Chronic Stress最新文献

{"title":"\"Association of Severity of Posttraumatic Stress Disorder With Inflammation: Using Total White Blood Cell Count as a Marker\".","authors":"Farrukh M Koraishy,&nbsp;Joanne Salas,&nbsp;Thomas C Neylan,&nbsp;Beth E Cohen,&nbsp;Paula P Schnurr,&nbsp;Sean Clouston,&nbsp;Jeffrey F Scherrer","doi":"10.1177/2470547019877651","DOIUrl":"https://doi.org/10.1177/2470547019877651","url":null,"abstract":"<p><strong>Background: </strong>Inflammation is known to be associated with posttraumatic stress disorder (PTSD). It is not known if total white blood cell (WBC) count, a routinely checked inflammatory marker, is associated with PTSD symptom trajectories using medical record data.</p><p><strong>Methods: </strong>We used latent class growth analysis to identify three-year PTSD symptom trajectories using PTSD Checklist (PCL) scores. The outcome for each patient was maximum WBC count from index PTSD diagnosis to last PCL. Using linear regression analysis, we then calculated and compared the average WBC count for each trajectory before and after controlling for age, gender, race, obesity, smoking, diabetes, hypertension, cardiovascular disease, depression and other co-morbid inflammatory conditions.</p><p><strong>Results: </strong>Patients were 40.2 (SD±13.5) years of age, 83.7% male and 67.9% white. We identified three PCL trajectory groups based on symptom severity over time: 'moderate-large decrease', 'moderate severe-slight decrease', and 'severe-persistent'. In adjusted analyses, 'severe-persistent' vs. 'moderate-large decrease' had significantly higher WBC count (B=0.64; 95%CI=0.18, 1.09; p=.006). Although non-significant, 'moderate severe-slight decrease' vs. 'moderate-large decrease' also had a higher WBC count (B=0.42; 95% CI: -0.02, 0.86; p=.061).</p><p><strong>Conclusion: </strong>Persistently severe PTSD is associated with a higher WBC count than improving PTSD. WBC appears to have utility for measuring the association between psychiatric disorders and inflammation in retrospective cohort studies involving large administrative medical record data bases.</p>","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2470547019877651","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37723439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Is the Confusion With Cortisol?","authors":"B. McEwen","doi":"10.1177/2470547019833647","DOIUrl":"https://doi.org/10.1177/2470547019833647","url":null,"abstract":"Cortisol has many roles not only in mediating the response to stress but also in the circadian rhythm, and it does so by both genomic and nongenomic cellular and molecular mechanisms. Yet, it is common to associate cortisol only with stress and, in particular, with the negative aspects of stress even though we would not survive without it. This commentary provides a brief overview not only of the diverse roles of cortisol but also of how to measure it to get meaningful information in the context of other mediators of stress and adaptation and the concepts of allostasis and allostatic load and overload. In particular, the adaptive plasticity of the brain mediated by glucocorticoids and excitatory amino acids is discussed in relation to misconceptions about what constitutes brain damage. Thus the confusion with cortisol is that it does too many important things both positive and negative!","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2470547019833647","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42070336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced Salience and Enhanced Central Executive Connectivity Following PTSD Treatment.","authors":"Chadi G Abdallah,&nbsp;Christopher L Averill,&nbsp;Amy E Ramage,&nbsp;Lynnette A Averill,&nbsp;Evelyn Alkin,&nbsp;Samaneh Nemati,&nbsp;John H Krystal,&nbsp;John D Roache,&nbsp;Patricia Resick,&nbsp;Stacey Young-McCaughan,&nbsp;Alan L Peterson,&nbsp;Peter Fox","doi":"10.1177/2470547019838971","DOIUrl":"https://doi.org/10.1177/2470547019838971","url":null,"abstract":"<p><strong>Background: </strong>In soldiers with posttraumatic stress disorder (PTSD), symptom provocation was found to induce increased connectivity within the salience network, as measured by functional magnetic resonance imaging (<i>f</i>MRI) and global brain connectivity with global signal regression (GBCr). However, it is unknown whether these GBCr disturbances would normalize following effective PTSD treatment.