European Journal of Psychotraumatology
October 23, 2020
R. Lanius, Braeden A. Terpou, M. Mckinnon
158 citations
Trauma can disrupt the sense of self, as reported by individuals with PTSD who describe feeling disconnected from themselves or emotionally numb. These self-related experiences are linked to the default mode network (DMN), a brain network active during rest and self-referential thought. In people with PTSD, the DMN shows reduced resting-state functional connectivity compared to healthy individuals, with greater reductions tied to more severe PTSD symptoms. Trauma may become intertwined with the sense of self through alterations in the DMN. Understanding these changes during rest and in response to trauma-related cues may inform therapies that address past and present experiences in PTSD treatment.
European Journal of Psychotraumatology
May 19, 2015
Ruth A. Lanius
126 citations
A recently proposed four-dimensional model categorizes trauma-related psychopathology into symptoms occurring within normal waking consciousness and those that are dissociative, associated with trauma-related altered states of consciousness (TRASC). The dimensions are time, thought, body, and emotion. Clinical applications and future research directions for each dimension are discussed. This model has transdiagnostic implications for trauma-related disorders in both the DSM and ICD. It provides a framework, guided by existing dissociation models, for future research on the phenomenological, neurobiological, and physiological underpinnings of trauma-related dissociation.
European Journal of Psychotraumatology
December 7, 2020
Candice M Monson, Anne C Wagner, Ann T Mithoefer et al.
90 citations
A small pilot study tested whether adding MDMA to cognitive-behavioural conjoint therapy (CBCT) for PTSD is safe and effective. Six couples, where one partner had PTSD, completed a condensed 7-week CBCT protocol that included two sessions where both partners received MDMA. No serious side effects occurred. PTSD symptoms improved substantially, as rated by clinicians, patients, and partners (effect sizes d = 1.85–3.59). Patients also showed improvements in depression, sleep, emotion regulation, and trauma-related beliefs. Relationship adjustment and happiness improved for both patients and partners (d = 0.64–2.79). MDMA may enhance CBCT's benefits for individuals with PTSD and their partners.
European Journal of Psychotraumatology
January 1, 2024
Richard J. Zeifman, Hannes Kettner, Stephen Ross et al.
34 citations
Therapeutic alliance—the quality of the relationship between therapist and client—predicts improvement in PTSD symptoms after MDMA-assisted psychotherapy. Among 22 adults with chronic PTSD who received MDMA during a clinical trial, stronger therapeutic alliance measured at sessions 4 and 9 (but not before the third session) was associated with lower clinician-assessed PTSD severity after treatment, even after accounting for initial symptom severity. Self-reported PTSD severity was also predicted by alliance at baseline, session 4, and session 9, though the baseline finding did not survive correction for multiple comparisons. These results provide initial evidence that common psychotherapeutic factors like alliance contribute to outcomes in MDMA-assisted therapy.
European Journal of Psychotraumatology
January 1, 2016
Daniela Rabellino, Sherain Harricharan, Paul Frewen et al.
25 citations
In individuals with the dissociative subtype of posttraumatic stress disorder (PTSD), the rubber hand illusion (RHI) provokes complex and differentiated responses, including subjective distress, depersonalization, derealization, tonic immobility, increased physiological arousal, and flashbacks. The illusion was induced after both synchronous and asynchronous brushing. These findings suggest that the RHI acts as a strong provocation stimulus, eliciting individual patterns of symptom presentation related to body misrepresentation and altered body ownership. The paradigm may be useful for studying the neurophenomenology of body distortion in trauma-related altered states of consciousness.
European Journal of Psychotraumatology
January 1, 2023
Barbara Niles, Ariel J Lang, Miranda Olff
16 citations
Most evidence supports trauma-focused psychotherapy as the first-line treatment for trauma, but many people worldwide seek Complementary and Integrative Health (CIH) therapies for wellness beyond symptom reduction. This special issue presents research on CIH interventions including mindfulness, service dogs, and scuba diving. A featured editorial highlights the importance of defining when, where, and how placebo responses work, noting that nonspecific elements like positive expectations, therapeutic rituals, healing symbols, and social interactions influence treatment response. CIH interventions harness these factors along with attention or emotion regulation.
