Early and later responses to trauma

Sometimes, I read two articles and feel confused, so I have decided to share my confusion today. Both studies look at trauma, one early on and one later. First, Kim et al. (2026) published “Multidimensional Resiliency Factors and Psychopathology after Acute Trauma: Results from a prospective cohort study” in Psychological Trauma: Theory, Research, Practice, and Policy.  Here are the edited abstract and impact statement:

Preventing posttraumatic psychopathology (e.g., depression or posttraumatic stress disorder [PTSD]) following an acute traumatic event requires attention to modifiable factors that may protect against such psychopathology. In this study, we aimed to identify the relative contributions of resiliency factors across multiple domains to posttraumatic psychopathology and to delineate subcomponents that may be most influential. This study leveraged prospective data from 2,043 trauma-exposed individuals recruited from emergency departments in the Advancing Understanding of RecOvery afteR traumA Study. We first used structural equation modeling to examine higher level regulatory and interpersonal strength domains following acute trauma exposure and their relative associations with symptoms of depression or PTSD at 3 months posttrauma. We then tested which specific factors within these domains were associated with 3-month symptoms. Both regulatory and interpersonal strength domains were linked to fewer symptoms of depression and PTSD 3 months later, though relational strengths were more strongly associated than regulatory strengths when modeled together. Within interpersonal strengths, higher levels of emotional support and supportive networks, but not social engagement, were associated with lower depressive and PTSD symptoms. Within regulatory strengths, trait resilience was associated with lower depressive and PTSD symptoms, and self-efficacy showed mixed associations, whereas mindfulness (measured as nonreactively observing internal experiences) was associated with higher symptoms.  Findings suggest enhancing interpersonal resiliency, above and beyond regulatory strengths, may be crucial in the aftermath of acute trauma, with emotional support and supportive networks as especially strong potential buffers against posttraumatic psychopathology.

The acute aftermath of a traumatic event presents a crucial window for preventing the development of depression and posttraumatic stress disorder. This study suggests that above and beyond regulatory strengths, relational factors play an outsized role during this period, pointing to interventions that target interpersonal contexts—especially supportive resources—following acute trauma exposure. This study also raises the possibility that factors generally seen as beneficial, such as awareness of one’s inner experiences, could be linked to greater distress in the short term. Overall, this study points to multiple domains of resiliency and specific factors within these domains as promising levers for early intervention

I liked this study for several reasons. First, it’s a huge sample and a prospective study of the first three months after hospitalization. Second, they examine both regulatory and interpersonal strength factors, finding that emotional support and social networks are highly protective as is resilience. Interestingly, however, social engagement didn’t especially help and self-efficacy had mixed associations. Most interesting to me for this examination is the finding that mindfulness “measured as nonreactively observing internal experiences” actually related to higher symptoms. However, the next study finds benefits of mindfulness. Khalifian, Glassman, Mackintosh, Grubbs, Herbert & Morland (2026) published “Improvement in Mindful Awareness during Prolonged Exposure Treatment Leads to Reduction in Posttraumatic Stress Disorder (PTSD) Symptoms and Anger Expression” in Psychological Trauma: Theory, Research, Practice, and Policy.  Again, the edited abstract and impact statement

Anger is a problematic symptom of posttraumatic stress disorder (PTSD) that causes significant distress, and it is often reported as a residual symptom following PTSD treatment. Although gold-standard treatments for PTSD can reduce anger, the mechanisms underlying this effect remain unknown. This study examines whether a gold-standard PTSD treatment, Prolonged Exposure, improves veterans’ mindful awareness and if that change leads to a reduction in PTSD symptoms and anger expression. This is a secondary data analysis of veterans randomly assigned to prolonged exposure delivered through home-based telehealth (n = 58), office-based telehealth (n = 59), or in-home, in-person treatment (n = 58). Veterans completed pre-, post-, and 6-month follow-up assessments of anger, as measured by the State and Trait Anger Expression Inventory-2, and PTSD symptoms PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5, as well as pre- and post-assessments of mindful awareness, as measured by the Mindful Attention Awareness Scale. Pre- to posttreatment improvement in mindful awareness was related to a reduction in both anger up (β = −0.84, p < .001) and PTSD symptoms (β = −0.79, p < .001) from baseline to 6-month follow-up. Specific components of prolonged exposure (e.g., in vivo and imaginal exposures) may improve mindful awareness, and findings suggest that improvement in mindful awareness reduces PTSD symptoms and anger expression.

These findings suggest that mindfulness may increase during prolonged exposure therapy, even without direct mindfulness training. Increases in mindful awareness were linked to greater reductions in posttraumatic stress disorder and anger over time, suggesting that learning to stay present and nonjudgmental may help patients tolerate distress and express emotion more effectively. Integrating brief mindfulness practices into prolonged exposure could further support fear extinction, emotional flexibility, and grounding without avoidance. Clinicians might consider incorporating structured mindfulness training alongside exposure exercises to strengthen emotional regulation and enhance recovery for individuals with posttraumatic stress disorder. 

This is a smaller sample of veterans and looks only at anger after prolonged exposure therapy. However, like many studies of PTSD and mindfulness, it finds mindfulness practices to be beneficial. This makes me wonder whether, in the immediate aftermath of trauma, as in the Kim et al. study, the inward focus of mindfulness actually heightens PTSD symptoms, but later in treatment, mindfulness training is more beneficial. I will look for more work on this issue.