There is a lack of consistent definition and operationalization of “brain fog” in the research literature, limiting current understandings of its phenomenology and implications for assessment and intervention. Given this, the current review synthesized available research on “brain fog” in those with PTSD and identified several themes including the association of cognitive complaints with PTSD symptoms, the role of physical and mental health comorbidities, considerations for assessment and intervention, as well as important areas of future investigation. The included RCTs36,37 assessed PTSD symptom severity using the CAPS-5, the PTSD Checklist for DSM-5 (PCL-5), and the PSS-IV. In addition, symptoms of depression and anxiety, functional impairment, perceived social support, working alliance, and treatment satisfaction were assessed using various scales. A list of the scales used in both included RCTs36,37 is provided in Appendix 2, Table 3, and a brief explanation of some of the commonly used scales is provided in Appendix 2, Table 4.

CBT for PTSD as a comorbid psychiatric condition

In the absence of timely intervention and psychological support, the disorder may precipitate a progressive decline in emotional, behavioral, and cognitive well-being, potentially culminating in suicidal ideation and behavior 19. For instance, exposure to childhood maltreatment has been identified as a significant risk factor for suicide in later life 20. Furthermore, individuals diagnosed with PTSD demonstrate an increased propensity for substance dependence, which exacerbates the burden of substance abuse and addiction, imposing a substantial socioeconomic and public health challenge 21. These findings underscore the profound impact of post-traumatic stress disorder (PTSD) on diverse societal groups, jeopardizing individual health, family stability, and posing a latent risk to society at large. A meta-analysis of 20 randomized controlled trials involving a total of 2085 adolescents diagnosed with PTSD was conducted.

The multiphase approach versus the unimodal approach

In addition to BPD, comorbidity occurs with depressive and anxiety disorders, drug and alcohol use problems, dissociative and somatic symptom disorders (Longo Reference Longo, Cecora and Rossi2019) and, not least, with quasi-psychotic symptoms. In addition, the general tendency towards dissociation appears to be considerably higher in ICD-11 CPTSD than in PTSD (Hyland Reference Hyland, Murphy and Shevlin2017). Therefore, a familiarity with the features of dissociation is important in the management of someone with CPTSD. Indeed, where the main symptom in a patient’s presentation is dissociation, so that the diagnosis is a dissociative disorder, the underlying cause still frequently appears to be ‘aversive and traumatic childhood experiences’. In this scenario, the dissociative disorder and CPTSD appear to be ‘aetiologically co-determined’ (Vonderlin Reference Vonderlin, Kleindienst and Alpers2018). The RCT by Littleton et al.37 measured symptoms of anxiety using the Four Dimensional Anxiety Scale (FDAS).

Exclusion Criteria

The systematic review by Sijbrandij et al.5 included studies that compared iCBT versus inactive control or active interventions. Overall, the experience of “brain fog” or subjective cognitive complaints is frequently reported among individuals with trauma, PTSD, and other related mental health concerns. It is unclear whether symptoms of “brain fog” always converge with objective measurements of cognitive deficits, however they nonetheless represent a form of functional impairment and suffering that may interfere with treatment. Given this significance, there are several clinical implications and considerations when clients with PTSD or trauma present reporting “brain fog”. Validation of the scales cognitive behavioral therapy and tools to screen for “brain fog” symptoms in PTSD may also be useful.

Selection Criteria and Methods

The control group received access to a psycho-educational website that contained informational content from the first three treatment modules (which focused on relaxation, grounding, and coping strategies). The website did not contain multimedia content or interactive exercises from the iCBT program. A limited literature search was conducted on key resources including Medline, PsycINFO, PubMed (for non-Medline records), the Cochrane Library, University of York Centre for Reviews and Dissemination (CRD) databases, Canadian and major international health technology agencies, as well as a focused Internet search. Methodological filters were applied to limit retrieval to randomized controlled trials (RCTs), non-randomized studies, health technology assessments, systematic reviews, and meta-analyses. The search was also limited to English language documents published between Jan 1, 2008 and Sep 25, 2018.

• Patients have memories of past trauma in several mental disorders, but the characteristic of the trauma memories in PTSD is that they are experienced as if the trauma were repeating ‘here and now’.
• Five mind–body interventions were found to be effective in treating PTSD symptoms in adolescents, with TF-CBT emerging as the most effective treatment.
• The included RCTs36,37 assessed PTSD symptom severity using the CAPS-5, the PTSD Checklist for DSM-5 (PCL-5), and the PSS-IV.
• It might be appropriate to involve other mental health professionals (such as a social worker) in safety planning to ensure that the external circumstances, such as emergency shelter plans, childcare and crisis mental healthcare plans, are attended to before the work on the trauma memory processing begins.
• Based on the SUCRA values for different outcomes, cluster ranking analysis was conducted to identify the optimal physical and psychological treatment group.
• Some patients who have CPTSD feel that they have had significant losses and hence it is not just about ‘reclaiming their lives’ but about ‘rebuilding their lives’.

• It usually takes two or three ‘sittings’ of imaginal reliving to access the hot spots sufficiently.
• Patients who present with CPTSD have had awful experiences in their life and, understandably, forming a trusting therapeutic relationship is unlikely to be easy.
• The relevant studies included patients who experienced trauma resulting from pregnancy loss, terrorism, combat, or mixed events.
• Numerous systematic reviews and meta-analyses have evaluated the efficacy of psychological and psychosocial treatments for PTSD in children and adolescents 39,40,41.
• For people with PTSD, the trauma and its aftermath tend to have highly threatening personal meanings that go beyond what other people would find horrific about the situation (Ehlers 2000).

However, only primary studies in populations with clinical levels of PTSD were considered relevant for our review. The relevant RCTs included those who had experienced trauma including war, terror, or diverse events. The number of participants in the individual RCTs ranged between 44 and 159, with a total of 373 participants included. The review by Olthuis et al.14 included adults (≥18 years of age) with a primary diagnosis of PTSD or subclinical PTSD according to the DSM.

Trauma-focused CBT (TF-CBT) is a cognitive behavioral treatment recommended by the American Psychological Association (APA) for PTSD in kids. If you have PTSD, your therapist might start by trying to understand your thought patterns and how they might have been impacted by the trauma you experience. CBT can be used for treating trauma because it can help you identify how traumatic experiences may have affected your thoughts and behaviors. We would like to thank St. Joseph’s Healthcare Hamilton medical librarian what is alcoholism Kaitryn Campbell for her assistance in our literature search.