European Journal of Psychotraumatology
January 1, 2021
L. Basedow, Sören Kuitunen-Paul, M. Wiedmann et al.
15 citations
Adolescents with both a substance use disorder and probable post-traumatic stress disorder report more frequent use of MDMA (ecstasy) than those without PTSD, and they start using substances at a younger age. PTSD symptoms, especially avoidance, appear before first MDMA use, which begins on average 2.2 years after PTSD onset. The association between MDMA use and avoidance symptoms may reflect an attempt to reduce those symptoms or a consequence of regular MDMA use.
European Journal of Psychotraumatology
December 1, 2025
Gabrielle Agin-Liebes, Richard J. Zeifman, Jennifer Mitchell
11 citations
MDMA-assisted therapy (MDMA-AT) for severe posttraumatic stress disorder (PTSD) improves self-compassion, which may explain its therapeutic benefits. In a double-blind trial with 82 adults, MDMA-AT significantly increased compassionate self-responding (self-kindness, common humanity, mindfulness) and decreased uncompassionate self-responding (self-judgment, isolation, over-identification) compared to placebo plus therapy, with large effect sizes on most subscales. Changes in self-compassion fully mediated the reduction in PTSD severity and depressive symptoms, but not in alcohol or substance use. Self-compassion appears to be a key psychological mechanism in MDMA-AT, suggesting that targeting it could refine treatments for PTSD with co-occurring depression.
European Journal of Psychotraumatology
August 29, 2023
Lihong Jiang, Amanda J. F. Tamman, Christopher L. Averill et al.
8 citations
Early trauma is linked to stronger glutamatergic synaptic strength in people with PTSD, measured via a novel in vivo marker called energy per cycle (EPC). In a sample of 34 adults (16 with PTSD, 18 healthy controls), higher early trauma correlated with higher EPC only in the PTSD group. Greater synaptic strength was associated with reduced behavioral inhibition, and EPC mediated stronger links between reward responsiveness and early trauma. These findings suggest that trauma-induced changes in synaptic plasticity may underlie psychiatric risk and point to potential targets for treatments like ketamine and psilocybin.
European Journal of Psychotraumatology
January 1, 2024
Jerome Herpers, Natalie Maximets, Noah N N van Dongen et al.
7 citations
Experts in MDMA-assisted therapy for PTSD overwhelmingly endorse the need for training, standardization, equity, and access, while identifying impediments in national approval processes and anticipating spill-over effects in clinical settings. A survey of 68 researchers and clinicians worldwide gathered opinions on clinical practices, training, and regulation. The findings call for science-informed policy development, active regulatory involvement, and international cooperation to incorporate MDMA-assisted therapy into European mental healthcare, particularly for PTSD treatment.
European Journal of Psychotraumatology
January 1, 2024
Meike Müller-Engelmann, Luisa Bahnemann, Stella Kümmerle
5 citations
An intervention combining cognitive techniques with loving-kindness meditations (C-METTA) reduced PTSD symptoms, trauma-related guilt, and trauma-related shame more than a wait-list condition in a small randomized trial of 32 trauma-exposed patients. The effects were large: PTSD symptoms (d = -1.09), guilt (d = -2.85), and shame (d = -2.14) all showed greater reductions with C-METTA, along with improvements in general psychopathology and self-criticism. The intervention consisted of six weekly individual sessions followed by a four-week practice phase. These results suggest C-METTA may offer improved care for patients with stress-related disorders.
European Journal of Psychotraumatology
December 1, 2025
Zheng Zhang, Qingqin Zhang, Ping Lu et al.
3 citations
In a randomized controlled trial of 80 head and neck cancer patients, a six-week mindfulness-based stress reduction (MBSR) program, compared with treatment as usual, significantly increased optimism from the start to the end of the program and from the end of the program to a later follow-up, with medium effect sizes. Hope did not increase during the program but did increase significantly at the follow-up. The program did not sustain changes in posttraumatic growth or experiential avoidance beyond the initial period. Experiential avoidance partially explained the link between MBSR and posttraumatic growth, while hope and optimism did not. The authors suggest MBSR can be part of treatment for these patients.
European Journal of Psychotraumatology
December 1, 2025
Eirini Aikaterini Melegkovits, Ava J C Mason, Jordan Reid et al.
