To maintain or enhance biodiversity and sea floor integrity, mapping benthic habitats is a mandatory requirement in compliance with the Marine Strategy Framework Directive (MSFD). The EU Commission ...Decision distinguishes between Broad Habitat Types (BHTs) and Other Habitat Types (OHTs). At the regional level, biotopes in the Baltic Sea region are classified according to the HELCOM underwater biotope and habitat classification (HUB). In this study, the habitats and their benthic communities were mapped for the entire German Baltic Sea at a high spatial resolution of 1 km. In two nature conservation areas of the Exclusive Economic Zone (EEZ) as well as selected focus areas in the coastal waters, the resolution we provide is even more detailed at 50 × 50 m. Hydroacoustic data recording and benthological surveys (using bottom grabs, underwater towing camera technology, and diver sampling) helped identify biotopes in high resolution. Based on these data, together with additional data acquired since 2010 (a total of over 7000 stations and transect sections), we were able to spatially delineate benthic biotopes and their communities via predictive habitat modelling. The results are provided as full-coverage maps each for BHT, OHT, and HUB (9 classes of BHTs, 5 classes of OHTs, and 84 classes of HUB) with a level of spatial detail that does not yet exist for the Baltic Sea, and they form an essential basis for future monitoring, status assessments, and protection and management measures.
This study contributes to a better understanding of geogenic reef distribution in the southern Baltic Sea and highlights the implications of survey-related factors on automated boulder classification ...when utilizing data from multiple surveys. The distribution of hard grounds and reefs is needed as a baseline for geological and biological studies, but also for offshore construction, navigation and coastal management. In this study we provide maps of the distribution of geogenic reefs for about 750 km
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in the southern Baltic Sea, at the sites Wismar Bay, Darss Sill and Plantagenet Ground. The maps are based on full-coverage backscatter surveys with different side scan sonar and multibeam echo sounder systems. The distribution and number of boulders in the backscatter maps was determined using a convolutional neural network combined with quality control by human experts. The extent of the geogenic reefs was calculated on the basis of the number of boulders in 50 m x 50 m grid cells. We compare the results with previous reef maps based on point sampling, which show reefs of either biogenic or geogenic origin. According to the earlier maps, 11% of the Plantagenet Ground seabed was classified as reef habitat type. This is similar to the result of our study (12%), although we only considered reefs of geogenic origin. In the Darss Sill, geogenic reefs are larger in this study than in previous maps (30% versus 23%). In both regions, the spatial distribution of reefs differs significantly between old and new maps. For Wismar Bay, previous maps classify 3% of the seafloor as habitat type reef, whereas this study classifies 35% as geogenic reef. The use of automated classification during seafloor mapping allowed large areas to be interpreted in a few days. It also provided more information on the distribution of boulders within the geogenic reef. However, the boulder distribution maps show the negative effects of survey geometry, frequency and environmental conditions on automated boulder classification when data from different surveys are combined.
The Clinician-Administered PTSD Scale (CAPS) is an extensively validated and widely used structured diagnostic interview for posttraumatic stress disorder (PTSD). The CAPS was recently revised to ...correspond with PTSD criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). This article describes the development of the CAPS for DSM-5 (CAPS-5) and presents the results of an initial psychometric evaluation of CAPS-5 scores in 2 samples of military veterans (Ns = 165 and 207). CAPS-5 diagnosis demonstrated strong interrater reliability (к = .78 to 1.00, depending on the scoring rule) and test-retest reliability (к = .83), as well as strong correspondence with a diagnosis based on the CAPS for DSM-IV (CAPS-IV; к = .84 when optimally calibrated). CAPS-5 total severity score demonstrated high internal consistency (α = .88) and interrater reliability (ICC = .91) and good test-retest reliability (ICC = .78). It also demonstrated good convergent validity with total severity score on the CAPS-IV (r = .83) and PTSD Checklist for DSM-5 (r = .66) and good discriminant validity with measures of anxiety, depression, somatization, functional impairment, psychopathy, and alcohol abuse (rs = .02 to .54). Overall, these results indicate that the CAPS-5 is a psychometrically sound measure of DSM-5 PTSD diagnosis and symptom severity. Importantly, the CAPS-5 strongly corresponds with the CAPS-IV, which suggests that backward compatibility with the CAPS-IV was maintained and that the CAPS-5 provides continuity in evidence-based assessment of PTSD in the transition from DSM-IV to DSM-5 criteria.
