Danielle C. Mathersul

Cognitive dysfunction is a hallmark of posttraumatic stress disorder (PTSD). Although treatments effectively reduce core PTSD symptoms, limited research has examined whether associated cognitive impairments improve following treatment. This study investigated cognitive changes in veterans receiving treatment for PTSD and explored the associations between cognitive improvement and PTSD symptom reduction. U.S. veterans (N = 85) with clinically significant PTSD symptoms were randomized to receive either cognitive processing therapy (CPT; n = 44) or Sudarshan Kriya yoga (SKY; n = 41) in a noninferiority trial. Cognitive function was assessed pre- and posttreatment using the Cambridge Neuropsychological Test Automated Battery. PTSD symptoms were assessed using the Clinician-Administered PTSD Scale (CAPS-5). Following treatment, participants showed significant improvements in episodic visual memory, d = 0.51, p < .001; motor learning, d = 0.57, p < .001; and visual sustained attention, d = 0.37, p = .005. There were no significant differences in cognitive improvement between the CPT and SKY groups. Changes in overall cognitive function were significantly correlated with PTSD symptom reductions across both treatment groups. Regardless of treatment, cognitive function improved alongside PTSD symptom reduction. These findings provide evidence that treating PTSD not only alleviates PTSD symptoms but may also improve associated cognitive function.Cognitive dysfunction is a hallmark of posttraumatic stress disorder (PTSD). Although treatments effectively reduce core PTSD symptoms, limited research has examined whether associated cognitive impairments improve following treatment. This study investigated cognitive changes in veterans receiving treatment for PTSD and explored the associations between cognitive improvement and PTSD symptom reduction. U.S. veterans (N = 85) with clinically significant PTSD symptoms were randomized to receive either cognitive processing therapy (CPT; n = 44) or Sudarshan Kriya yoga (SKY; n = 41) in a noninferiority trial. Cognitive function was assessed pre- and posttreatment using the Cambridge Neuropsychological Test Automated Battery. PTSD symptoms were assessed using the Clinician-Administered PTSD Scale (CAPS-5). Following treatment, participants showed significant improvements in episodic visual memory, d = 0.51, p < .001; motor learning, d = 0.57, p < .001; and visual sustained attention, d = 0.37, p = .005. There were no significant differences in cognitive improvement between the CPT and SKY groups. Changes in overall cognitive function were significantly correlated with PTSD symptom reductions across both treatment groups. Regardless of treatment, cognitive function improved alongside PTSD symptom reduction. These findings provide evidence that treating PTSD not only alleviates PTSD symptoms but may also improve associated cognitive function.

Posttraumatic stress disorder (PTSD) and chronic pain (CP) are highly co-occurring conditions, characterised by poor treatment outcomes and shared mechanisms that exacerbate symptom severity and functional impairment. This randomised, waitlist-controlled trial evaluated the efficacy of a six-week heart rate variability biofeedback (HRVBF) intervention in improving concurrent symptoms of PTSD and CP. Data of 73 Australian participants (mean age: 42.2; 14 male, 59 female), meeting clinical criteria for both conditions, were analysed following either six weeks of HRVBF or waitlist control. Symptom changes were assessed using validated psychometric measures. The HRVBF group demonstrated significant reductions in PTSD symptoms, with a 24.3 % decrease in PTSD Checklist total scores (d = −0.02) and improvement across all symptom clusters, compared to no significant change in the waitlist group. Similarly, trauma-related distress (Impact of Events Scale) decreased by 18.9 % (d = 0.03) post-intervention. Pain interference (Brief Pain Inventory – short form) improved significantly (24.9 % reduction; d = 0.19), whereas reductions in pain intensity and pain disability did not differ significantly between groups. These results highlight the potential of HRVBF as an effective intervention for co-occurring PTSD and CP.

Autistic children experience higher rates of anxiety compared to their nonautistic peers; however, psychotherapeutic treatments for anxiety such as cognitive behavioral therapy often have limited effectiveness in this population. This study protocol presents a novel, co-designed video-recorded yoga intervention for anxiety, tailored to the unique needs of autistic children. The proposed randomized controlled trial aims to evaluate the efficacy of this intervention compared to a treatment-as-usual waitlist control group. Primary outcomes include changes in anxiety severity, assessed using the Anxiety Disorders Interview Schedule or DSM-5 (ADIS-5) and the Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD). Secondary outcomes examine emotion regulation and intolerance of uncertainty using the Emotion Dysregulation Inventory (EDI) and the Intolerance of Uncertainty Scale Child version (IUSC), alongside physiological changes in heart rate variability. Data will be analyzed using repeated measures analysis to assess intervention effects, with mediation analysis exploring the roles of emotion regulation, intolerance of uncertainty, and autonomic function in anxiety reduction. Findings will contribute to the growing evidence base for complementary interventions in autistic populations. If effective, this co-designed yoga intervention could provide an accessible, adaptable, and scalable option for treating anxiety in autistic children, particularly those facing barriers to traditional therapies.