</p><p><strong>Methods: </strong>69 US Army soldiers with (n = 42) and without PTSD (n = 27) completed <i>f</i>MRI at rest and during symptom provocation using subject-specific script imagery. Then, participants with PTSD received 6 weeks (12 sessions) of group cognitive processing therapy (CPT) or present-centered therapy (PCT). At week 8, all participants repeated the <i>f</i>MRI scans. The primary analysis used a region-of-interest approach to determine the effect of treatment on salience GBCr. A secondary analysis was conducted to explore the pattern of GBCr alterations posttreatment in PTSD participants compared to controls.</p><p><strong>Results: </strong>Over the treatment period, PCT significantly reduced salience GBCr (<i>p</i> = .02). Compared to controls, salience GBCr was high pretreatment (PCT, <i>p</i> = .01; CPT, <i>p</i> = .03) and normalized post-PCT (<i>p</i> = .53), but not post-CPT (<i>p</i> = .006). Whole-brain secondary analysis found high GBCr within the central executive network in PTSD participants compared to controls. <i>Post hoc</i> exploratory analyses showed significant increases in executive GBCr following CPT treatment (<i>p</i> = .01).</p><p><strong>Conclusion: </strong>The results support previous models relating CPT to central executive network and enhanced cognitive control while unraveling a previously unknown neurobiological mechanism of PCT treatment, demonstrating treatment-specific reduction in salience connectivity during trauma recollection.</p>","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2470547019838971","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37348472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Purpose in Life and Conscientiousness Protect Against the Development of Suicidal Ideation in U.S. Military Veterans With PTSD and MDD: Results From the National Health and Resilience in Veterans Study.","authors":"Elizabeth Straus, Sonya B Norman, Jessica C Tripp, Michelle Pitts, Robert H Pietrzak","doi":"10.1177/2470547019872172","DOIUrl":"10.1177/2470547019872172","url":null,"abstract":"<p><strong>Background: </strong>Although several studies have examined risk factors for suicidal ideation among veterans, little is known about risk and protective factors for suicidal ideation in high-risk veteran samples. Thus, this study examined a broad range of risk and protective factors associated with the development of suicidal ideation in a high-risk sample of U.S. veterans who screened positive for current posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD).</p><p><strong>Methods: </strong>Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative, prospective cohort study of U.S. veterans. Veterans completed self-report measures to screen for PTSD and MDD and to assess for risk and protective factors. The sample included 222 veterans with PTSD and/or MDD who did not endorse suicidal ideation at baseline and completed at least one assessment over a seven-year follow-up period. A multivariable binary logistic regression analysis was conducted to examine baseline factors associated with incident suicidal ideation.</p><p><strong>Results: </strong>Nearly one in three (27.1%) of veterans with PTSD and/or MDD developed suicidal ideation over the seven-year follow-up period. Non-Caucasian race and lower scores on measures of purpose in life, conscientiousness, and frequency of religious service attendance were independently associated with incident suicidal ideation. Lower purpose in life (52.3%) and conscientiousness (33.2%) explained the vast majority of variance in incident suicidal ideation.</p><p><strong>Conclusion: </strong>Nearly 30% of veterans with PTSD and/or MDD who did not endorse suicidal ideation at baseline developed suicidal ideation over a seven-year period. Prevention and treatment efforts designed to bolster purpose in life and conscientiousness may help mitigate risk for suicidal ideation in this high-risk population.</p>","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6880965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47112772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporoparietal Junction Functional Connectivity in Early Schizophrenia and Major Depressive Disorder.","authors":"Jacob Penner,&nbsp;Elizabeth A Osuch,&nbsp;Betsy Schaefer,&nbsp;Jean Théberge,&nbsp;Richard W J Neufeld,&nbsp;Ravi S Menon,&nbsp;Nagalingam Rajakumar,&nbsp;Peter C Williamson","doi":"10.1177/2470547018815232","DOIUrl":"https://doi.org/10.1177/2470547018815232","url":null,"abstract":"<p><strong>Background: </strong>The temporoparietal junction (TPJ) has been linked to lower-level attentional and higher-level social processing, both of which are affected in schizophrenia (SZ) and major depressive disorder (MDD). We examined resting functional connectivity of bilateral anterior and posterior TPJ in SZ and MDD to evaluate potential anomalies in each disorder and differences between disorders.