| 1. |
- Bragesjö, Maria, et al.
(författare)
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Condensed internet-delivered prolonged exposure provided soon after trauma : A randomised pilot trial
- 2021
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 23
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Tidskriftsartikel (refereegranskat)abstract
- Exposure to trauma is common and may have detrimental psychological consequences. Brief exposure therapy provided early after trauma has shown encouraging results in promoting recovery. To scale up treatment availability, we developed a 3-week internet-delivered intervention comprised of four modules based on prolonged exposure (condensed internet-delivered prolonged exposure; CIPE) with therapist support. In this pilot study, we assessed the feasibility, acceptability, and preliminary efficacy of CIPE delivered within 2 months after the index event. Thirty-three participants were randomised to CIPE or a waiting list (WL). The frequency, vividness and distress of intrusive recollections or flashback memories of the traumatic event were assessed using an intrusive memory smartphone app. Symptoms of post-traumatic stress were assessed by the PTSD Symptom Checklist for DSM-5 (PCL-5). The most common index traumas in the sample were rape, interpersonal violence and life-threatening accidents. A majority of participants (82%) randomised to CIPE completed all modules, and the number of logins per participant to the Internet platform was high during the three-week intervention (M = 19.6, SD = 11.8). At post-treatment, the CIPE participants had a more favourable reduction than the WL group on the vividness and distress ratings, as well as on the PCL-5 sum score (bootstrapped d = 0.85; 95% CI [0.25-1.45]). Treatment effects were sustained at 6-months follow up and no severe adverse events associated with the intervention were found. CIPE seems to be a feasible and possibly efficacious early intervention after trauma. Large-scale trials are needed to assess its efficacy and long-term benefits.
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| 2. |
- Bragesjö, Maria, et al.
(författare)
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Condensed Internet-delivered prolonged exposure provided soon after trauma : a randomised trial
- 2021
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Ingår i: Psychological Medicine. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; , s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Background Exposure to trauma is common and can have a profoundly negative impact on mental health. Interventions based on trauma-focused cognitive behavioural therapy have shown promising results to facilitate recovery. The current trial evaluated whether a novel, scalable and digital early version of the intervention, Condensed Internet-Delivered Prolonged Exposure (CIPE), is effective in reducing post-traumatic stress symptoms.Method A single-site randomised controlled trial with self-referred adults (N = 102) exposed to trauma within the last 2 months. The participants were randomised to 3 weeks of CIPE or a waiting list (WL) for 7 weeks. Assessments were conducted at baseline, week 1–3 (primary endpoint), week 4–7 (secondary endpoint) and at 6-month follow-up. The primary outcome measure was PTSD Checklist for DSM-5 (PCL-5).Results The main analysis according to the intention-to-treat principle indicated statistically significant reductions in symptoms of post-traumatic stress in the CIPE group as compared to the WL group. The between-group effect size was moderate at week 3 (bootstrapped d = 0.70; 95% CI 0.33–1.06) and large at week 7 (bootstrapped d = 0.83; 95% CI 0.46–1.19). Results in the intervention group were maintained at the 6-month follow-up. No severe adverse events were found.Conclusions CIPE is a scalable intervention that may confer early benefits on post-traumatic stress symptoms in survivors of trauma. The next step is to compare this intervention to an active control group and also investigate its effects when implemented in regular care.
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| 3. |
- Bragesjö, Maria, et al.
(författare)
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Demanding and effective : participants' experiences of internet-delivered prolonged exposure provided within two months after exposure to trauma
- 2021
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Ingår i: European Journal of Psychotraumatology. - : Informa UK Limited. - 2000-8198 .- 2000-8066. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The use of remotely delivered early intervention after trauma may prevent and/or reduce symptoms of post-traumatic stress. Our research group evaluated a novel three-week therapist-guided internet-delivered intervention based on prolonged exposure (Condensed Internet-Delivered Prolonged Exposure; CIPE) in a pilot trial. The results indicated that the intervention was feasible, acceptable and reduced symptoms of post-traumatic stress at post-intervention compared to a waiting-list condition. Exposure to traumatic memories can be emotionally demanding and there is a need for detailed investigation of participants' experiences in receiving this type of intervention remotely.Objective: Investigate participants' experiences of receiving CIPE early after trauma.Method: In this study, qualitative thematic analysis was used and semi-structured interviews with 11 participants six months after intervention completion were conducted. All interviews were audio-recorded and transcribed verbatim.Results: One overarching theme labelled as 'demanding and effective' was identified. Participants expressed that treatment effects could only be achieved by putting in a lot of effort and by being emotionally close to the trauma memory during exposure exercises. Participants reported CIPE to be a highly credible- and educative intervention that motivated them to fully engage in exposure exercises. The most distressing parts of the intervention was perceived as tolerable and important to do to heal psychologically after trauma. For many participants, the possibility to engage in the intervention whenever and where it suited them was helpful, although some participants described it as challenging to find a balance between their own responsibility and when to expect therapist support. The internet-based format was perceived as a safe forum for self-disclosure that helped some participants overcome avoidance due to shame during imaginal exposure.Conclusion: CIPE was considered demanding, yet effective by the interviewed participants. The most distressing parts of the intervention was perceived to be the most important and were tolerable and feasible to provide online.
