Post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) are chronic psychiatric disorders that have overlapping symptomology and risk factors, including altered motivation and impulsive behavior. Exposure to a predator odor stressor (2,3,5-Trimethyl-3-Thiazoline (TMT)) produces PTSD-like symptomology in rats. Individual differences in stress-coping behaviors such as freezing and defensive digging during TMT exposure can predict long-term differences in alcohol-related behaviors and altered neurobiology. Here, we evaluated the relationship between stress-coping behavior during TMT exposure and reward-related decision making. In Experiment 1, delay discounting curves in male and female rats were evaluated before and >2 weeks after TMT exposure using an adjusting-amounts delay discounting task. In Experiment 2, using a concurrent choice self-administration procedure, lever responses and preference for alcohol over sucrose were evaluated before and >2 weeks after TMT exposure in females. Additionally, motivation for competing reinforcers was evaluated using progressive ratios. Digging during TMT exposure was correlated with greater post-TMT impulsive choice (Experiment 1), reduced sucrose lever responses both before and after TMT exposure (Experiment 2), and reduced sucrose lever breakpoint after TMT (Experiment 2). High-digging rats showed greater delay discounting than low-digging rats after TMT exposure, though neither were different from controls. Additionally, compared to controls, TMT-exposed females had greater motivation for both alcohol and sucrose self-administration when available concurrently. Overall, these findings suggest that behavior prior to and during a stressful experience can predict individual differences in decision making, which may help future studies identify the neurobiology underlying risk for aberrant reward-related behaviors after a traumatic event.

Use of psychedelic substances is increasing across unregulated, state-regulated, research, ceremonial/religious, and medical settings in the United States. Concurrently, a growing body of clinical research signals the potential for therapeutic applications for specific psychedelics in the treatment of depression, post-traumatic stress disorder, substance use disorders, and other health conditions. This evolving landscape presents both promise and complexity. From a public health perspective, a structured public health preparedness approach is needed to prioritize safety, workforce readiness, and data infrastructure in a manner that promotes individual and collective well-being while supporting responsible evidence development. This commentary proposes priorities for public health preparedness for psychedelics: (1) education and prevention of adverse events; (2) behavioral health workforce development; and (3) strategic information and data analysis. Educational efforts should emphasize clear risk communication, substance-specific messaging, prevention of adverse events, and practical guidance to support policy decision-making. Workforce considerations include defining core competencies, clarifying ethical boundaries and informed consent, establishing training and technical assistance infrastructure, strengthening capacity across the behavioral health workforce, and preparing providers to respond to patients using psychedelics outside regulated systems. Strategic information priorities include strengthening data systems and improving coordination and harmonization of epidemiologic monitoring related to patterns of use, adverse events, treatment-seeking behaviors, and the implications of evolving policy environments. As psychedelics enter mainstream discourse, public health institutions must adopt a balanced approach that considers both benefits and risks. A proactive, health-promoting, and data-driven framework can help ensure that policies and practices are grounded in safety and core public health principles.

Psychedelic-assisted therapy (PAT) is an emerging complex intervention for psychiatric and existential conditions (i.e., forms of distress related to meaning, mortality, and identity, such as that arising in life-threatening illness); however, a systematic characterization of the evaluation methods used across the entire clinical intervention remains incomplete. This scoping review synthesizes the scientific literature on the methodologies and frameworks for evaluating PAT, covering pre-session screening, acute experience, intervention processes, post-session integration, clinical and existential outcomes, safety, and service evaluation.

Post-traumatic stress disorder (PTSD) involves maladaptive aversion processing and anxiety disorders; however, the correlation between these components and their underlying neural circuit mechanisms remains unclear. The single prolonged stress and shock (SPS&S) model reliably induced PTSD-related aversive behaviors in mice through functional reorganization of the zona incerta (ZI)→lateral habenula (LHb) neural pathway. The ZI primarily projected to the lateral subregion of the LHb (LHbL) and consisted predominantly of GABAergic neurons. During the SPS&S expression phase, mice exhibit weakened ZI-LHb connectivity, accompanied by reduced miniature inhibitory postsynaptic current (mIPSC) frequency in ZI-targeted postsynaptic LHb neurons. Circuit-specific suppression of ZI→LHb neurons in naive mice recapitulated PTSD-related symptoms. Compared to control mice, ‌the‌ presynaptic and postsynaptic neurons in the ZI-LHb pathway of SPS&S expression mice show weakened and amplified activation, respectively, during aversive stimulus processing. During the SPS&S acquisition and expression phase, chemogenetic activation of this pathway rescued anxiety-like behaviors and aversion responses without affecting depression. Downstream tracing reveals divergent functions: the ZI-LHb-ventral tegmental area (VTA) pathway mediates aversion, while ZI-LHb-rostromedial tegmental nucleus (RMTg) primarily regulates anxiety manifestations. Our findings establish the ZI-LHb circuit as a dual-control hub in PTSD-related phenotype, offering new therapeutic targets.