Background
Negative emotions and stress are theorised to play a role in the onset and maintenance of voice-hearing experiences. However, previous research has not explored these temporal relationships in daily life using differentiated psychological constructs.

Aim
Using ecological momentary assessment, this study examined the moment-to-moment relationships between negative and positive emotion valence and intensity, stressful and pleasurable events, and voice-hearing onset.

Materials & Methods
Forty voice-hearers completed seven days of smartphone-based surveys, rating their emotions and their intensity, perceived stress and pleasure of life events, and presence of voice-hearing.

Results
Multilevel modelling showed that stressful events, but not pleasurable events, were significantly predictive of voice-hearing, both concurrently and in the next time point. Neither negative nor positive emotion intensity predicted voice-hearing, nor did they moderate the relationship between voice-hearing onset and stressful or pleasurable events, respectively.

Discussion
These findings suggest that factors which differentiate perception of stressful events from self-reported negative emotions may be useful intervention targets, such as mitigating prolonged external stressors, reducing sensitivity to external stressors and targeting negative perceptions or resistance to these stressors.

Conclusion
Clinically, our findings underscore the relevance of stress and a negative perception of externally oriented events, with further research needed to explore useful interventions for targeting these mechanisms.

Cognitive behavioural therapy (CBT) is the first-line non-pharmacological intervention for the most prevalent and co-occurring mental health conditions (anxiety, major depressive, posttraumatic stress, and alcohol use disorders). However, CBT response rates are variable and access is limited by cost, availability, and up-take. Yoga demonstrates efficacy for these conditions and may be more accessible than CBT. However, to better refine personalised healthcare and ensure maximum generalisability to “real-world” presentations, we need methodologically robust randomised controlled trials (RCTs) that compare yoga to appropriate controls, monitor mental health co-occurrences, and examine biomarkers and mechanisms of action alongside outcomes. We present the study protocol for an ongoing, experimenter-masked, parallel-group, non-inferiority design RCT to evaluate the efficacy of 10-week yoga (novel intervention) versus 10-week transdiagnostic CBT (the Unified Protocol; evidence-based active control) for co-occurring anxiety, major depressive, posttraumatic stress, or alcohol use disorders among community-dwelling Australian adults (aged ≥18 years). The protocol is approved by Murdoch University Human Research Ethics Committee. The primary outcome measure is the Kessler Psychological Distress Scale (weeks 0, 11, 23, 35) and power analyses determined a minimum of 67 participants per group are required to assess non-inferiority. Secondary outcomes include a clinician-administered interview, self-reported symptoms, and functional outcomes. Sleep and emotion regulation self-report measures (including ecological momentary assessment) and physiological biomarkers (actigraphy, heart rate variability) will be tested as potential moderators and mediators of outcome. Experimenter-masked analyses will use both intent-to-treat and per-protocol approaches.

Findings will inform evidence-based formal recommendations and policy regarding the implementation of yoga into healthcare and may advance precision medicine.

Objective
Eating disorders (EDs) often co-occur with social anxiety disorder (SAD). However, little research has examined the influence of SAD symptoms on ED treatment outcomes in the context of individual outpatient cognitive-behavior therapy for eating disorders (CBT-ED). It is plausible that SAD symptom severity could improve as a result of ED treatment, given the high overlap between EDs and SAD. We sought to test whether baseline SAD symptoms moderate early response to CBT-ED or post-treatment outcomes in CBT-ED, and the degree to which SAD symptoms improve during therapy despite SAD not being an explicit treatment target.

Method
ED clients (N = 226) aged ≥16 years were treated with CBT-ED. Outcomes were ED symptoms, clinical impairment, and SAD symptoms measured at baseline, session 5 and post-treatment.

Results
Baseline SAD was a weak moderator of early and post-treatment ED symptoms and impairment. SAD symptoms improved moderately over treatment among clients who started with elevated levels of SAD symptomology.

Discussion
Clients with EDs can experience good therapeutic outcomes regardless of their social anxiety severity at pre-treatment. SAD symptoms reduced over CBT-ED, but protocol enhancements such as exposure-based strategies that directly target co-occurring social-evaluative concerns may help achieve larger reductions in SAD symptoms.

