Previous research with youth has shown that clinicians tend to diagnose and treat post-traumatic stress disorder (PTSD) in trauma-exposed clients, even when clinical presentations indicate that PTSD is not the primary diagnosis. The current study sought to examine this trauma-related diagnostic overshadowing bias in adult cases across different types of trauma exposure. Mental health professionals (N = 232) reviewed two vignettes describing an adult seeking treatment for either obsessive-compulsive disorder (OCD) symptoms or substance use disorder (SUD) symptoms (target disorders). Each participant was randomly assigned to one vignette in which one client endorsed exposure to trauma (i.e., sexual trauma or physical trauma) and one vignette in which the client reported no trauma exposure. Following each vignette, participants responded to questions related to the diagnosis and treatment of the client. In both cases, participants were significantly less likely to choose the target diagnosis and treatment and more likely to choose a PTSD diagnosis and trauma treatment when trauma exposure was present in the vignettes. Evidence for the bias was strongest for vignettes that contained sexual trauma compared to vignettes that contained physical trauma. Evidence for the bias was also more consistent in the OCD case compared to the SUD case. Results indicate evidence for the existence of trauma-related diagnostic overshadowing in adult populations, though the strength of this bias may be dependent on aspects of the trauma and overall clinical presentation. More work is needed to understand factors that may impact the presence of this bias.

Background: Guilt and shame are common moral emotions following potentially morally injurious events (PMIEs), which involve events that violate one’s deeply held moral values. However, not all individuals will experience guilt and shame following PMIEs and the mechanisms by which PMIEs lead to guilt and shame are not well understood. This study set out to examine the role of event-related intrusive rumination, event-related deliberate rumination, cognitive flexibility, and their interactions, in predicting PMIE-related guilt and shame. Methods: A subsample of undergraduate participants exposed to an objective PMIE and endorsing a subjective PMIE (N = 323) completed self-report assessments. Results: Higher levels of event-related intrusive rumination and event-related deliberate rumination and lower levels of cognitive flexibility were associated with higher levels of PMIE-related shame. Only higher levels of event-related deliberate rumination were associated with greater PMIE-related guilt. Moreover, the predictors explained much greater variance in PMIE-related shame (R2Adj = 0.44) than PMIE-related guilt (R2Adj = 0.05). There was no significant interaction between event-related rumination and cognitive flexibility in predicting PMIE-related guilt or shame. Limitations: This study was cross-sectional, the sample was mostly female, and all data was collected via self-report. Longitudinal studies are needed to explore these potential mechanistic processes. Conclusions: Our findings suggest that differential pathways may affect whether individuals experience guilt or shame following PMIEs. Rumination and cognitive flexibility may be valuable clinical targets for interventions aimed at addressing PMIE-related shame.

This study assessed whether different types of childhood maltreatment (CM) (i.e., abuse vs. neglect) had differential relationships with heart rate variability (HRV) and baroreflex sensitivity (BRS), two established markers of autonomic functioning. Additionally, this study used a moderated mediation model to investigate the potentially mediating role of HRV in the relationship between CM subtypes and adult psychopathology, and whether these relationships differed in those with high vs. low resting HRV. Secondary analysis was performed using the MIDUS II Biomarker Project dataset. Structural equation modeling was used to assess the relationships between key variables at baseline, as well as reactivity and recovery to stressor tasks. Baseline pathways from abuse and neglect to BRS were nonsignificant, as was the pathway from HRV to psychopathology. Notably, greater abuse was significantly predictive of lower HRV (standardized ß = -.42, p<.01) while greater neglect was significantly predictive of higher HRV (standardized ß = .32, p<.05). Additionally, higher childhood abuse was significantly predictive of greater adult psychopathology (standardized ß = .39, p<.001), but childhood neglect was not found to be related to adult psychopathology in this sample. Significant relationships between target variables were only found in those with low HRV. Our findings suggest that greater differentiation between abuse and neglect are appropriate in investigations of the impact of CM on adult physical and mental health outcomes. Additionally, our findings contribute further evidence that low HRV may be a transdiagnostic endophenotype for mood-related pathology.

The increase in availability of patient data through consumer health wearable devices and mobile phone sensors provides opportunities for mental health treatment beyond traditional self-report measurements. Previous studies have suggested that wearables can be effectively used to benefit the physical health of people with mental health issues, but little research has explored the integration of wearable devices into mental health care. As such, early research is still necessary to address factors that might impact integration including patients' motivations to use wearables and their subsequent data.

The aim of this study was to gain an understanding of patients’ motivations to use or not to use wearables devices during an intensive treatment program for post-traumatic stress disorder (PTSD). During this treatment, they received a complementary Fitbit. We investigated the following research questions: How did the veterans in the intensive treatment program use their Fitbit? What are contributing motivators for the use and nonuse of the Fitbit?

We conducted semistructured interviews with 13 veterans who completed an intensive treatment program for PTSD. We transcribed and analyzed interviews using thematic analysis.

We identified three major motivations for veterans to use the Fitbit during their time in the program: increase self-awareness, support social interactions, and give back to other veterans. We also identified three major reasons certain features of the Fitbit were not used: lack of clarity around the purpose of the Fitbit, lack of meaning in the Fitbit data, and challenges in the veteran-provider relationship.

To integrate wearable data into mental health treatment programs, it is important to understand the patient’s perspectives and motivations in using wearables. We also discuss how the military culture and PTSD may have contributed to our participants' behaviors and attitudes toward Fitbit usage. We conclude with possible approaches for integrating patient-generated data into mental health treatment settings that may address the challenges we identified.