Public Significance Statement
This study evaluated the DSM-5 version of the Clinician-Administered PTSD Scale (CAPS-5), a widely used structured interview for posttraumatic stress disorder, in 2 samples of military veterans. Results indicated that the CAPS-5 is psychometrically sound and corresponds closely with the previous DSM-IV version of the CAPS.
We calculated the reliable change index (RCI) and clinically significant change (CSC) values for two widely used measures of posttraumatic stress disorder (PTSD): The Clinician-Administered PTSD ...Scale for DSM-5 (CAPS-5) and the PTSD Checklist for DSM-5 (PCL-5) and examined how symptom changes at these thresholds related to improvements in psychosocial functioning. We used data from three independent samples of male military veterans, including two randomized controlled trials for PTSD (N = 198 for Sample 1 and N = 102 for Sample 2) and a cross-sectional study of primary care patients (N = 228). For Sample 1, within-person change in CAPS-5 and PCL-5 scores of ≥13 and 15, respectively, was indicative of reliable change. For Sample 2, within-person change in CAPS-5 and PCL-5 scores of ≥12 and 18, respectively, was indicative of reliable change. Scores of ≤8 and 28 on the CAPS-5 and PCL-5, respectively, indicated a participant is more likely to belong to the non-PTSD population than the PTSD population (i.e., clinically significant change) in both Samples 1 and 2. Participants who exhibited reliable or CSC reported significantly better psychosocial functioning at all posttreatment assessments than those who did not. Results provide thresholds for identifying clinically meaningful PTSD symptom change using these measures. Care should be taken to interpret these values appropriately and relative to numerous other definitions for meaningful symptom change.
Public Significance Statement
We calculated two values for determining if change in posttraumatic stress disorder (PTSD) symptoms were clinically meaningful using two common measures among male veterans. Results indicate these margins were associated with marked improvement in psychosocial functioning.
Evidence-based treatments for posttraumatic stress disorder (PTSD) exist, but all require 8 to 15 sessions and thus are less likely to be completed than brief treatments. Written exposure therapy ...(WET) is a brief and efficacious treatment that has not been directly compared with prolonged exposure therapy (PE), a more time-intensive, exposure-based treatment.
To determine whether WET is noninferior to PE in treating PTSD among veterans.
A randomized noninferiority clinical trial was conducted between September 9, 2019, and April 30, 2022. Participants were 178 veterans with PTSD presenting to 1 of 3 Veterans Affairs medical centers. Inclusion criteria consisted of a primary diagnosis of PTSD and stable medication. Exclusion criteria included current psychotherapy for PTSD, high suicide risk, active psychosis, unstable bipolar disorder, and severe cognitive impairment. Independent evaluations were conducted at baseline and 10, 20, and 30 weeks after the first treatment session. Data were analyzed from January 1 to March 31, 2023.
Participants assigned to WET (n = 88) received five to seven 45- to 60-minute sessions. Participants assigned to PE (n = 90) received eight to fifteen 90-minute sessions. The WET sessions included 30 minutes of writing-based imaginal exposure conducted in session, whereas PE sessions included 40 minutes of in-session imaginal exposure and between-session in vivo exposures.
The primary outcome was change in PTSD symptom severity measured with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) from baseline to the 20-week assessment; noninferiority was defined as a less than 10-point difference between the 2 treatment groups. Difference in treatment dropout was also examined.
Of the 178 participants, 134 (75.3%) were men, and the mean (SD) age was 44.97 (13.66) years. In terms of race, 37 participants (20.8%) were Black, 112 (62.9%) were White, 11 (6.2%) were more than 1 race, and 18 (10.1%) were of other race (including American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander some participants did not specify their race when selecting the category "other"); in terms of ethnicity, 19 participants (10.7%) were Hispanic. Changes in PTSD symptom severity from baseline to all subsequent assessments among individuals randomized to WET were noninferior relative to individuals randomized to PE. The largest difference between treatments was observed at 10 weeks and was in favor of WET (mean difference, 2.42 95% CI, 0.35-1.46 points). Participants were significantly less likely to drop out of WET compared with PE (11 12.5% vs 32 35.6%; χ2 = 12.91; Cramer V = 0.27).
