Open research questions in Posttraumatic Stress Disorder Research

What the literature leaves open

• CONCLUSIONS STS may be a significant issue for a proportion of neurosurgeons, although the generalizability of the study findings is limited considering the low response rate.

  The physical and emotional impact of serious adverse patient events on neurosurgeons · 2026 · DOI

• Discussion: While many MHPSS interventions for people who had experienced GBV led to meaningful improvements in mental health, GBV reduction, and economic empowerment, variability in effectiveness highlights the need for culturally adapted, context-specific approaches and further research on long-term effects in fragile settings.

  Mental Health and Psychosocial Support Interventions for Individuals Affected by Gender-Based Violence in Fragile Contexts: A Systematic Review · 2026 · DOI

• Future work should examine whether more fine-grained, locally focused narrative coding (e.g., focusing on the most emotionally intense or distressing moments within the trauma narrative), as recommended in adult work (Brewin, 1 3Research on Child and Adolescent Psychopathology (2026) 54:75 2014), yields stronger links with PTSD than the global indi- ces examined here. Second, research should prioritise the development and validation of developmentally appropriate, culturally grounded measures of trauma memory qualities for younger children in LMICs. This might include picto- rial response formats, interactive digital tools, and play- based paradigms that reduce literacy demands and reliance on sophisticated metacognitive language, alongside formal tests of measurement invariance and qualitative work to ensure conceptual equivalence. This should also consider potential confounds which may be introduced through translation processes. This would determine whether the lack of validity and predictive utility of narrative-based methodologies can be attributed to population-specific fac- tors or to translated isiXhosa. Finally, intervention studies, particularly those evaluating trauma-focused cognitive ther- apies in children exposed to multiple and chronic trauma, should routinely assess trauma memory qualities over time to clarify whether perceived changes in memory character- istics mediate symptom improvement, and whether such mediation differs across cultural contexts.

  Cross-Cultural Validation of Manual and Automated Methods for Extracting Trauma Memory Features and Predicting PTSD in Young Populations · 2026 · DOI

• Future factor analytic studies should recruit large samples of trauma-exposed preschool-aged children and parents and measure posttraumatic stress and related psychopathology with ample item coverage for each hypothesized dimension to ensure the minimum of three items per factor is met after weak items are dropped. Semi-structured interviews and symptom inventories based on the DSM-5 often use symptom criteria as if they were singular behaviors that can be validly assessed with single items. But the symptom criteria are better understood as complex patterns of behavior constituted by a set of related simple behaviors. For example, “hypervigilance” and “socially withdrawn behavior” could each be assessed by the presence of multiple concrete behaviors occurring at different frequencies, times, and contexts. The two PTSD-6Y avoidance criteria are each composed of three abstract categories of things that are avoided (e.g., “people, conversations, or interpersonal situations”), each of which is constituted by a broad set of concrete particulars. Assessing each individually would not only improve the reliability and validity of each symptom measure but also enhance the power of factor analyses to identify the latent structure of PTSS. To fully explore the content domain of early childhood posttraumatic stress, more in-depth, qualitative, observational research may first be needed to generate expansive, developmentally tailored, quantitative symptom inventories that can subsequently be trimmed down via factor analysis.

  Exploring Dimensions of Posttraumatic Stress in Young Children · 2026 · DOI

• Future research using multicenter, and mixed-methods designs is warranted to further investigate the potential effects of PICU diaries on parental psychological outcomes.

  PICU diaries and parental PTSD symptoms—a pilot randomized controlled trial assessing feasibility and psychological outcomes · 2026 · DOI

• Background Public safety communicators (PSCs, 911 call-takers, dispatchers, and others) play a critical role in Canada's emergency response system, yet they remain largely understudied compared with other public safety professionals (PSP).

  Prevalence of Post-Traumatic Stress Injuries Among Canadian Public Safety Communicators: A Nationwide Comparative Study: Prévalence des blessures de stress post-traumatique chez les communicateurs en sécurité publique canadiens : étude comparative nationale · 2026 · DOI

• Indeed, the findings of the present study demonstrate the impact that working in the role of an FLO can have in regard to STS and future research is needed to explore what additional guid- ance and training might be provided to help increase and protect FLO wellbeing against the adverse impact of work- ing with families who have lost loved ones (e.

