = 12.6), d = 0.71. Analyses of clinically meaningful change thresholds showed similar results across treatments, with 51.9% of CPT, 47.8% of EMDR, and 53.1% of PE clients experiencing a PCL-5 score reduction of at least 18 points after four or more sessions. Dropout prior to four sessions was notable, with 27.5%-40.1% of clients across treatment groups discontinuing treatment before reaching this threshold. Overall, the findings provide real-world evidence supporting the effectiveness of CPT, EMDR, and PE in military-affiliated populations and validate their continued use in community mental health settings.

Providing posttraumatic stress disorder (PTSD) treatment in primary care is a key strategy for increasing treatment access. This qualitative descriptive study examined patients' perspectives on the effectiveness of written exposure therapy (WET) and antidepressant medications for PTSD delivered in primary care. We interviewed a purposive sample of adult patients with probable PTSD who participated in a pragmatic comparative effectiveness trial in federally qualified health center (FQHC) and Veterans Health Administration (VHA) primary care clinics. The interviews assessed changes experienced during treatment and aspects of treatment that were helpful or could be improved. We analyzed interview transcripts using inductive thematic analysis. Among trial participants who completed interviews (n = 65; FQHC: 46.2%, VHA: 53.8%), 41.5% received WET, 33.8% received medications, and 24.6% received both. Most interviewees reported experiencing positive changes during treatment (e.g., symptoms, habits/activities, empowerment), but some reported experiencing limited changes or negative changes. Interviewees described multiple aspects of WET and medication treatment as helpful (e.g., gaining an understanding of PTSD) and suggested possible improvements (e.g., more WET sessions, more opportunities to talk to clinicians). Some findings were specific to either WET or medications, but most were discussed in relation to both treatment types. The implementation of these treatments in primary care should involve strategies for primary care clinicians to efficiently educate patients about PTSD during both WET and medication treatment, shared decision-making tools that are appropriate for the primary care setting, and effective linkage to specialty mental health care for patients who desire more contact with clinicians.

Despite an increase in the number of veterans receiving posttraumatic stress disorder (PTSD) care in the community, little work has examined the coordination and quality of care, particularly as it relates to U.S. Department of Veterans Affairs (VA) standards. To this end, the current project sought to document community care characteristics among veterans receiving outpatient psychotherapy services for PTSD. Specifically, the coordination of care and congruency with VA standards were examined. Data, which were collected over a 2-year period from a VA hospital in the southeastern United States, included 123 PTSD community care consults across 103 unique veterans (M = 47.80 years, SD = 12.03; 72.4% Male; 50.4% Black). The majority of consults were new referrals for care (62.6%) due to the clinical service not being available or the average drive time to the nearest VA facility exceeding 30 min (77.2%). Regarding the coordination of care, records were not available for 27.6% of consults. Among veterans with treatment records, most were seen for an intake and psychotherapy (38.2%), followed by intake only and psychotherapy only. Formal diagnostic assessments were not documented in any intake records, with 21.2% of psychotherapy records documenting the use of a first-line treatment for PTSD. Notably, most intake records (56.1%) failed to document any assessment of suicide risk, and no psychotherapy records indicated the loss of a PTSD diagnosis. The findings highlight gaps in the coordination and quality of care, particularly as it relates to VA standards, for veterans receiving PTSD care in the community.