Post-traumatic stress symptoms (PTSS) are prevalent among children with cancer and their families. Although family-based interventions such as the Surviving Cancer Competently Intervention Programme (SCCIP) are effective, their reliance on mental health specialists limits scalability, highlighting the need for nurse-led approaches. This trial aims to evaluate the efficacy of SCCIP-N, a nurse-led family-based psychosocial intervention, in reducing PTSS among families of paediatric cancer patients in China.

Background: Posttraumatic stress disorder (PTSD) is characterized by daily fluctuations in cognitive and affective processes. Little is known about how these processes relate to PTSD severity before and after individuals engage in a therapeutic intervention.Objective: This study used a daily diary design to examine same-day and next-day associations of affect and posttrauma cognitions with posttraumatic stress symptoms (PTSS) during a novel PTSD intervention focused on processing positive memories.Methods: Participants were 70 trauma-exposed adults who completed four sessions of the Processing of Positive Memories Technique (PPMT). Participants completed 21 daily surveys pre - and post- PPMT on PTSS, positive and negative affect, and posttrauma cognitions. Multilevel models and multilevel interrupted time series analyses were used to examine same-day and next-day associations between study variables and changes over time.Results: Multilevel models showed that more negative affect, less positive affect, and more posttrauma cognitions were associated with higher same-day PTSS (ps < .001). In contrast, daily fluctuations in negative affect, positive affect, and posttrauma cognitions did not predict next-day PTSS after accounting for prior-day PTSS. Multilevel interrupted time series models revealed that the same-day association between negative affect and PTSS weakened over time following PPMT (p = .035).Conclusion: Findings emphasize the importance of daily affective and cognitive processes in shaping short-term PTSS trajectories and suggest that PPMT may have its most enduring effects on the association between negative affect processes and PTSS.

Home destruction is a severe traumatic event strongly associated with psychological distress, particularly in conflict settings. Hemodialysis patients face heightened vulnerability due to chronic illness and dependence on continuous medical care. This study examined whether anxiety mediates the relationship between home destruction and post-traumatic stress disorder (PTSD) among hemodialysis patients in Gaza following the military assault on October 7, 2023. A cross-sectional study was conducted across five dialysis centers in Gaza. Anxiety symptoms were measured using the Depression Anxiety Stress Scale (DASS-21), and PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5). Structural equation modeling with bootstrapped confidence intervals evaluated mediation effects. Among 383 participants, 83.6% reported moderate-to-extreme anxiety, and 58% met the PTSD cutoff. Home destruction was highly prevalent, affecting 66.1%, with 53.5% experiencing total loss of residence. Significant positive correlations were found among home destruction, anxiety, and PTSD. Mediation analysis showed that anxiety fully accounted for the association between home destruction and PTSD (significant indirect effect, non-significant direct effect after adjustment). In adjusted models controlling for gender and current residency, the total effect was no longer significant, consistent with full statistical mediation. The model explained 42% of the variance in PTSD scores, almost entirely through anxiety (R2 = 0.02 for anxiety from home destruction alone). Given the cross-sectional design, this mediation should be interpreted as a statistical association rather than evidence of a causal pathway, and longitudinal studies are needed to confirm temporal relationships. Although causality cannot be determined from this cross-sectional study, the observed indirect association suggests that integrating anxiety-focused mental health support into dialysis services may help reduce PTSD symptoms among conflict-affected hemodialysis patients. Pilot intervention studies are needed to test this hypothesis.