  The Role of Resilience and Internal Locus of Control as Protective Factors Against Secondary Trauma and Poor Wellbeing in UK Police Family Liaison Officers · 2026 · DOI

• This is an important limitation to consider as a significant body of research has demonstrated the significance of opera- tional stressors and organisational stressors in predicting wellbeing (Drew & Williamson, 2024). As with any cross-sectional study, our findings are limited to the time in which the study was conducted and the sample of participants.

  The Role of Resilience and Internal Locus of Control as Protective Factors Against Secondary Trauma and Poor Wellbeing in UK Police Family Liaison Officers · 2026 · DOI

• Future research should investigate the TICSES’ predictive validity by correlating scores with observed trauma-informed behaviors and classroom outcomes.

  The Trauma-Informed Care Self-Efficacy Scale (TICSES): Development and Validation for Turkish Pre-service Teachers · 2026 · DOI

• PTSD Coach, a mobile app originally developed for trauma-exposed veterans, has shown promise but has not been evaluated with WTC GRs or adapted for Spanish-speaking responders.

  A Clinician-Supported Mobile App to Reduce Mental Health Symptoms Among World Trade Center Responders in Florida: Protocol for a Randomized Controlled Trial · 2026 · DOI

• This review provides the first synthesis of modifications to TF-CBT for lay counselor delivery. We note several limita- tions of this work. First, only studies published in English were included in this review due to resource constraints and language proficiency of the research team, which may introduce biases in the representation of evidence included. Second, because we aimed to synthesize modifications, we are unable to draw conclusions about the efficacy of spe- cific strategies. Future research should examine the relative importance of modifications and implementation strategies to better understand which are essential for lay counselor- delivery. The lack of available demographic informa- tion (e.g., race/ethnicity) of clients and lay counselors is a notable limitation with implications for the generalizabil- ity of findings. Enhanced reporting of demographic char- acteristics is important to better tailor treatment delivery and implementation strategies to fit the local context and unique community needs. Although we sought to differ- entiate the process, treatment modifications, and imple- mentation strategies, these categories may not reflect fully disparate constructs (e.g., the Apprenticeship Model is both an aspect of the modification process and implementation strategies), and there may be overlap in findings reported across sections. The details of modifications varied widely across studies and were not systematically reported, which further limited this review. In particular, modification pro- cesses and implementation strategies were often not clearly described, which aligns with findings from prior reviews that these activities are not consistently reported (Barnett et al. 2018a, b), posing challenges for comprehensively syn- thesizing these in-text. It is possible that some modification activities were omitted from papers due to various reasons (e.g., were not the main aim of the paper, due to page limits of journals), and as a result, would be missing from the pres- ent review. Additionally, this review was focused on char- acterizing adaptations that were relevant to task-shifting models and did not include cultural adaptations. All studies included in the review implemented culturally modified ver- sions of TF-CBT and in some cases, it was difficult to dis- cern whether the process and modifications reported were aimed at enhancing cultural relevance of the intervention or fit with the lay counselor treatment model. We attempted to resolve this through double-coding and consensus meet- ings during data extraction, but it is possible that relevant modifications were not included in this review if they were described by authors as cultural adaptations. These limita- tions underscore the importance of systematic reporting of key details of modifications (e.g., the purpose of each modi- fication). Consistent with calls in the field, we recommend that researchers anchor reporting of modifications in estab- lished frameworks that have been developed to enhance consistency, such as FRAME (Wiltsey Stirman et al., 2019).

  Lay Counselor Delivery of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): A Systematic Review · 2026 · DOI

