Sofie Folke

Background: Posttraumatic stress disorder (PTSD) is a serious and debilitating condition among military veterans. Exposure to potentially traumatic events (PTEs) may lead to PTSD and PTE sensitivity may be influenced by the personality trait neuroticism.

Objective: The current investigation aims to test whether exposure to PTEs during deployment is associated with changes in PTSD symptoms, and whether individual levels of neuroticism are related to resilience or sensitivity to such exposures.

Methods: The study sample included 701 Danish soldiers deployed to Afghanistan in 2009. PTSD symptoms were measured pre-, peri- and post-deployment (T1-T3) with the PTSD Checklist-Civilian Version. PTSD symptom load was modelled in a mixed linear model along with an extensive list of covariates. Interactions between time, exposure, and neuroticism were tested in order to assess whether neuroticism moderated the effect of PTEs upon PTSD symptoms.

Results: On average, PTSD symptoms decreased from T1 through T3. Factors associated with higher PTSD symptom levels included number of past trauma, neuroticism, and low age at deployment. Interaction analyses showed that individuals with low and medium neuroticism levels displayed no significant change in PTSD symptoms, and individuals with high neuroticism displayed a significant decrease in PTSD symptoms. These changes were consistent across levels of perceived exposure to danger and combat and witnessing the consequences of war.

Conclusions: Results indicate that low levels of neuroticism appear to be related to resilience. Individuals with high levels of neuroticism displayed elevated PTSD symptoms across all time points, but contrary to expectations, they reported a significant decrease in PTSD symptoms from pre- to post-deployment.

Background: The International Trauma Interview (ITI) is the first clinician-administered diagnostic tool developed to assess posttraumatic stress disorder (PTSD) and Complex PTSD(CPTSD), both recently recognized in the ICD-11. The current study aims to test the construct and discriminant validity of the ITI in a population of treatment-seeking veterans.

Method: 124 Danish veterans seeking psychological treatment were interviewed by a group of trained clinicians for ICD-11 PTSD and CPTSD before beginning treatment at the Military Psychological Department in the Danish Defense. A series of confirmatory factor models were estimated in order to identify the extent to which latent variable operationalizations provide potential explanations for the associations between symptoms.

Results: Results indicate that symptoms of CPTSD, as measured by the ITI, are best represented by a single higher-order factor. We also found that a bifactor model provided adequate fit tothe data. The commonly identified two-factor higher-order model was rejected due to the lack of discriminant validity between PTSD and DSO. The higher order model was found to explain associations between symptoms of CPTSD and symptoms of depression, stress, anxiety, and well-being.

Conclusion: The ITI does not fit a two-factor higher-order model in a sample of treatment-seeking Danish veterans. Rather, a single higher order factor shows excellent fit, and is found to explain associations between ITI symptoms and other internalizing symptoms.

Background: A number of studies have tested the factor structure of the suggested ICD-11 symptom criteria for PTSD and complex PTSD (CPTSD) across various trauma populations, finding support for two different models in line with the ICD-11 theoretical rationale. Objective: Here, we aim to explore the factor structure of the Danish version of the International Trauma Questionnaire (ITQ) by testing two alternative factor models that have previously gained support in a large sample of treatment-seeking veterans. Method: Treatment-seeking Danish soldiers and veterans (N = 599) recruited from the Military Psychology Department in the Danish Defence completed the International Trauma Questionnaire (ITQ). Confirmatory factor analysis (CFA) was used to assess fit of a first-order and a second-order model. Results: Both models fit the data well but displayed latent variable correlations above 1 and negative variances (known as Heywood cases), indicating model misspecification or other problems. The specification problems included the latent variable Affect Dysregulation. Conclusions: Based on our results and results reported in previous CFAs of the ITQ, we suggest consideration of the proposed models. While many previous studies did find support for the models with no indications of misfit, others find Heywood cases concerning the same items and latent variables as our analysis. Hence, models of (C)PTSD based on the ITQ should be carefully evaluated and interpreted.

