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Journal ArticleDOI

The network approach to posttraumatic stress disorder: a systematic review.

08 Jan 2020-European Journal of Psychotraumatology (Eur J Psychotraumatol)-Vol. 11, Iss: 1, pp 1700614-1700614
TL;DR: A systematic review of network analysis studies of posttraumatic stress symptoms found that Amnesia was consistently reported to have lowest strength, while there was substantial heterogeneity regarding which nodes had highest strength centrality.
Abstract: Background: The empirical literature of network analysis studies of posttraumatic stress symptoms (PTSS) has grown rapidly over the last years.Objective: We aimed to assess the characterist...
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Journal ArticleDOI
TL;DR: This editorial presents a decennial review of core topics in the field addressing a range of topics that are core to both the journal and to psychotraumatology as a discipline, and concludes with recommendations concerning top priorities for future research.
Abstract: On 6 December 2019 we start the 10th year of the European Journal of Psychotraumatogy (EJPT), a full Open Access journal on psychotrauma. This editorial is part of a special issue/collection celebrating the 10 years anniversary of the journal where we will acknowledge some of our most impactful articles of the past decade (also discussed below and marked with * in the reference list). In this editorial the editors present a decennial review of the field addressing a range of topics that are core to both the journal and to psychotraumatology as a discipline. These include neurobiological developments (genomics, neuroimaging and neuroendocrine research), forms of trauma exposure and impact across the lifespan, mass trauma and early interventions, work-related trauma, trauma in refugee populations, and the potential consequences of trauma such as PTSD or Complex PTSD, but also resilience. We address innovations in psychological, medication (enhanced) and technology-assisted treatments, mediators and moderators like social support and finally how new research methods help us to gain insights in symptom structures or to better predict symptom development or treatment success. We aimed to answer three questions 1. Where did we stand in 2010? 2. What did we learn in the past 10 years? 3. What are our knowledge gaps? We conclude with a number of recommendations concerning top priorities for the future direction of the field of psychotraumatology and correspondingly the journal.

54 citations

Journal ArticleDOI
TL;DR: In this paper, a systematic review of depression network studies using PRISMA guidelines was conducted, where the most critical symptoms and their connections were determined and the most robust symptoms connections aggregated into a summary network.

46 citations

Journal ArticleDOI
TL;DR: This work investigated whether three pre-treatment centrality indices were significantly correlated with the strength of the association between a symptom’s change and the change in the severity of all other symptoms in the network from pre- to post-treatment (Δnode-Δnetwork association).
Abstract: In the network approach to psychopathology, psychiatric disorders are considered networks of causally active symptoms (nodes), with node centrality hypothesized to reflect symptoms’ causal influence within a network. Accordingly, centrality measures have been used in numerous network-based cross-sectional studies to identify specific treatment targets, based on the assumption that deactivating highly central nodes would proliferate to other nodes in the network, thereby collapsing the network structure and alleviating the overall psychopathology (i.e., the centrality hypothesis). Here, we summarize three types of evidence pertaining to the centrality hypothesis in psychopathology. First, we discuss the validity of the theoretical assumptions underlying the centrality hypothesis in psychopathology. We then summarize the methodological aspects of extant studies using centrality measures as predictors of symptom change following treatment, while delineating their main findings and several of their limitations. Finally, using a specific dataset of 710 treatment-seeking patients with posttraumatic stress disorder (PTSD) as an example, we empirically examine node centrality as a predictor of therapeutic change, replicating the approach taken by previous studies, while addressing some of their limitations. Specifically, we investigated whether three pre-treatment centrality indices (strength, predictability, and expected influence) were significantly correlated with the strength of the association between a symptom’s change and the change in the severity of all other symptoms in the network from pre- to post-treatment (Δnode-Δnetwork association). Using similar analyses, we also examine the predictive validity of two simple non-causal node properties (mean symptom severity and infrequency of symptom endorsement). Of the three centrality measures, only expected influence successfully predicted how strongly changes in nodes/symptoms were associated with change in the remainder of the nodes/symptoms. Importantly, when excluding the amnesia node, a well-documented outlier in the phenomenology of PTSD, none of the tested centrality measures predicted symptom change. Conversely, both mean symptom severity and infrequency of symptom endorsement, two standard non-network-derived indices, were found to be more predictive than expected influence and remained significantly predictive also after excluding amnesia from the network analyses. The centrality hypothesis in its current form is ill-defined, showing no consistent supporting evidence in the context of cross-sectional, between-subject networks.

36 citations


Cites background or methods or result from "The network approach to posttraumat..."

  • ...Overall, the results were comparable to network analyses of similar samples [29, 30]....

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  • ...Moreover, even when following the same procedure outlined and implemented in an R package, instability of some centrality indices across studies still emerges [30]....

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  • ...Thus, the expected influence centrality measure only predicted the ΔnodeΔnetwork association in two out of the four analytic scenarios, both of which included this known phenomenological outlier [30]....

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  • ...have nevertheless dominated the network empirical research over the last several years [1, 30]....

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  • ...Second, while networks based on cross-sectional data and/ or group-level analysis are most common [30, 46], some...