• This manuscript presents a clinical case study rather than a single-case experimental design. Case studies are well- suited for illustrating the application of TF-CBT with ado- lescents and for highlighting clinical decision-making in Journal of Child & Adolescent Trauma (2026) 19:897–9151 3 context. Unlike single-case experimental designs, which require repeated, systematic measurement to evaluate causal effects, the aim here is descriptive: to provide a detailed, practice-oriented illustration of how TF-CBT components were implemented with an adolescent with cumulative trauma. This clarification is important for interpreting the scope and generalizability of the findings. This case study describes the TF-CBT process and out- comes for one adolescent–caregiver dyad and therefore does not allow for broad generalization. Standardized measures were administered at intake and discharge, but the interpreta- tion of change relies partly on qualitative clinical observations, which may reflect therapist perspective. Additionally, although the case highlights culturally responsive and developmentally informed adaptations, these strategies may not fully reflect the experiences or needs of all adolescents with cumulative trauma. As with all clinical case studies, the improvements observed cannot be attributed solely to TF-CBT, as develop- mental changes, contextual shifts, or non-specific therapeu- tic factors may have contributed. Nonetheless, the detailed description of treatment decision-making, caregiver engage- ment, and trauma-specific clinical work provides a useful illustration of how TF-CBT can be thoughtfully implemented with adolescents navigating multiple traumas. 913 cultural pride, belonging, connectedness, and positive rela- tional experiences. This intentional integration aligns with emerging research demonstrating that culturally grounded and identity-affirming interventions enhance both engage- ment and outcomes in trauma-focused treatment. Maribel’s case illustrates how TF-CBT can be deliv- ered with fidelity while remaining responsive to the devel- opmental, cultural, and contextual realities of a teen with cumulative trauma. Her progress demonstrates that when clinicians implement the core components of TF-CBT with individualized, culturally attuned strategies and strong care- giver involvement, adolescents can achieve meaningful reductions in trauma-related symptoms and build competen- cies that support resilience far beyond the therapy setting. Through a developmentally informed, culturally responsive, and relationally focused approach, TF-CBT becomes not only a model for treating trauma, but a pathway for healing negative impacts of trauma on development and strengthen- ing identity, agency, and long-term well-being. Acknowledgements We want to express our deep gratitude for the adolescents we have worked with who have helped us grow as clini- cians and humans. Authors’ Contributions The authors' names are listed in order of con- tributed effort.

  Clinical and Developmental Considerations for Implementing Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) With Adolescents Who Have Experienced Multiple Traumas: a Case Study · 2026 · DOI

• As reviewed, the results provided support for the intervention’s effectiveness; however, limitations of the methodology and sample size impact our ability to generalize our findings beyond our sample. First, postmeeting data collection was carried out only once, which provided us only one opportunity to collect feedback about the longer term impact of the intervention. Considering the novelty of the intervention and dependent variables, an additional posttest measurement (a week or more) after the intervention may have provided more informative results regarding changes in outcome scores. In addition, another potential limitation was the use of purposive sampling. Survivor participants were all recruited by one of the authors through an established network of psychotherapists in the community. Had we sought out other practitioners through hospitals or outside of the local community, the observations within the current study may have resulted in different outcomes. The use of purposive sampling as well as time and resource limitations resulted in the authors not utilizing a control group or seeking a comparison group for the study, which is an added limitation from generalizability. Another limitation due to sampling bias is that both groups of participants were previously involved in self-development: the survivors in a minimum of six months of individual psychotherapy and the allies as members of MKP. Ally participants were recruited through MKP, which means each ally had engaged in previous relationship work through MKP men’s circles. Therefore, it’s unclear whether male participants in an expression circle who are not members of MKP would have a different influence on the outcomes observed among survivors in the current study. A different recruitment and sampling process, seeking participants who had not committed to some ongoing self-reflective or healing process prior to the intervention, may have resulted in different outcomes. There were limitations with the use of Likert-scaled tools to quantify an RJ-based intervention that is challenging to quantify. Interventions, conferences, and RJ methods, such as the expression circle, are rooted in storytelling and expression that were not formally captured as a part of the study. Therefore, qualitative data collection or a mixed methods design may have been better suited for understanding the observed outcomes from the expression circle. Regarding instrumentation, the authors opted to use the PC-PTSD-5 due to the brevity of the measure, which, although it is a psychometrically tested instrument, provides dichotomous responses. Because the PC-PTSD-5 was given immediately after the intervention, the authors note the limited ability of the data analysis and level of PTSD severity. Because PTSD is a chronic mental health issue, measuring traumatic stress immediately after the intervention also does not accurately capture any changes regarding PTSD symptoms. The PC- PTSD-5 instrument, although it provided some validity in the research, provided limited feedback on changes in PTSD symptoms due to its limitation of five ‘‘yes’’ or ‘‘no’’ questions. For subsequent studies, a more viable PTSD measure, such as the PTSD Clinical List-5 (Weathers et al., 2013) is recommended as it would capture more fully a subject’s PTSD symptoms as well as their severity. Using a more comprehensive measure assessing PTSD l D o w n o a d e d f r o m h t t p: / / m e r i d a n a. i l l e n p r e s s. c o m / j / p s g p a r t i c e - p d l f / / / / 6 9 1 2 1 3 2 9 3 7 8 0 / i 0 7 3 1 - 1 2 7 3 - 6 9 - 1 - 2 1 p d.

