BRIEF RESEARCH REPORT article
Front. Psychiatry
Sec. Anxiety and Stress Disorders
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1599424
This article is part of the Research TopicStress-induced Psychopathology: From Mechanisms to InterventionsView all 10 articles
Implications for Optimizing Treatment Timing: Day of Week Variation in PTSD Symptom Clusters
Provisionally accepted
Quinn M Biggs1,2*
Jing Wang1,2Carol S Fullerton1Rohul Amin1,3Joseph A Hooke1,2Natasha Dhanraj1Robert J Ursano1- 1Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, United States
- 2Henry M Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, Maryland, United States
- 3Walter Reed National Military Medical Center, Bethesda, Maryland, United States
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Introduction: Posttraumatic stress disorder (PTSD) has four symptom clusters: intrusion, avoidance, negative cognitions/mood, and hyperarousal. Little is known about day-to-day variation in the symptom clusters. If there is such variation, it highlights the need to develop more person-specific interventions. This study examined the day of the week and weekday versus weekend variation in PTSD symptom clusters in individuals with and without PTSD. Methods: Using an ecological momentary assessment methodology, participants (N=159; 80 with probable PTSD, 79 without PTSD) completed self-report assessments of posttraumatic stress symptoms (PTSS) four times daily for 15 days. Linear mixed models were used to examine associations between the seven days of the week and weekday versus weekend variation in PTSD symptom clusters and PTSD. Results: All four symptom clusters varied across the seven days of the week among participants with PTSD (intrusion: p=.038, avoidance: p<.001, negative cognitions/mood: p=.007, hyperarousal: p<.001), but not among those without PTSD. Among those with PTSD, the four symptom clusters were higher on weekdays than weekends (intrusion: p=.008, avoidance: p=.002, negative cognitions/mood: p<.001, and hyperarousal: p<.001). However, among those without PTSD, weekdays were higher than weekends only for the intrusion (p=.042) and hyperarousal (p=.017) clusters. Differences in when symptom clusters peaked were also noted. Conclusions: Among individuals with PTSD, the four symptom clusters vary by the day of the week with more symptoms on weekdays compared to weekends. Identification of the factors associated with day-to-day variation in PTSD symptom clusters may be important for understanding the neurobiology of PTSD and for treatment.
Keywords: posttraumatic stress disorder, symptom clusters, Ecological Momentary Assessment, Treatment timing, Military Personnel
Received: 25 Mar 2025; Accepted: 23 Sep 2025.
Copyright: © 2025 Biggs, Wang, Fullerton, Amin, Hooke, Dhanraj and Ursano. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Quinn M Biggs, quinn.biggs.ctr@usuhs.edu
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