Due to Puerto Rico's location, there is heightened vulnerability to the consequences of natural disasters, contributing to an elevated risk of posttraumatic stress disorder (PTSD). Given PTSD's heterogeneous nature, this study examined whether PTSD factor structure, based on DSM-5 criteria and measured using the PTSD Checklist for DSM-5 (PCL-5), was equivalent across hurricane-exposed Puerto Ricans (n = 596) and non-Latiné White (NLW) individuals (n = 459). Confirmatory factor analysis (CFA) indicated the seven-factor hybrid model of PTSD was the best-fitting structure, χ(N = 897, 298) = 685.59, CFI = .967, TLI = .958, RMSEA = .054, SRMR = .038. Latent factor correlations (range: .61-.93) supported the distinctiveness of PTSD symptom dimensions. PTSD prevalence estimates varied significantly (DSM-5: 47.8%, hybrid: 28.2%). Multigroup CFA results supported partial scalar invariance, with PCL-5 Item 8 (memory impairment) requiring varying intercepts, χ(N = 897, 330) = 806.97, p < .001, CFI = .960, TLI = .954, RMSEA = .057, 90% CI [.052, .062], SRMR = .047, BIC = 49,586.9. NHWs reported higher avoidance (ΔM = 0.186), p = .011; negative affect (ΔM = 0.160), p = .028; anhedonia (ΔM = 0.217), p = .002; and dysphoric arousal symptoms (ΔM = 0.187), p = .015, relative to Puerto Ricans. Strong associations between PTSD factors and depression and psychological distress, βs = .57-.82, supported convergent validity. Findings highlight the relevance of the hybrid model for conceptualizing PTSD symptoms among hurricane-exposed populations, with important implications for culturally informed assessment and treatment in Puerto Rican communities.

Exposure-based therapies are widely accepted as the gold-standard intervention for both obsessive compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). Despite their co-occurrence, little research has explored exposure-based treatment in individuals who experience both OCD and PTSD. At an academic medical center mental health program, four different treatment approaches combining exposure and response prevention (ERP) and prolonged exposure (PE) therapies were piloted for veterans with co-occurring OCD and PTSD. We present each approach with a brief case study. Two sequential models are discussed: massed PE followed by spaced ERP (Model 1) and ERP "prestart" spaced sessions followed by 1-week massed ERP and then 1-week massed PE (Model 2). Two integrated models are presented: ERP prestart spaced sessions, followed by massed PE with ERP elements integrated (Model 3) and massed ERP with PE integrated (Model 4). The results demonstrate reductions in OCD and PTSD symptom severity for the sequenced treatment, starting with ERP of Model 2, as well as the integrated approaches of Models 3 and 4, which emphasized OCD-related psychoeducation and response prevention prior to beginning imaginal exposure for PTSD. These models showed reliable change (RC) for both OCD (RC = 2.35-4.06) and PTSD (RC: 4.46-7.39). Impacts of these variations in exposure sequencing and spacing are discussed. We provide recommendations for next steps, including systematic research in rigorous and larger-scale studies of exposure-based treatments for co-occurring OCD and PTSD.

Many individuals feel compelled to seek reminders of trauma that produce distress outside of a therapeutic context (i.e., "self-trigger"). To better understand this behavior, we examined and categorized the motives behind self-triggering by qualitatively analyzing the free responses of 355 participants to the question, "In your own words, why do you self-trigger?" In Study 1, researchers determined whether previously identified motives could be reliably coded. In Study 2, a separate group of researchers identified motives inductively, without knowledge of the a priori motives. Most a priori motives were reliably identified in Study 1, and both studies revealed a range of additional motives. Across both studies, the most prevalent motives included determining the meaning of one's traumatic event, self-punishment, and efforts to validate one's identity as a trauma survivor. Validation was consistently associated with more frequent self-triggering, Study 1: δ = -.19, 95% CI [-.35, -.02]; Study 2: δ = -.19, 95% CI [-.32, -.05], whereas the desire to avoid emotional numbness, Study 1: δ = .21, 95% CI [.02, .39], or seek arousal, Study 2: δ = .22, 95% CI [.06, .37], were associated with less frequent self-triggering. Motives categorized as "unknown" were also associated with less frequent self-triggering, Study 1: δ = .35, 95% CI [.08, .56]; Study 2 δ = .35, 95% CI [.08, .56]. The findings suggest motives for self-triggering are diverse and may serve different functions-cognitive, interpersonal, moral, physiological, or sexual-depending on the individual, with implications for conceptualizing trauma-related emotional regulation and behavioral responses.