In this study, WET was noninferior to PE in PTSD symptom change and was associated with significantly less attrition. Findings suggest that WET may transcend previously observed barriers to PTSD treatment for both patients and clinicians.
ClinicalTrials.gov Identifier: NCT03962504.
Written exposure therapy (WET), a 5-session intervention, has been shown to efficaciously treat posttraumatic stress disorder (PTSD). However, this treatment has not yet been directly compared with a ...first-line PTSD treatment such as cognitive processing therapy (CPT).
To determine if WET is noninferior to CPT in patients with PTSD.
In this randomized clinical trial conducted at a Veterans Affairs medical facility between February 28, 2013, and November 6, 2016, 126 veteran and nonveteran adults were randomized to either WET or CPT. Inclusion criteria were a primary diagnosis of PTSD and stable medication therapy. Exclusion criteria included current psychotherapy for PTSD, high risk of suicide, diagnosis of psychosis, and unstable bipolar illness. Analysis was performed on an intent-to-treat basis.
Participants assigned to CPT (n = 63) received 12 sessions and participants assigned to WET (n = 63) received 5 sessions. The CPT protocol that includes written accounts was delivered individually in 60-minute weekly sessions. The first WET session requires 60 minutes while the remaining 4 sessions require 40 minutes.
The primary outcome was the total score on the Clinician-Administered PTSD Scale for DSM-5; noninferiority was defined by a score of 10 points. Blinded evaluations were conducted at baseline and 6, 12, 24, and 36 weeks after the first treatment session. Treatment dropout was also examined.
For the 126 participants (66 men and 60 women; mean SD age, 43.9 14.6 years), improvements in PTSD symptoms in the WET condition were noninferior to improvements in the CPT condition at each of the assessment periods. The largest difference between treatments was observed at the 24-week assessment (mean difference, 4.31 points; 95% CI, -1.37 to 9.99). There were significantly fewer dropouts in the WET vs CPT condition (4 6.4% vs 25 39.7%; χ21 = 12.84, Cramer V = 0.40).
Although WET involves fewer sessions, it was noninferior to CPT in reducing symptoms of PTSD. The findings suggest that WET is an efficacious and efficient PTSD treatment that may reduce attrition and transcend previously observed barriers to PTSD treatment for both patients and providers.
clinicaltrials.gov Identifier: NCT01800773.
The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) versions of the Clinician-Administered PTSD Scale (CAPS-5) and PTSD Checklist (PCL-5) are widely used PTSD measures. ...Researchers and clinicians routinely use both measures in tandem to quantify symptom change, despite substantive instrumentation differences beyond administration modality, and absent a theoretical rationale or differential hypotheses for the two measures. The degree to which these measures provide comparable estimates of symptom change is unknown. This study examined concordance in change between CAPS-5 and PCL-5 scores over time. Participants were male veterans (N = 198) randomly assigned to one of two group PTSD treatments. We administered both the CAPS-5 and PCL-5 at baseline, midtreatment, immediately posttreatment, and 3-, 6-, and 12-month posttreatment. Results indicated that CAPS-5 and PCL-5 scores changed over time in a similar manner, as evidenced by generally parallel repeated-measures effect sizes, highly correlated slopes of change (r = .878), and similar associations with improvements in measures of depression and psychosocial functioning. However, the two measures did not produce identical estimates of symptom change. Estimates of symptom improvement were somewhat less concordant at posttreatment follow-up assessments; by the 12-month posttreatment assessment, changes in CAPS-5 scores from baseline indicated somewhat greater symptom improvement than changes in PCL-5 scores (CAPS-5 ESsg = −0.67, PCL-5 ESsg = −0.53). Collectively, results indicate that CAPS-5 and PCL-5 scores produce similar but not identical estimates of PTSD symptom change. Thus, although PCL-5 scores closely approximate symptom change estimated by CAPS-5 scores, the two measures are not interchangeable.