2 citations
Among people with subclinical psychosis who have a history of developmental trauma, dissociative experiences are common, confusing, and often distressing. These experiences involve detachment and compartmentalization and are linked to emotions, past trauma, and psychotic-like phenomena. The findings underscore the need for better clinical recognition and tailored interventions for this group.
European Journal of Psychotraumatology
November 4, 2025
Michele Topel, Donald S. Ciccone
2 citations
Combining low-dose sublingual ketamine with EMDR therapy significantly reduced PTSD symptom severity and functional impairment in eight clients. After four sessions of Ketamine Assisted EMDR Therapy™ (KA-EMDR), PTSD symptom scores dropped from an average of 15.50 to 9.88, and functional impairment scores fell from 8.50 to 5.25. Clients reported less fear, greater self-compassion and emotional clarity, and minimal adverse effects. The approach may enhance adaptive memory reconsolidation by improving access to traumatic memories while reducing hyperarousal. Larger controlled trials are needed to confirm these preliminary findings.
European Journal of Psychotraumatology
January 7, 2025
Cresta Asah, Hinuga Sandahl, Lone Baandrup et al.
2 citations
Among refugees with post-traumatic stress disorder (PTSD), 71% of 176 participants reported dream enactment behavior (DEB)—acting out dreams during sleep. Those with DEB showed significantly less improvement in sleep quality after PTSD therapy compared to those without DEB, regardless of the specific treatment received. DEB was not linked to differences in overall symptom severity or daily functioning. Additionally, 60% of participants with DEB did not report trauma-related nightmares, suggesting that trauma-associated sleep disorder (TASD) does not capture all cases of DEB in PTSD. The findings indicate that DEB is a common feature of sleep in PTSD that may limit treatment effectiveness for sleep problems.
European Journal of Psychotraumatology
December 1, 2026
Maud Rothärmel, Lila Mekaoui, François Kazour et al.
1 citation
In a retrospective study of 22 adults with treatment-resistant depression and comorbid post-traumatic stress disorder who received esketamine nasal spray, trauma re-experiencing episodes occurred during treatment sessions. For 16 patients (72.7%) these episodes disappeared as sessions progressed. Treatment was stopped for 6 patients (27.3%) due to re-experiencing. Among those who continued esketamine, depression response rate was 45.5% and remission 22.7%; PTSD improvement rate was 45.5% and remission 18.2%. The findings suggest esketamine can be safely administered in this comorbid population and that trauma re-experiencing does not prevent clinical improvement.
European Journal of Psychotraumatology
December 1, 2026
V Ursule Taujanskaite, Sunjeev K. Kamboj
A 6-item short form of the Clinician Administered Dissociative States Scale (CADSS-SF) was developed using data from three studies of nitrous oxide in 229 healthy volunteers, then validated in 80 separate participants. The single-factor scale, composed of derealization and depersonalization items, showed excellent model fit and internal consistency (omega = 0.87), correlated strongly with the full 19-item CADSS (r ≥ 0.88), and moderately with a measure of psychotomimesis (r = 0.63). The CADSS-SF enables rapid, repeated assessment of dissociation during drug intoxication without disrupting the experience, but primarily captures derealization and depersonalization and requires further validation beyond drug-induced dissociation in healthy populations.
European Journal of Psychotraumatology
December 1, 2026
Philip Gerrans, Hugh McGovern, Jakob Hohwy et al.
Complex post-traumatic stress disorder (C-PTSD) involves lasting difficulties with emotions, self-concept, and relationships, beyond typical PTSD symptoms. This review proposes a neurocognitive explanation based on predictive processing and self-modelling, focusing on how the brain's insula integrates bodily signals, emotions, and self-awareness. The authors suggest that C-PTSD arises from maladaptive predictions shaped by prolonged interpersonal trauma, leading to unstable self-regulation. They examine MDMA-assisted psychotherapy as one intervention that may temporarily alter emotional salience, trust, and self-related thinking. The framework generates testable hypotheses about self-modelling in C-PTSD and offers guidance for developing treatments that target affective regulation and self-referential processing.