</p><p><strong>Methods: </strong>Resting-state functional magnetic resonance imaging data were acquired from 24 patients with SZ, 24 patients with MDD, and 24 age-matched healthy controls. We performed seed-based functional connectivity analyses with seed regions in bilateral anterior and posterior TPJ, covarying for gender and smoking.</p><p><strong>Results: </strong>SZ had reduced connectivity versus controls between left anterior TPJ and dorsolateral prefrontal cortex (dlPFC) and posterior cingulate cortex (PCC); between left posterior TPJ and middle cingulate cortex, left dorsal PFC, and right lateral PFC; between right anterior TPJ and bilateral PCC; and between right posterior TPJ and middle cingulate cortex, left posterior insula, and right insula. MDD had reduced connectivity versus controls between left posterior TPJ and right dlPFC and between right posterior TPJ and PCC and dlPFC. SZ had reduced connectivity versus MDD between right posterior TPJ and left fusiform gyrus and right superior-posterior temporal cortex.</p><p><strong>Conclusion: </strong>Functional connectivity to the TPJ was demonstrated to be disrupted in both SZ and MDD. However, TPJ connectivity may differ in these disorders with reduced connectivity in SZ versus MDD between TPJ and posterior brain regions.</p>","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":" ","pages":"2470547018815232"},"PeriodicalIF":0.0,"publicationDate":"2018-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2470547018815232","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37962653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Default Mode Network Maturation and Environmental Adversities During Childhood.","authors":"Keila Rebello,&nbsp;Luciana M Moura,&nbsp;Walter H L Pinaya,&nbsp;Luis A Rohde,&nbsp;João R Sato","doi":"10.1177/2470547018808295","DOIUrl":"https://doi.org/10.1177/2470547018808295","url":null,"abstract":"<p><p>Default mode network (DMN) plays a central role in cognition and brain disorders. It has been shown that adverse environmental conditions impact neurodevelopment, but how these conditions impact in DMN maturation is still poorly understood. This article reviews representative neuroimaging functional studies addressing the interactions between DMN development and environmental factors, focusing on early life adversities, a critical period for brain changes. Studies focused on this period of life offer a special challenge: to disentangle the neurodevelopmental connectivity changes from those related to environmental conditions. We first summarized the literature on DMN maturation, providing an overview of both typical and atypical development patterns in childhood and early adolescence. Afterward, we focused on DMN changes associated with chronic exposure to environmental adversities during childhood. This summary suggests that changes in DMN development could be a potential allostatic neural feature associated with an embodiment of environmental circumstances. Finally, we discuss about some key methodological issues that should be considered in paradigms addressing environmental adversities and open questions for future investigations.</p>","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":" ","pages":"2470547018808295"},"PeriodicalIF":0.0,"publicationDate":"2018-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2470547018808295","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37962654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychotic-Like Symptoms and the Temporal Lobe in Trauma-Related Disorders: Diagnosis, Treatment, and Assessment of Potential Malingering.","authors":"Francesca L Schiavone,&nbsp;Margaret C McKinnon,&nbsp;Ruth A Lanius","doi":"10.1177/2470547018797046","DOIUrl":"https://doi.org/10.1177/2470547018797046","url":null,"abstract":"<p><strong>Objective: </strong>To overview the phenomenology, etiology, assessment, and treatment of psychotic-like symptoms in trauma-related disorders focusing on the proposed role of temporal lobe dysfunction.