Impact and cultural acceptance of the Narrative Exposure Therapy in the aftermath of a natural disaster in Burundi

Background: In the aftermath of natural disasters, affected populations are at risk of suffering from trauma-related mental health disorders such as posttraumatic stress disorder (PTSD) or depression. Particularly in poor post-conflict regions, these mental disorders have the potential to impair the ability of individuals to move on with their lives. We aimed to evaluate the feasibility, cultural acceptance, and effect of a trauma-focused psychotherapy, Narrative Exposure Therapy (NET), in the aftermath of a flood disaster in Burundi. Methods: Fifty-one individuals who were living in emergency camps overseen by the Burundian Red Cross in the aftermath of a flood disaster, and who had lost homes and close relatives, were invited to participate in semi-structured diagnostic interviews. Trained Burundian psychology students conducted these interviews, and six sessions of NET were offered to the 15 individuals most affected by trauma-related symptoms. An additional group of psychology students, blind to the treatment conditions, conducted three and 9 months follow-ups with them including also 25 participants who had reported significant but less severe trauma-related symptoms, assessing mental health symptoms, acceptance of NET, stigmatization due to trauma symptoms, and participants’ economic well-being. Results: Between baseline and 9-months post-intervention assessment, symptoms of PTSD (Hedges’ g = 3.44) and depression (Hedges’ g = 1.88) improved significantly within participants who received NET and within those who received no treatment (Hedges’ gPTSD = 2.55; Hedges’ gdepression = 0.72). Furthermore, those who received NET felt less stigmatized by their participation in the intervention than by the trauma-related mental health symptoms they experienced. Overall, participants reported that they would be willing to forego as much as 1 month’s worth of income in exchange for receiving trauma-focused interventions in the months following the disaster. Conclusions: Individuals severely affected by trauma-related mental health symptoms might benefit significantly from NET in the aftermath of natural disasters, while less affected individuals seem to recover spontaneously. Despite significant challenges conducting NET in emergency camps in the aftermath of natural disaster in a post-conflict country, such interventions are feasible, appreciated and might have long-lasting impacts on the lives of survivors if conducted with due respect to participants’ privacy. Trial registration: UKCR2014 , the 19.06.2014, retrospectively registered

Structural and functional neuroplasticity in posttraumatic stress disorder: fear learning and context processing

In this thesis, structural and functional brain differences are investigated in three studies between patients with posttraumatic stress disorder (PTSD) and healthy trauma (TC) or non-trauma exposed (HC) control subjects and results are discussed within a common psychobiological model of PTSD. In this work, we provide a meta-analysis including 30 studies with 1,700 participants on structural white matter differences, investigate white and gray matter alterations in PTSD (154 subjects) and examine behavioral and psychophysiological alterations during contextual fear processing using virtual reality in a functional magnetic resonance imaging study (63 subjects). In summary, this work suggests that patients with PTSD show alterations in structural and functional brain activity that can both be associated to fear learning and context processing. Our work proposes above all that lower volume and activity within the prefrontal cortex in combination with functional alterations in the hippocampi can be associated with deficient contextual fear processing

Commentary on Raghuraman et al. (2021). On the Long-Term Efficacy and Effectiveness of Narrative Exposure Therapy