Introduction: Military veterans suffering from severe symptoms of Post-Traumatic Stress Disorder (PTSD) often experience significant bodily manifestations that recommended psychological trauma-focused therapies might not fully address. Aim: This study aims to evaluate the impacts of Basic Body Awareness Therapy (BBAT) on movement quality, arousal regulation, and bodily experience among Danish military veterans with severe PTSD symptoms undergoing psychological trauma-focused therapy. Methods: This cohort study included 37 Danish male military veterans with severe PTSD symptoms (consistent with PTSD diagnosis) who received individual BBAT sessions alongside psychological trauma-focused therapy (e. g. trauma-focused cognitive processing and prolonged exposure therapy). Assessments were conducted at baseline and after 12 BBAT sessions using the Body Awareness Scale Movement Quality and Experience (BAS MQ-E) and questionnaires evaluating self-rated interoceptive awareness and subjective somatic, PTSD, depression , anxiety, and stress symptoms. The Wilcoxon Signed Rank Test, including Wilcoxon effect size ('r'), was used to estimate changes. Differences between completers and dropouts were also analyzed. Results: Significant improvements were observed in overall movement quality (BAS MQ from 0.97-0.49, Wil-coxon effect size = 0.79) and overall bodily experiences (BAS E from 1.43 to 0.86, Wilcoxon effect size = 0.74). Notable enhancements were found in interoceptive awareness with large effect sizes for indicators such as Noticing, Attention Regulation, Emotional Awareness, Self-regulation, and Body Listening. Additionally, significant improvements were seen in somatic symptoms, PTSD, depression, anxiety, and stress. Conclusion: The findings suggest that BBAT may improve movement quality, bodily experience, and arousal regulation in Danish male veterans with severe PTSD symptoms undergoing trauma treatment.

While a number of studies have investigated risk factors and comorbidities of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) in various trauma exposed samples, few studies have been conducted in military samples. Existing studies with military samples have included rather small samples. The aim of the present study was to identify risk factors and comorbidities of ICD-11 PTSD and CPTSD in a large sample of previously deployed, treatment-seeking soldiers and veterans. Methods: Previously deployed, treatment-seeking Danish soldiers and veterans (N = 599), recruited from the Military Psychology Department of the Danish Defense, completed the International Trauma Questionnaire (ITQ), as well as questionnaires of common mental health difficulties, trauma exposure, functioning and demographics. Multivariate multinomial logistic regression analysis explored differences in self-reported exposure to adversity and health outcomes between those meeting ICD-11 criteria for probable PTSD, CPTSD and no trauma disorder. Results: A total of 13.0% met probable ICD-11 criteria for PTSD and 31.4% for CPTSD. Risk factors for CPTSD (compared to those with no trauma disorder) included exposure to warfare or combat, longer duration since the traumatic event and being single. Those with CPTSD were more likely than those with PTSD or no trauma disorder to endorse symptoms of depression, anxiety, stress, use of psychotropic medication, and suicide attempts. Conclusion: CPTSD is a more common and debilitating condition compared to PTSD in treatment-seeking soldiers and veterans. Further research should focus on testing existing and novel interventions for CPTSD in the military.

Background: While empirical support for the ICD-11 distinction between posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) is growing, empirical research into the ICD-11 model of CPTSD in military populations is scarce and inconsistent.
Objective: To replicate a study from our own group identifying distinct classes based on CPTSD symptoms using the International Trauma Questionnaire (ITQ) and to identify predictors and functional outcomes associated with a potential distinction between PTSD and CPTSD.
Method: Formerly deployed treatment-seeking Danish soldiers (N = 294) completed the ITQ and self-report measures of traumatic life events prior to treatment. Latent profile analysis (LPA) was used to extract classes based on CPTSD symptoms.
Results: LPA revealed four classes; (1) high CPTSD symptoms ('CPTSD', 28.7%); (2) high PTSD symptoms and lower DSO symptoms ('PTSD', 23.5%); (3) high DSO symptoms ('DSO', 17.3%); and (4) low symptoms ('Low Symptoms', 30.5%). In comparison to the PTSD-class, CPTSD-class membership was not predicted by traumatic events in adult life and in childhood. The CPTSD class was more often single/divorced/widowed compared to the PTSD class. Moreover, the CPTSD class more often used psychotropic medicine compared to the DSO-class and Low Symptoms-class.
Conclusion: Using the ITQ, this study yields empirical support for the ICD-11 model of CPTSD within a clinical sample of veterans. The results replicate findings from our previous study that also identified distinct profiles of ICD-11 PTSD and CPTSD.
The study identified separate classes representing CPTSD, PTSD, DSO and Low Symptoms in treatment-seeking military veterans based on the International Trauma Questionnaire.
CPTSD is a more debilitating condition than PTSD.
Findings replicate a previous LPA study of treatment-seeking Danish veterans.

Mentalization is a developmental achievement defined as the capacity to understand behavior in terms of mental states. This study investigated mentalization in psychoanalytic psychotherapy (PPT) and cognitive behavior therapy (CBT) through a secondary data analysis of findings from a randomized controlled trial for bulimia nervosa. It was hypothesized that mentalization would predict alliance and outcome in both treatments, whereas increase in mentalization was only expected after PPT. Furthermore, it was investigated whether change in mentalization predicted symptom change. A total of 70 participants with bulimia nervosa were randomized to PPT or CBT. Participants were assessed at 3 time points with the Eating Disorder Examination and the Adult Attachment Interview (rated for reflective functioning [RF]). Therapy sessions were rated with the Vanderbilt Therapeutic Alliance Scale. Higher intake RF significantly predicted better alliance, whereas no association was observed between RF and outcome. A significant interaction between time, therapy type, and RF found RF improving more in PPT than in CBT. There was a significant association between RF change and symptom change in the PPT group. The study suggests a relation between RF and psychotherapy process, whereas the relation between RF and outcome is more complex. Furthermore, PPT seems to enhance mentalization, which seems related to symptomatic improvement, suggesting that mentalization might serve as a specific mechanism of change in PPT.