This systematic review and meta-analysis evaluated the effectiveness of Virtual Reality Exposure Therapy (VRET) for treating Post-Traumatic Stress Disorder (PTSD) in military veterans. A comprehensive search of electronic databases identified 9 randomized controlled trials involving 444 veterans that met inclusion criteria. The primary outcomes were changes in PTSD symptom severity measured by the Clinician-Administered PTSD Scale (CAPS) and PTSD Checklist (PCL). The meta-analysis demonstrated significant reductions in PTSD symptom severity in pre-post comparisons following VRET. In contrast, comparisons between VRET and control conditions showed smaller and more variable effects, highlighting the importance of cautious interpretation when assessing comparative efficacy. The pooled mean difference in CAPS scores was 33.73 (95% CI: 7.80 to 59.65) for pre-post comparisons, indicating a marked reduction in symptom severity following treatment. For PCL scores, the pooled mean difference was 20.96 (95% CI: 13.05 to 28.86). When compared to controlled conditions, VRET was associated with modest effects, with a pooled mean difference of 4.86 (95% CI: -8.34 to 18.07) for CAPS scores and 1.93 (95% CI: - 0.02 to 3.89) for PCL scores. Overall, combining pre-post and controlled comparisons yielded statistically significant effects favoring VRET, with mean differences of 23.26 (95% CI: 8.00 to 38.52) for CAPS and 13.66 (95% CI: 5.00 to 22.31) for PCL scores. However, high heterogeneity was observed across studies, warranting cautious interpretation. Risk of bias assessment indicated low to moderate risk of bias across the included studies. Visual inspection of funnel plots suggested no strong asymmetry; however, interpretation is limited due to the small number of studies included. These findings suggest that VRET may be an effective intervention for reducing PTSD symptoms in military veterans, particularly in within-group analyses, although comparative effects relative to control conditions were more modest. The immersive features of VRET may offer an alternative means of delivering exposure-based interventions, although patient acceptability and clinical utility likely vary across individuals and settings. VRET shows promise as an alternative or adjunct to conventional treatments, potentially improving engagement and reducing dropout rates. However, small sample sizes in some studies and heterogeneity of results limit definitive conclusions. Further large-scale trials are needed to establish VRET's comparative efficacy and long-term benefits in military populations.Aim: To systematically review and meta-analyze the efficacy of virtual reality-based exposure therapy (VR-ET) for treating post-traumatic stress disorder (PTSD) in military veterans.Objectives: To evaluate the efficacy of VR-based exposure therapy in reducing PTSD symptoms and achieving remission among military veterans. 2. To compare the efficacy of different VR protocols, such as: Immersive vs. non-immersive systems, Combat-related vs. non-combat trauma scenarios 3. To explore heterogeneity in treatment outcomes based on: Veteran-specific factors (e.g., age, service duration, comorbidities)Study characteristics (e.g., sample size, design, control group) 4. To identify barriers to implementation of VR-based exposure therapy in veteran healthcare systems, including: Cost and resource availability, Technological literacy among patients and providers, Logistical and infrastructural limitations.

Post-traumatic stress disorder (PTSD) is associated with dysfunction of the hypothalamo-pituitary-adrenocortical (HPA) axis, accompanied by alterations in immune function, microbiota composition, and brain regions, including the hippocampus. CRHR2 receptor agonists, urocortin 2 (UCN2) and urocortin 3 (UCN3), regulate stress-related neuroendocrine activity. The present study aimed to investigate how a single intranasal administration of UCN2 or UCN3 modulates bacterial composition and inflammatory activity in the spleen/isolated splenocytes and alters the expression of neuroinflammatory and neurogenic markers in the dorsal (dHipp) and ventral hippocampus (vHipp) in male rats exposed to single prolonged stress (SPS) model of PTSD. SPS increased Enterobacteriaceae 16S rRNA levels and slightly reduced Lactobacillus abundance, while both urocortins prevented these effects. In the spleen, SPS suppressed expression of immune cell function markers, whereas UCN3 mitigated these effects. In isolated splenocytes stimulated ex vivo with lipopolysaccharide, UCN2 and UCN3 restored the reduced mRNA expression of proinflammatory markers, including IL-1β, IL-12p40, NOS, and CD69. Alterations in inflammatory markers correlated with Enterobacteriaceae and Lactobacillus. In the brain, SPS-induced changes were observed primarily in the vHipp, where expression of neuroinflammatory markers, including Iba1, TREM2, and CX3CR1, were decreased and restored by urocortin treatment. Conversely, SPS increased DCX mRNA levels, whereas UCN2 and UCN3 reduced them. Neuroinflammatory markers in the vHipp correlated with splenic microbiota and inflammatory markers. Overall, these findings suggest that CRHR2 stimulation by intranasal UCN2/UCN3 administration prevents PTSD-induced alterations through interconnected effects on splenic microbiota composition, peripheral immune responses, and hippocampal synaptic plasticity and neuroinflammatory markers.