  Expression Circle Group: Incorporating Psychodrama Toward Empowering Sexual Assault Survivors · 2026 · DOI

• 7 0 7 3 9 Rother H-A, Hayward RA, Paulson JA, Etzel RA, Shelton M, Theron LC (2022) Impact of extreme weather events on Sub-Saharan African child and adolescent mental health: the implications of a systematic review of sparse research findings.

  How Much Do We Know About the Mental Health Economic Costs of Disasters? · 2026 · DOI

• While such experiences are known to increase the risk of PTSD in the general population, it remains unclear whether sexual abuse, gender, or age at first trauma are similarly predictive of PTSD symptom severity in individuals with MID-BIF.

  Sexual and Non-Sexual Trauma in Relation to PTSD in People with Mild Intellectual Disabilities or Borderline Intellectual Functioning · 2026 · DOI

• Although research on military sexual trauma (MST) increasingly examines its effects on women’s occupations, its broader impact, particularly beyond gendered roles, remains underexplored.

  Exploring the Impact of Military Sexual Trauma on Occupational Participation in Canadian Women and Gender-Diverse Veterans Through Qualitative Interviews · 2026 · DOI

• Conclusions The use of mental health services is insufficient for the care of probable PTSD, which is associated with increased tobacco or alcohol use, encouraging further research to improve the use of mental health services among police staff.

  Help‐Seeking and Substance Use Among Police Staff After the 2018 Strasbourg Christmas Market Attack · 2026 · DOI

• Abstract Objectives Nonattachment, defined as the capacity to relate to internal experiences, identities, and external circumstances without clinging, avoidance, or over-identification, has been associated with reduced psychological distress and enhanced well-being, yet its deliberate cultivation within trauma-focused interventions remains underexplored.

  Efficacy of a Digital Nonattachment-Based Intervention for Post-traumatic Stress Symptoms: A Randomised Controlled Trial · 2026 · DOI

• ObjectiveBiopsychosocial models recognize multiple determinants of post-trauma mental disorders, but their relative and interactive effects remain unclear.

  Refining the biopsychosocial model of trauma: vulnerability and social support as primary predictors of mental disorders in a clinical sample · 2026 · DOI

• Given the high prevalence of PTSD among emergency department nurses and its strong associations with occupational burnout, maladaptive coping styles, low resilience, and reduced social support, the study underscores the urgent need for targeted, institution-level interventions. Hospital administrations and nursing managers should prioritize the implementation of structured support systems. These may include the creation of peer-led or professionally facilitated support groups, where nurses can process stress in a safe, nonjudgmental setting. Additionally, training programs in evidence-based coping strategies, such as cognitive- behavioral techniques or mindfulness-based stress reduction, could enhance positive coping and reduce emotional exhaustion. Initiatives to boost psychological resilience—such as resilience workshops, mentorship programs, or resilience coaching—can help staff adapt more effectively to acute stressors. Furthermore, efforts to increase access to and utilization of social support, both within and beyond the workplace (e.g., employee assistance programs, supervisor check-ins, team-based bonding activities), are essential in mitigating the impact of occupational trauma. These interventions should be tailored to the high-intensity, fast-paced nature of emergency departments and ideally be evaluated through future longitudinal studies to assess their long-term impact on mental health outcomes. Implementing stress management programs, reducing excessive workloads, and promoting a healthy work-life balance can lower burnout, which is a key risk factor for PTSD. Encouraging practices like yoga, meditation, and deep breathing exercises can help manage stress before it escalates into PTSD. Programs focused on reframing negative experiences and developing emotional regulation skills can enhance resilience, while Cognitive Behavioral Therapy can assist individuals in restructuring negative thoughts and building coping mechanisms to deal with traumatic memories.