In the past years, several systematic reviews and meta-analyses have been published assessing the effectiveness of narrative exposure therapy [NET; (Lely et al., 2019; Raghuraman et al., 2021; Siehl et al., 2021; Wei and Chen, 2021)]. The meta-analyses had different aims and came to different conclusions about the effectiveness of NET. Lely et al. (2019) and Wei and Chen (2021) focused on between-treatment effects, post intervention, comparing NET with active and non-active control- treatment-conditions. In addition to comparing between-treatment effects Raghuraman et al. (2021) and Siehl et al. (2021) assessed also the temporal stability of the effects. The latter two studies investigated the reduction of symptom severity of posttraumatic stress disorder (PTSD) and the percentage of PTSD diagnoses over several follow-up periods. Raghuraman et al. (2021) indicated a medium standardized mean difference (SMD) in favor of NET in comparison to active and inactive control groups in the long-term and no benefit regarding PTSD diagnoses. The authors cautioned against using the existing evidence to inform policies and guidelines. In contrast, Siehl et al. (2021) found a large SMD in favor of NET compared to active or inactive control groups in the long-term. They reported an improvement of effectiveness over time when analyzing active control groups and concluded that NET is an effective treatment approach in post-conflict settings and refugee populations, highlighting the high external validity of the trials. Acknowledging the significant efforts of both author groups to select, code, and analyze the existing evidence, we aim to clarify potential underlying reasons for the differences between the two meta-analyses. The purpose of this commentary is two-fold: (a) discuss more generally ways to assess the quality of a treatment, such as NET, that is used in a broad range of contexts and (b) more specific differences between the two meta-analyses in (1) selecting and analyzing strategies, and (2) potential coding errors

To trust or not to trust? Face and voice modulation of virtual avatars

Introduction: This study explores the graduated perception of apparent social traits in virtual characters by experimental manipulation of perceived affiliation with the aim to validate an existing predictive model in animated whole-body avatars.Methods: We created a set of 210 animated virtual characters, for which facial features were generated according to a predictive statistical model originally developed for 2D faces. In a first online study, participants (N = 34) rated mute video clips of the characters on the dimensions of trustworthiness, valence, and arousal. In a second study (N = 49), vocal expressions were added to the avatars, with voice recordings manipulated on the dimension of trustworthiness by their speakers.Results: In study one, as predicted, we found a significant positive linear (p < 0.001) as well as quadratic (p < 0.001) trend in trustworthiness ratings. We found a significant negative correlation between mean trustworthiness and arousal (τ = −.37, p < 0.001), and a positive correlation with valence (τ = 0.88, p < 0.001). In study two, wefound a significant linear (p < 0.001), quadratic (p < 0.001), cubic (p < 0.001), quartic (p < 0.001) and quintic (p = 0.001) trend in trustworthiness ratings. Similarly, to study one, we found a significant negative correlation between mean trustworthiness and arousal (τ = −0.42, p < 0.001) and a positive correlation with valence (τ = 0.76, p < 0.001).Discussion: We successfully showed that a multisensory graduation of apparent social traits, originally developed for 2D stimuli, can be applied to virtually animated characters, to create a battery of animated virtual humanoid male characters. These virtual avatars have a higher ecological validity in comparison to their 2D counterparts and allow for a targeted experimental manipulation of perceived trustworthiness. The stimuli could be used for social cognition research in neurotypical and psychiatric populations

Structural white and gray matter differences in a large sample of patientswith Posttraumatic Stress Disorder and a healthy and trauma-exposedcontrol group: Diffusion tensor imaging and region-based morphometry

Differences in structural white and gray matter in survivors of traumatic experiences have been related to the development and maintenance of Posttraumatic Stress Disorder (PTSD). However, there are very few studies on diffusion tensor imaging and region based morphometry comparing patients with PTSD to two control groups, namely healthy individuals with or without trauma experience. It is also unknown if differences in white and gray matter are associated. In this cross-sectional study, we examined white- and gray matter differences between 44 patients with PTSD, 49 trauma control and 61 healthy control subjects. We compared the groups applying Tract-Based Spatial Statistics (TBSS) for a whole brain white matter analysis as well as region of interest analyses for white and gray matter. First, trauma control subjects in comparison to patients with PTSD and healthy control subjects showed significantly a) higher fractional anisotropy (FA) in the left corticospinal tract and inferior fronto-occipital fasciculus than patients with PTSD, b) higher FA in the left inferior fronto-occipital-, right inferior– and right superior longitudinal fasciculi, c) higher FA in the forceps minor and d) higher volume of the left and right anterior insulae. Second, we show significant correlations between the FA in the forceps minor and the gray matter volume in the left and right anterior insulae. Third, the mean FA value in the forceps minor correlated negatively with symptom severity of PTSD and depression as well as trait anxiety, whereas the gray matter volume in the left anterior insula correlated negatively with symptom severity in PTSD. Our findings underline the importance of brain structures critically involved in emotion regulation and salience mapping. While previous studies associated these processes primarily to functional and task-based differences in brain activity, we argue that morphometrical white and gray matter differences could serve as targets in neuroscientifically-informed prevention and treatment interventions for PTSD