European Journal of Psychotraumatology
December 1, 2025
Corinna Schreiber, Stella Kümmerle, Meike Müller-Engelmann
A combination of cognitive techniques and loving-kindness meditation (C-METTA) significantly reduced PTSD symptoms, trauma-related guilt, and trauma-related shame in 25 survivors of interpersonal violence, 96% of whom were women aged 19–61. Effect sizes were large, ranging from d = 1.12 to d = 1.67 for PTSD symptoms, d = 1.54 for guilt, and d = 1.26 for shame. Childhood trauma, cumulative trauma, and chronic PTSD did not influence treatment effectiveness. The authors suggest C-METTA may expand treatment options for PTSD following interpersonal violence, though regression to the mean should be considered as a confounding factor.
European Journal of Psychotraumatology
December 1, 2026
Chulei Tang, Ting Zhao, Simin Yu et al.
An integrated mindfulness-based programme combining the Community Resiliency Model and mindfulness-based stress reduction reduced posttraumatic stress disorder symptoms and improved antiretroviral therapy adherence in people with HIV. Eighty-two participants with HIV and PTSD were assigned to either the intervention or a control group. The intervention group showed significantly greater reductions in PTSD symptoms and improvements in ART adherence immediately after the programme and at a three-month follow-up. Increased mindfulness, enhanced resilience, and decreased rumination partially explained the effect on PTSD symptoms. The authors argue the programme offers a low-resource intervention for trauma and treatment adherence in HIV-positive populations.
European Journal of Psychotraumatology
October 8, 2024
A. Reffi, Philip Cheng, D. Kalmbach et al.
Among 88 predominantly low-income, Black, urban patients hospitalized after traumatic injury, those exposed to interpersonal violence (e.g., assault) were significantly more likely to experience trauma-related nightmares (TRNs) over two months than those exposed to non-interpersonal trauma (e.g., motor vehicle collision): 80% vs. 48.7%. Interpersonal violence patients had nearly five times greater odds of TRNs across timepoints. TRNs at one month prospectively predicted more severe PTSD symptoms at two months, beyond initial PTSD status. The authors propose that early nightmare-focused treatment after interpersonal violence may reduce PTSD risk.
European Journal of Psychotraumatology
January 1, 2022
Anne Malaktaris, Caitlin L Mclean, Sheetal Mallavarapu et al.
Among US military veterans with posttraumatic stress disorder (PTSD) who participated in the Mantram Repetition Program—a portable meditative practice involving mindful repetition of a sacred phrase—higher frequency of daily mantram repetition was linked to greater improvements in PTSD symptom severity, trait anger, state anger, mental health well-being, and spiritual well-being, though not physical health well-being. The associations showed small effect sizes. The findings suggest that encouraging regular practice may enhance the benefits of meditation-based interventions for veterans with PTSD.
European Journal of Psychotraumatology
January 1, 2022
Lionel Gibert, Mathieu Coulange, Jean-Charles Reynier et al.
A controlled randomized clinical pilot study compared scuba diving combined with mindfulness exercises (the Bathysmed® protocol) to a non-specific multisport program for reducing PTSD symptoms. The Bathysmed® protocol improved PCL-5 scores more than multisport, but the result was not significant. It significantly reduced intrusion symptoms after one month. Trait mindfulness scores improved up to one month after the course, but not significantly. Three months after the course, no differences between groups remained on PCL-5 or Freiburg Mindfulness Inventory scores. The authors suggest mindfulness must be practiced long-term for stable benefits and that further work is needed to confirm these partial but encouraging results.
European Journal of Psychotraumatology
January 1, 2019
Robert-Jacek Gorzka, Katja Rebling, Helge Höllmer et al.
The Hamburg Nightmare Questionnaire (HNQ) is a short self-rating instrument developed to assess nightmares, differentiate between nightmare types, and measure their impact on daytime functioning. In a sample of 707 German soldiers, the HNQ showed satisfactory psychometric properties, including a sound factorial structure, adequate internal consistency, and initial indications of construct validity for its subscales. The HNQ is a reliable and economic tool for assessing posttraumatic nightmares in clinical and research settings.
European Journal of Psychotraumatology
January 1, 2019
Jennifer N Crawford, Alexander M Talkovsky, Jill E Bormann et al.
A meditation-based program called the Mantram Repetition Program (MRP) reduced hyperarousal symptoms in veterans with PTSD more than a non-specific psychotherapy control. Hyperarousal reductions were greater at both post-treatment and 8-week follow-up, and these reductions also helped decrease other PTSD symptom clusters. The findings suggest that targeting hyperarousal may be a key pathway to recovery from PTSD.