</p><p><strong>Method: </strong>We describe the literature pertaining to (i) psychotic-like symptoms and temporal lobe dysfunction in trauma-related disorders and (ii) psychological testing profiles in trauma-related disorders. We define trauma-related disorders as borderline personality disorder, post-traumatic stress disorder, and the dissociative disorders. Our search terms were dissociative disorders, temporal lobe, trauma, post-traumatic stress disorder, borderline personality disorder, psychosis, and malingering.</p><p><strong>Results: </strong>Trauma-related psychotic-like symptoms are common and can differ in phenomenology from primary psychotic symptoms. Hallucinations consist of auditory <i>and</i> nonauditory content that may or may not relate to traumatic content. Child voices are highly suggestive of complex dissociative disorders. Critically, not only do these symptoms resemble those seen in temporal lobe epilepsy, but the temporal lobe is implicated in trauma-related disorders, thus providing a plausible neurobiological explanation. Despite such evidence, these symptoms are frequently considered atypical and misdiagnosed. Indeed, common structured psychological assessment tools categorize these symptoms as possible indicators of invalid testing profiles.</p><p><strong>Conclusion: </strong>Psychotic-like symptoms are common in trauma-related disorders, may be related to temporal lobe dysfunction, and are frequently misinterpreted. This may lead to ineffective treatment and inappropriate determinations of malingering in the forensic system.</p>","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":" ","pages":"2470547018797046"},"PeriodicalIF":0.0,"publicationDate":"2018-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2470547018797046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37962651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of Self-Directedness and Cooperativeness in Relation to Post-Traumatic Stress Disorder Symptom Trajectories After Military Deployment.","authors":"Alieke Reijnen,&nbsp;Elbert Geuze,&nbsp;Rosalie Gorter,&nbsp;Eric Vermetten","doi":"10.1177/2470547018803511","DOIUrl":"https://doi.org/10.1177/2470547018803511","url":null,"abstract":"<p><strong>Background: </strong>Personality traits, such as the character traits self-directedness and cooperativeness, might play a role in the risk of developing post-traumatic stress disorder (PTSD) after deployment to a combat zone. However, it is unclear whether these traits are preexisting risk factors or if event-related changes might also be associated with PTSD symptoms over time. Therefore, the current aim was to assess if military deployment is associated with changes in cooperativeness and self-directedness and to study how these traits are related to PTSD symptom trajectories.</p><p><strong>Methods: </strong>In a large cohort of military personnel (N = 1007), measurements were performed before, at one and six months, and two and five years after deployment to Afghanistan. Linear mixed-effect models were used to assess the individual change in the traits over time and to study the relation with potential predictors.</p><p><strong>Results: </strong>Cooperativeness was found to remain stable, whereas self-directedness was found to slightly decrease over time. This decrease was related to the development of PTSD symptoms over time. Furthermore, lower levels of self-directedness were associated with the symptomatic trajectories of PTSD symptoms. Lower levels of cooperativeness were only associated with the recovered PTSD trajectory.</p><p><strong>Conclusions: </strong>So, not only do the findings confirm that lower levels of these character traits are associated with the development of PTSD symptoms, it was also shown that there are differences in the relation between these traits and the course of PTSD symptoms. Studying methods to promote the levels of these character traits might help to improve the resiliency of military personnel.</p>","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":" ","pages":"2470547018803511"},"PeriodicalIF":0.0,"publicationDate":"2018-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2470547018803511","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37962649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduction of Distress Intolerance With Salutotherapeutic Interventions: Results From a Randomized Controlled Clinical Trial.","authors":"Josephine Otto,&nbsp;Michael Linden","doi":"10.1177/2470547018800484","DOIUrl":"https://doi.org/10.1177/2470547018800484","url":null,"abstract":"<p><strong>Background: </strong>Distress tolerance is the ability to pursue one's goals in the presence of (chronic) stressors, hardship, adversities and negative internal states, and psychological distress. By contrast, distress intolerance is a transdiagnostic indicator of mental illness and a mediator in coping with problems in life, work demands, or stress in general. There is a lack of data regarding intervention strategies. The objective of the present study is to test the differential effects of two treatment approaches: \"regeneration fostering\" versus \"resistance training.