  Post-traumatic stress status among emergency department nurses during the winter H1N1 influenza season and correlations with burnout, coping, resilience, and support · 2026 · DOI

• One important limitation of this study is the absence of follow-up assessments. Given that PTSD symptoms can develop weeks or even months after exposure to traumatic events, the short data collection window may not fully capture the true incidence of PTSD among participants. As a result, cases of delayed-onset PTSD may have been missed. To address this limitation, future research should consider adopting a longitudinal study design, incorporating follow-up assessments at multiple time points (e.g., 3 months, 6 months postexposure). This would allow for a more comprehensive understanding of the onset, progression, and persistence of PTSD symptoms over time, and would enhance the accuracy and clinical relevance of findings related to mental health outcomes among healthcare workers during epidemic or pandemic events. 4.2 Recommendation Self-report measurement: The scales used in this study were based on self-reporting by the participants, which introduces subjectivity and individual differences. Respondents may be influenced by social expectations or self-perception, challenging the reliability and accuracy of the results.

  Post-traumatic stress status among emergency department nurses during the winter H1N1 influenza season and correlations with burnout, coping, resilience, and support · 2026 · DOI

• Despite the robust findings, several limitations should be noted. One concern is the reliance on self-report measures, which introduces the potential for response bias, as participants may have under- or over-reported their symptoms. The self-selected nature of the sample also raises the possibility that individuals experiencing mental health challenges may have been more likely to participate, which could have inflated the prevalence estimates. Alternatively, those with the most severe symptoms may have been unable or unwilling to participate, therefore resulting in underestimation. It is centre communication also possible that individuals most severely impacted by PPTEs and/or organisational stressors may have left the organisation, either voluntarily or due to medical leave. Furthermore, due to the high frequency of PPTE exposure employees, most among participants fell into the highest bracket of exposure. This lack of variability in exposure levels and the small sample size prevented us from examining the dose-response relationships between PPTE exposure and mental health outcomes using methods such as logistic regression. The bespoke measure of PPTE exposure used in this study highlights the need for a validated measure that is specifically designed for occupations with repeated direct and indirect exposure to a range of events. Finally, the survey used in this study was originally designed with operational firefighters in mind, which may have resulted in the communication centre employees' unique stressors being underrepresented in the quantitative measures. Future studies should aim to develop more targeted instruments the mental health and occupational stressors of this group.

  Beyond the Frontline: Exploring Indirect Trauma and Organisational Stress in Emergency Communication Centre Employees · 2026 · DOI

• Future work should examine the systematic implementation of proactive SIX Cs protocols in first-responder training curricula, military operational contexts, and mass-casualty preparedness programs, with attention to both performance outcomes and long- term psychological resilience.

  Proactive psychological first aid in mass-casualty recovery: a theory-driven case analysis of the SIX Cs model · 2026 · DOI

• Several limitations should be acknowledged. This is a single theory-driven case analysis authored by the team commander, who designed and implemented the intervention, and as such it is subject to observer bias, role-based interpretation, and the welldocumented tendency toward positive retrospective reconstruction of consequential events. The authors are aware that this dual role, as both intervening agent and primary analyst, constitutes a significant methodological limitation that independent replication would be required to address. Critically, no systematic quantitative or qualitative outcome data were collected. No psychometric instruments assessing acute stress, peritraumatic dissociation, PTSD symptoms, heart rate variability, or cognitive performance were administered before, during, or after the intervention. The absence of such data means that the functional outcomes attributed to the protocol, including reduced helplessness, sustained cognitive engagement, and adaptive memory encoding, remain entirely inferential. The post-event observations reported are drawn from informal, unstructured conversations, lack any comparison condition, and are vulnerable to social desirability effects in a military context where acknowledgment of distress carries professional cost. The authors do not claim that the SIX Cs protocol caused the observed outcomes; the case demonstrates feasibility and theoretical coherence, not efficacy. Future work must move beyond the case report format toward prospective, controlled designs with standardized outcome measurement if the effectiveness of proactive SIX Cs implementation is to be established rather than inferred. At the same time, it is worth acknowledging explicitly that what constitutes a methodological limitation in conventional research contexts may, in the setting of large-scale and unprecedented mass-casualty events, also reflect an unavoidable structural reality. Prospective data collection, whether quantitative or qualitative, is frequently not feasible during acute operational response to events of the scale and nature of the October 7 attack. In such contexts, retrospective, experience-based analyses conducted by those present during the event may represent among the only viable forms of scholarly contribution available. The present case report should therefore be understood not merely as a study constrained by the absence of systematic measurement, but as an illustration of the kind of theoretically grounded, that may be uniquely captures what controlled research designs cannot access: real-time, field-level implementation of a structured psychological intervention under valuable precisely because practitioner-authored documentation it stress. Acknowledging conditions of maximum operational future prospective this does not diminish the need for research; the present contribution within the broader landscape of knowledge generation in disaster mental health.