Public significance
Eating disorders often co-occur with anxiety disorders such as social anxiety. We found people who had both social anxiety and an eating disorder benefited as much from eating disorder treatment as people who did not have social anxiety. People who were socially anxious became less anxious as a by-product of receiving eating disorder treatment. It may be possible to reduce social anxiety further by enhancing eating disorder treatment protocols.

Background
Chronic pain (CP) and PTSD often co-occur, leading to increased symptom severity, anxiety, depression, disability, and opioid use. Reduced cardiac vagal activity (CVA) and emotion regulation (ER) are both observed within these patients, which is indicated to induce heightened anxiety when faced with pain or trauma reminders. Thus, we aim to specifically target CVA via heart rate variability biofeedback (HRVBF), which to our knowledge has yet to be evaluated in comorbid patients exhibiting CP and PTSD. Additionally, via high frequency data sampling, the trajectories of CVA and ER during HRVBF will be assessed, elucidating potential mechanisms driving clinical benefits.

Methods
This study utilises a six-week randomized waitlist control HRVBF intervention, with a three-month follow-up, in a target sample of N=80, diagnosed with CP and PTSD. Based on the role of CVA in pain, PTSD and ER, we hypothesize that HRVBF will improve symptom severity and enhance ER. Daily HRV and ER assessments, as well as laboratory testing of breathing patterns and HRV at multiple time points throughout the intervention allows for in-depth mediation analysis to infer potential causal relationships between CVA and ER during biofeedback.

Discussion
This study aids in developing new treatment protocols for comorbid CP and PTSD. Furthermore, whilst the association between CVA and ER is well documented, causal relationships during HRVBF have thus far not been delineated. The high data sampling approach provides the opportunity to clarify their interaction in the progression of CP and PTSD.

Objectives Disrupted emotion processes are commonly linked to the onset and maintenance of auditory verbal hallucinations. However, a comprehensive approach using an extended emotion model has not previously been applied to voice‐hearers to distinguish impairments in emotion processes from non‐clinical populations. The present study hypothesised voice‐hearers, as compared to controls, would have (1) higher reactivity to negative emotions and lower reactivity to positive emotions, (2) more difficulties regulating negative and positive emotions, (3) more maladaptive strategy use, and (4) higher alexithymia. Method T‐tests tested these hypotheses, comparing self‐report measures of emotional reactivity, emotion regulation and alexithymia in voice‐hearers ( n = 50) to controls ( n = 53). Results There were no group differences in emotional reactivity to positive or negative emotions. Compared to controls, voice‐hearers showed difficulties in both positive and negative emotion regulation, were more likely to use expressive suppression, and were more likely to be alexithymic. Conclusions These findings may help researchers and clinicians identify difficulties in voice‐hearers' emotion processing, providing better direction for case formulation and treatment.

Introduction: High variability in response and retention rates for posttraumatic stress disorder (PTSD) treatment highlights the need to identify "personalized" or "precision" medicine factors that can inform optimal intervention selection before an individual commences treatment. In secondary analyses from a non-inferiority randomized controlled trial, behavioral and physiological emotion regulation were examined as non-specific predictors (that identify which individuals are more likely to respond to treatment, regardless of treatment type) and treatment moderators (that identify which treatment works best for whom) of PTSD outcome.

Methods: There were 85 US Veterans with clinically significant PTSD symptoms randomized to 6 weeks of either cognitive processing therapy (CPT; n = 44) or a breathing-based yoga practice (Sudarshan kriya yoga; SKY; n = 41). Baseline self-reported emotion regulation (Difficulties in Emotion Regulation Scale) and heart rate variability (HRV) were assessed prior to treatment, and self-reported PTSD symptoms were assessed at baseline, end-of-treatment, 1-month follow-up, and 1-year follow-up.

Results: Greater baseline deficit in self-reported emotional awareness (similar to alexithymia) predicted better overall PTSD improvement in both the short- and long-term, following either CPT or SKY. High self-reported levels of emotional response non-acceptance were associated with better PTSD treatment response with CPT than with SKY. However, all significant HRV indices were stronger moderators than all self-reported emotion regulation scales, both in the short- and long-term. Veterans with lower baseline HRV had better PTSD treatment response with SKY, whereas Veterans with higher or average-to-high baseline HRV had better PTSD treatment response with CPT.

Conclusions: To our knowledge, this is the first study to examine both self-reported emotion regulation and HRV, within the same study, as both non-specific predictors and moderators of PTSD treatment outcome. Veterans with poorer autonomic regulation prior to treatment had better PTSD outcome with a yoga-based intervention, whereas those with better autonomic regulation did better with a trauma-focused psychological therapy. Findings show potential for the use of HRV in clinical practice to personalize PTSD treatment.

Clinical trial registration: ClinicalTrials.gov identifier, NCT02366403