\"</p><p><strong>Methods: </strong>Inpatients of a psychosomatic hospital were randomly allocated to either a resistance training group therapy (<i>n</i> = 65)-that is, active coping with demands and endurance-or a regeneration fostering group therapy (<i>n</i> = 62)-that is, recovery, mindful indulgence, and creative activities. They were compared with a group of patients who received treatment as usual (<i>n</i> = 43), without special treatments for distress intolerance, and the outcome was measured with the \"Distress Intolerance Scale.\" One-way and repeated measure analyses of variance and paired <i>t</i> tests were used for the analysis.</p><p><strong>Results: </strong>The \"regeneration\" group showed a significant improvement in distress intolerance, whereas there was no significant change for the treatment-as-usual group and in the \"resistance\" group. Post hoc tests were conducted with paired sample <i>t</i> tests for pre-post comparisons for each group. No differences were found for the treatment-as-usual group (<i>mean difference</i>: 0.03, <i>SD</i> (mean difference): 0.89; <i>t</i>(42) = 0.266, <i>p</i> = 0.792, <i>d</i> = 0.04) and for the resistance group (<i>mean difference</i>:-0.07, <i>SD</i> (mean difference): 0.73; <i>t</i>(63) = -0.736, <i>p</i> = 0.464, <i>d</i> = 0.08). The regeneration group showed a significant decline in distress intolerance (<i>mean difference</i>: 0.29, <i>SD</i> (mean difference): 0.72; <i>t</i>(61) = 3.156, <i>p</i> = 0.002, <i>d</i> = 0.38).</p><p><strong>Conclusions: </strong>In the treatment of distress intolerance, it seems promising to focus on positive psychology interventions and resources. Limitations of the study are that it was conducted with psychosomatic inpatients only and that no follow-up data are available.</p>","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":" ","pages":"2470547018800484"},"PeriodicalIF":0.0,"publicationDate":"2018-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2470547018800484","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37962652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Bias in Randomized Clinical Trials on Psychological Therapies for Post-Traumatic Stress Disorder in Adults.","authors":"Juliana Martins Scalabrin,&nbsp;Marcelo F Mello,&nbsp;Walter Swardfager,&nbsp;Hugo Cogo-Moreira","doi":"10.1177/2470547018779066","DOIUrl":"https://doi.org/10.1177/2470547018779066","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the factorial validity and internal consistency of a measurement model underlying risk of bias as endorsed by Cochrane for use in systematic reviews; more specifically, how the risk of bias tool behaves in the context of studies on psychological therapies used for treatment of post-traumatic stress disorder in adults.</p><p><strong>Methods: </strong>We applied confirmatory factor analysis to a systematic review containing 70 clinical trials entitled \"Psychological Therapies for Chronic Post-Traumatic Stress Disorder in Adults\" under a Bayesian estimator. Seven observed categorical risk of bias items (answered categorically as low, unclear, or high risk of bias) were collected from the systematic review.</p><p><strong>Results: </strong>A unidimensional model for the Cochrane risk of bias tool items returned poor fit indices and low factor loadings, indicating questionable validity and internal consistency.</p><p><strong>Conclusion: </strong>Although the present evidence is restricted to psychological interventions for post-traumatic stress disorder, it demonstrates that the way risk of bias has been measured in this context may not be adequate. More broadly, the results suggest the importance of testing the risk of bias tool, and the possibility of rethinking the methods used to assess risk of bias in systematic reviews and meta-analyses.</p>","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":" ","pages":"2470547018779066"},"PeriodicalIF":0.0,"publicationDate":"2018-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2470547018779066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37964763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}