  Proactive psychological first aid in mass-casualty recovery: a theory-driven case analysis of the SIX Cs model · 2026 · DOI

• Additionally, defining ET expo- sure based on endorsement of a single item represents a rela- tively inclusive threshold and does not account for differences in trauma type or severity.

  Interaction Effect of Panic Disorder Diagnosis and Early Trauma History on Cortical Gyrification Patterns · 2026 · DOI

Most-cited papers in Posttraumatic Stress Disorder Research

• Posttraumatic stress disorder in the World Mental Health Surveys · Psychological Medicine · 2017 · 1,203 citations
• Traumatic Events and Posttraumatic Stress in Childhood · Archives of General Psychiatry · 2007 · 1,135 citations
• Post-traumatic stress disorder following disasters: a systematic review · Psychological Medicine · 2007 · 1,090 citations
• Gender differences in posttraumatic stress disorder. · Psychological Bulletin · 2007 · 782 citations
• Childhood adversity, adult stressful life events, and risk of past-year psychiatric disorder: a test of the stress sensitization hypothesis in a population-based sample of adults · Psychological Medicine · 2009 · 719 citations
• Full and partial posttraumatic stress disorder: findings from a community survey · American Journal of Psychiatry · 1997 · 686 citations
• Bringing the War Back Home · Archives of Internal Medicine · 2007 · 672 citations
• Previous Exposure to Trauma and PTSD Effects of Subsequent Trauma: Results From the Detroit Area Survey of Trauma · American Journal of Psychiatry · 1999 · 665 citations
• Psychological treatments for chronic post-traumatic stress disorder · The British Journal of Psychiatry · 2007 · 663 citations
• Regional Cerebral Blood Flow in the Amygdala and Medial PrefrontalCortex During Traumatic Imagery in Male and Female Vietnam Veterans With PTSD · Archives of General Psychiatry · 2004 · 651 citations

Most recent work

• Moral injury among humanitarian aid personnel: a preliminary examination of associations with rumination and mental health · Journal of International Humanitarian Action · 2026
• Brain Imaging Research on Posttraumatic Stress Disorder: Using Big Data to Guide Clinical Applications · American Journal of Psychiatry · 2026
• Circuit-Targeted TMS for PTSD: Where, When, How, and for Whom? · American Journal of Psychiatry · 2026
• Social Correlates of Trauma and Posttraumatic Stress Disorder: The Importance of Context · Harvard Review of Psychiatry · 2026
• Anxiety-buffer disruption in combat soldiers: the contributions of exposure to combat-related threats, attachment anxiety, and ideological threat to mental health and addiction · Anxiety Stress & Coping · 2026
• Exploring the Cultivation of Nonattachment for Symptoms of Post-Traumatic Stress: A Reflexive Thematic Analysis · Journal of Humanistic Psychology · 2026
• Beyond the Frontline: Exploring Indirect Trauma and Organisational Stress in Emergency Communication Centre Employees · New Zealand journal of psychology · 2026
• Contextual Factors Associated with Posttraumatic Stress Among Campus Sexual Assault Survivors · Journal of Trauma & Dissociation · 2026
• Handling the worst: A review of approaches to handling trauma materials for the minimization of worker distress · Journal of Workplace Behavioral Health · 2026
• Trauma-focused therapy integrated with cognitive behavioural therapy for psychosis for people with post-traumatic stress disorder and psychosis (the STAR trial): a multicentre, pragmatic, randomised trial in the UK · The Lancet Psychiatry · 2026

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