Background: The WHO International Classification of Diseases, 11th version (ICD-11), includes a trauma-related diagnosis of complex posttraumatic stress disorder (CPTSD) distinct from posttraumatic stress disorder (PTSD). Results from previous studies support the validity of this distinction. However, no studies to date have evaluated the ICD-11 model of PTSD and CPTSD in treatment-seeking military veterans.Objective: To determine if the distribution of symptoms in treatment-seeking Danish veterans was consistent with the ICD-11 PTSD and CPTSD symptom profiles. Based on previous studies, we hypothesized that separate classes representing PTSD and CPTSD would be found that membership of a potential CPTSD-class would be predicted by a larger number of childhood traumas, and that a potential distinction between PTSD and CPTSD would be supported by differences in sociodemographic and functional outcomes.Method: Participants (N = 1,541) were formerly deployed Danish soldiers who completed proxy measures of ICD-11 PTSD and disturbances in self-organization (DSO) symptoms, along with self-report measures of traumatic life events, prior to starting treatment at the Military Psychology Department of the Danish Defence.Results: All hypotheses were supported. Latent profile analysis (LPA) revealed separate classes representing PTSD and CPTSD. In comparison to the PTSD-class, membership of the CPTSD-class was predicted by more childhood traumatic experiences, and members of this class were more likely being single/divorced/widowed and more likely to use psychotropic medication. Besides a PTSD-class and a CPTSD-class, LPA revealed a Low Symptoms-class, a Moderate DSO-class, a Hyperarousal-class, and a High DSO-class, with clear differences in functional outcomes between classes.Conclusion: Findings replicate previous studies supporting the distinction between ICD-11 PTSD and CPTSD. In addition, there seem to be groups of treatment-seeking military veterans that do not fulfil full criteria for a trauma-related disorder. Further research should explore subsyndromal PTSD and CPTSD profiles in veterans and other populations.

Background: In this naturalistic study, patients with personality disorders (N = 388) treated at Stolpegaard Psychotherapy Center, Mental Health Services, Capital Region of Denmark were allocated to two different kinds of treatment: a standardized treatment package with a preset number of treatment hours (basic hospital service) and 2: a specialized treatment program for the most severely affected patients without a predetermined restricted number of treatment hours and significantly more individual psychotherapy (regional specialized hospital services).

Aims: To investigate patient characteristics associated with clinicians' allocation of patients to the two different personality disorder services.

Methods: Patient characteristics across eight domains were collected in order to study whether there were systematic differences between patients allocated to the two different treatments. Patient characteristics included measures of symptom severity, personality pathology, trauma and socio-demographic characteristics. Significance testing and binary regression analysis were applied to identify important predictors.

Results: Patient characteristics on fifteen variables differed significantly, all in the expected direction, with patients in regional specialized hospital services showing more pathology and psychosocial problems. In the regression model, only age and two variables capturing psychosocial functioning remained significant predictors of allocation.

Discussion: The finding that younger age was the most significant predictor of longer treatment replicates an earlier finding of allocation to treatment for personality disorder. Overall, this study therefore lends further support to the importance of demographic and social contextual factors in clinicians' allocation of patients to different treatment services for personality disorder.

Studies of therapist adherence in relation to treatment outcome have produced mixed results. The aim of the present study was to investigate change in therapist adherence to cognitive–behavioral therapy (CBT) for bulimia nervosa over time, and to investigate the relationship between adherence and client outcome in early, middle, and late phases of treatment. Thirty-six clients received the focused form of “enhanced” CBT (CBT-E) for bulimia nervosa. Trained observers rated audiotapes of 92 full-length therapy sessions from early (Session 3), middle (Session 11), and late phases (Session 20) of treatment using the Cognitive–Behavioral Therapy Treatment Protocol Adherence Scale. Change in adherence across the 3 treatment phases was examined using multilevel analysis. The relationship between early, middle, and late adherence levels and end-of-treatment binging frequency was examined using multilevel Poisson regression analysis. Adherence decreased significantly over the course of treatment. Higher levels of therapist adherence in early and middle phases of treatment were associated with reduced binging frequency, whereas higher levels of adherence measured late in treatment was not. Results indicate that therapists’ adherence to the CBT-E treatment protocol decreases over time and that high levels of protocol adherence in early and middle phases of treatment are more important for positive client outcomes than high levels of adherence in the end of treatment. (PsycInfo Database Record (c) 2025 APA, all rights reserved)