Mutation or loss of Wilms' tumor gene 1 (WT1) are not major reasons for immune escape in patients with AML receiving WT1 peptide vaccination

<p>Abstract</p> <p>Background</p> <p>Efficacy of cancer vaccines may be limited due to immune escape mechanisms like loss or mutation of target antigens. Here, we analyzed 10 HLA-A2 positive patients with acute myeloid leukemia (AML) for loss or mutations of the WT1 epitope or epitope flanking sequences that may abolish proper T cell recognition or epitope presentation.</p> <p>Methods</p> <p>All patients had been enrolled in a WT1 peptide phase II vaccination trial (NCT00153582) and ultimately progressed despite induction of a WT1 specific T cell response. Blood and bone marrow samples prior to vaccination and during progression were analyzed for mRNA expression level of WT1. Base exchanges within the epitope sequence or flanking regions (10 amino acids N- and C-terminal of the epitope) were assessed with melting point analysis and sequencing. HLA class I expression and WT1 protein expression was analyzed by flow cytometry.</p> <p>Results</p> <p>Only in one patient, downregulation of WT1 mRNA by 1 log and loss of WT1 detection on protein level at time of disease progression was observed. No mutation leading to a base exchange within the epitope sequence or epitope flanking sequences could be detected in any patient. Further, no loss of HLA class I expression on leukemic blasts was observed.</p> <p>Conclusion</p> <p>Defects in antigen presentation caused by loss or mutation of WT1 or downregulation of HLA molecules are not the major basis for escape from the immune response induced by WT1 peptide vaccination.</p

A stable and replicable neural signature of lifespan adversity in the adult brain

Environmental adversities constitute potent risk factors for psychiatric disorders. Evidence suggests the brain adapts to adversity, possibly in an adversity-type and region-specific manner. However, the long-term effects of adversity on brain structure and the association of individual neurobiological heterogeneity with behavior have yet to be elucidated. Here we estimated normative models of structural brain development based on a lifespan adversity profile in a longitudinal at-risk cohort aged 25 years (n = 169). This revealed widespread morphometric changes in the brain, with partially adversity-specific features. This pattern was replicated at the age of 33 years (n = 114) and in an independent sample at 22 years (n = 115). At the individual level, greater volume contractions relative to the model were predictive of future anxiety. We show a stable neurobiological signature of adversity that persists into adulthood and emphasize the importance of considering individual-level rather than group-level predictions to explain emerging psychopathology

A stable and replicable neural signature of lifespan adversity in the adult brain

Environmental adversities constitute potent risk factors for psychiatric disorders. Evidence suggests the brain adapts to adversity, possibly in an adversity-type and region-specific manner. However, the long-term effects of adversity on brain structure and the association of individual neurobiological heterogeneity with behavior have yet to be elucidated. Here we estimated normative models of structural brain development based on a lifespan adversity profile in a longitudinal at-risk cohort aged 25 years (n = 169). This revealed widespread morphometric changes in the brain, with partially adversity-specific features. This pattern was replicated at the age of 33 years (n = 114) and in an independent sample at 22 years (n = 115). At the individual level, greater volume contractions relative to the model were predictive of future anxiety. We show a stable neurobiological signature of adversity that persists into adulthood and emphasize the importance of considering individual-level rather than group-level predictions to explain emerging psychopathology