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Journal ArticleDOI
TL;DR: In recent years, a new framework for analyzing and understanding posttraumatic stress disorder (PTSD) was introduced; the network approach, but only a limited number of network studies investigated comorbidity.
Abstract: BACKGROUND In recent years, a new framework for analyzing and understanding posttraumatic stress disorder (PTSD) was introduced; the network approach. Up until now, network analysis studies of PTSD were largely conducted on small to medium sample sizes (N < 1,000), which might be a possible cause of variability in main findings. Moreover, only a limited number of network studies investigated comorbidity. METHODS In this study, we utilized a large sample to conduct a network analysis of 17 symptoms of PTSD (DSM-IV), and compared it to the result of a second network consisting of symptoms of PTSD and depression (based on Patient Health Questionnaire-9 [PHQ-9]). Our sample consisted of 502,036 treatment-seeking veterans, out of which 158,139 had fully completed the assessment of symptoms of PTSD and a subsample of 32,841 with valid PCL and PHQ-9 that was administered within 14 days or less. RESULTS Analyses found that in the PTSD network, the most central symptoms were feeling distant or cut off from others, followed by feeling very upset when reminded of the event, and repeated disturbing memories or thoughts of the event. In the combined network, we found that concentration difficulties and anhedonia are two of the five most central symptoms. CONCLUSION Our findings replicate the centrality of intrusion symptoms in PTSD symptoms' network. Taking into account the large sample and high stability of the network structure, we believe our study can answer some of the criticism regarding stability of cross-sectional network structures.

29 citations


Cites background or result from "The network approach to posttraumat..."

  • ...A growing body of research has examined the network structure of PTSD (Birkeland et al., 2020) Regarding symptom centrality, most studies consistently reported psychogenic amnesia as the least central symptom....

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  • ...This is in accordance with factor analytic studies of PTSD (Armour et al., 2016; Birkeland et al., 2020) that showed a consistently low factor loading, which suggests that amnesia might not serve as a core symptom in PTSD....

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  • ...Consistent with most previous research, psychogenic amnesia was found to be the least central node (Armour et al., 2016; Birkeland et al., 2020; Fried et al., 2018; Lazarov et al., 2019; Moshier et al., 2018)....

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  • ...…the centrality of symptoms, yet, in most studies, re‐experiencing symptoms and detachment have been found to be pivotal (Armour et al., 2017; Birkeland et al., 2020; Fried et al., 2018), which is replicated and extended to treatment‐seeking veterans with PTSD. Results of a “PTSD and…...

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  • ...Although other studies have found it to be one of the top central in smaller samples, it was never before found to be the most (Armour et al., 2017; Birkeland et al., 2020; Fried et al., 2018)....

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Journal ArticleDOI
TL;DR: The data suggest that a wide range of trauma-spectrum symptoms were reported by a large Italian sample during the COVID-19 pandemic and should be routinely assessed in clinical practice.
Abstract: Background: Recent evidence showed adverse mental health outcomes associated with the COVID-19 pandemic, including trauma-related symptoms. The Global Psychotrauma Screen (GPS) is a brief instrumen...

26 citations

References
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Journal ArticleDOI
TL;DR: Moher et al. as mentioned in this paper introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses, which is used in this paper.
Abstract: David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses

62,157 citations

Journal Article
TL;DR: The QUOROM Statement (QUality Of Reporting Of Meta-analyses) as mentioned in this paper was developed to address the suboptimal reporting of systematic reviews and meta-analysis of randomized controlled trials.
Abstract: Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field,1,2 and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research,3 and some health care journals are moving in this direction.4 As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers' ability to assess the strengths and weaknesses of those reviews. Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in 4 leading medical journals in 1985 and 1986 and found that none met all 8 explicit scientific criteria, such as a quality assessment of included studies.5 In 1987, Sacks and colleagues6 evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in 6 domains. Reporting was generally poor; between 1 and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement.7 In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials.8 In this article, we summarize a revision of these guidelines, renamed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), which have been updated to address several conceptual and practical advances in the science of systematic reviews (Box 1). Box 1 Conceptual issues in the evolution from QUOROM to PRISMA

46,935 citations

Journal ArticleDOI
TL;DR: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) is introduced, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses.
Abstract: Moher and colleagues introduce PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses. Us...

23,203 citations

Journal ArticleDOI
TL;DR: A cognitive model of persistence of PTSD is proposed that is consistent with the main clinical features of PTSD, helps explain several apparently puzzling phenomena and provides a framework for treatment by identifying three key targets for change.

5,002 citations


"The network approach to posttraumat..." refers background in this paper

  • ...…that psychological and physiological cue reactivity lay at the core of PTSD. Cognitive models of PTSD emphasize the role of memories or intrusions of trauma (Brewin, Gregory, Lipton, & Burgess, 2010; Rubin, Berntsen, & Bohni, 2008), and negative (threat-relevant) cognitions (Ehlers & Clark, 2000)....

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Journal ArticleDOI
TL;DR: This paper proposes generalizations that combine tie strength and node centrality, and illustrates the benefits of this approach by applying one of them to Freeman’s EIES dataset.

2,713 citations