Public Significance Statement
We found that the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) versions of the Clinician-Administered PTSD Scale (CAPS-5) and PTSD Checklist (PCL-5)-a widely used PTSD interview and questionnaire, respectively-produce similar but not identical estimates of PTSD symptom change. Thus, although PCL-5 scores closely approximate symptom change estimated by CAPS-5 scores, the two measures are not interchangeable.
Although there are effective psychotherapies available for posttraumatic stress disorder (PTSD), brief treatments for PTSD are needed to expand the reach of treatment. Written exposure therapy (WET) ...is a brief treatment that has the potential to fill an important need in PTSD treatment and has a rapidly expanding evidence base to support its use. In this paper we provide information on how WET was developed, and we present proposed underlying mechanisms of the treatment and evidence supporting the underlying mechanism. The current evidence supporting WET for the treatment of PTSD is reviewed. The evidence indicates that WET is an efficacious and effective treatment approach for PTSD and is noninferior to more time-intensive evidence-based treatments for PTSD. The paper concludes with suggestions for expanding the evidence base of WET that is necessary for it to be considered a first-line treatment approach across clinical practice guidelines.
•Sudden treatment gains in posttraumatic stress symptoms was examined.•Sudden gains occurred in both treatment conditions.•Patients who displayed sudden gains had better treatment outcome.•Expressing ...more negative emotion in trauma narratives predicted sudden gains.•Sudden gains may be helpful in predicting individual trauma-focused treatment response.
In the current study, we examined the degree to which sudden gains (large, rapid, and stable symptom reduction in a one-session interval) predicted treatment outcome in adults randomized to two different trauma-focused treatments. Adults diagnosed with PTSD were randomized to either written exposure therapy (WET; n = 63), a brief, exposure-based treatment for posttraumatic stress disorder (PTSD), or the more time-intensive Cognitive Processing Therapy (CPT; n = 63). Findings showed that 20.6% of participants who received WET and 17.5% of participants who received CPT experienced sudden gains. Sudden gains occurred earlier in WET (M session = 2.69, SD = 0.75) than in CPT (M session = 5.64, SD = 3.01). However, there were no treatment condition differences in the magnitude of the sudden gains. Treatment outcomes were significantly better for those who experienced sudden gains compared with those who did not, regardless of treatment assignment. Exploratory analyses of participants’ trauma narratives revealed that expressing more negative emotion predicted the occurrence of sudden gains in both treatment conditions. Negative beliefs about the self and others did not predict sudden gains. The findings are discussed in terms of how they may help identify individual early response patterns that predict outcomes in trauma-focused treatments.
We examined whether extinction or changes negative trauma-related beliefs occur either prior to or concurrently with changes in posttraumatic stress symptoms among individuals who received either ...Cognitive Processing Therapy (CPT) or Written Exposure Therapy (WET) using statistical methods that permit proper discernment of temporal sequence. Community participants with PTSD (N = 126) were evenly randomized to 12 sessions of CPT or 5 sessions of WET. We assessed within- and between-session changes in arousal and valence and changes in trauma-related beliefs 6-, 12-, 24-, 36- and 60-weeks following the first treatment session. Between-session change in post-session emotional valence temporally preceded PTSD symptom reduction among participants who received WET but did not predict subsequent symptom reduction. Although negative trauma-related beliefs changed in parallel with and correlated with PTSD symptom reduction in both conditions, this change did not temporally precede symptom reduction. Our results are inconsistent with those from prior studies and suggest these constructs may more appropriately be characterized as correlates, rather than mediators, of symptom reduction. These results highlight the value of discernment of the temporal sequence of change between hypothesized mediators and symptoms and underscore that we still have much to learn about how evidence-based treatments reduce PTSD symptoms.
•This study found that extinction and changes negative trauma-related beliefs, two hypothesized mediators of PTSD treatment outcome, exhibited a parallel pattern of change with symptoms.•Accordingly, these constructs may more appropriately be characterized as correlates of, rather than mediators of, symptom reduction.
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