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| 4. |
- Holmes, Emily A., et al.
(författare)
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'I Can't Concentrate' : A Feasibility Study with Young Refugees in Sweden on Developing Science-Driven Interventions for Intrusive Memories Related to Trauma
- 2017
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Ingår i: Behavioural and Cognitive Psychotherapy. - : CAMBRIDGE UNIV PRESS. - 1352-4658 .- 1469-1833. ; 45:2, s. 97-109
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Tidskriftsartikel (refereegranskat)abstract
- Background: The number of refugees is the highest ever worldwide. Many have experienced trauma in home countries or on their escape which has mental health sequelae. Intrusive memories comprise distressing scenes of trauma which spring to mind unbidden. Development of novel scalable psychological interventions is needed urgently. Aims: We propose that brief cognitive science-driven interventions should be developed which pinpoint a focal symptom alongside a means to monitor it using behavioural techniques. The aim of the current study was to assess the feasibility and acceptability of the methodology required to develop such an intervention. Method: In this study we recruited 22 refugees (16-25 years), predominantly from Syria and residing in Sweden. Participants were asked to monitor the frequency of intrusive memories of trauma using a daily diary; rate intrusions and concentration; and complete a 1-session behavioural intervention involving Tetris game-play via smartphone. Results: Frequency of intrusive memories was high, and associated with high levels of distress and impaired concentration. Levels of engagement with study procedures were highly promising. Conclusions: The current work opens the way for developing novel cognitive behavioural approaches for traumatized refugees that are mechanistically derived, freely available and internationally scalable.
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| 5. |
- Kanstrup, Marie, et al.
(författare)
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A single case series using visuospatial task interference to reduce the number of visual intrusive memories of trauma with refugees
- 2021
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Ingår i: Clinical Psychology and Psychotherapy. - : John Wiley & Sons. - 1063-3995 .- 1099-0879. ; 28:1, s. 109-123
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Tidskriftsartikel (refereegranskat)abstract
- The current worldwide so-called "refugee crisis" has led to an unprecedented increase in migration globally. Because of stigma and language barriers, mental health care for refugees is limited. There is a need for novel, scalable psychological interventions. We investigated whether a brief behavioural intervention involving a memory reminder cue and Tetris gameplay on a smartphone reduces intrusive memories in refugees using a single case (N= 4) ABAB withdrawal design. The baseline phase (A) included a no-intervention week; the intervention phase (B) included an in-person session with the researchers, comprised of the behavioural intervention followed by self-guided use in daily life the following week. All participants reported a decrease in intrusive memories after the intervention, as well as functional improvements (e.g., in concentration). Importantly, participants rated the intervention as feasible and acceptable. As one in-person session was effective in persistent intrusion reduction, ABAB proved not to be the optimal design as intrusions did not rebound in the withdrawal phase. Findings are promising and highlight the need for further evaluation of novel interventions for mental health problems in refugees.
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| 6. |
- Kanstrup, Marie, et al.
(författare)
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Reaching people soon after a traumatic event : an exploratory observational feasibility study of recruitment in the emergency department to deliver a brief behavioral intervention via smartphone to prevent intrusive memories of trauma.
- 2021
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Ingår i: Pilot and feasibility studies. - : Springer Science and Business Media LLC. - 2055-5784. ; 7:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The current study explored how to recruit patients soon after a traumatic event, to deliver a novel intervention in a new emergency department in Sweden. This brief behavioral intervention aims to prevent intrusive memories and is delivered soon after trauma in the emergency department. In the UK, it has shown promising results. Traumatic events resulting in admission to the emergency department (e.g., road traffic accidents) may result in subsequent mental health problems such as post-traumatic stress disorder, where intrusive memories of the trauma constitute a core clinical feature. Early interventions that prevent intrusive memories after psychological trauma are lacking. Specific aims were to explore identification of eligible patients (aim 1), fitting in with emergency department staff routines to deliver the study protocol (aim 2), and using the patients' own smartphones to deliver intervention/control task (aim 3). Two changes to the previous study were (i) extending the trauma types included (ii) a new control condition, also by smartphone.METHODS: This is an explorative observational study. Data was both analyzed descriptively and using the Framework method.RESULTS: We identified several possible ways to recruit patients, and establish a sense of embeddedness in the Swedish emergency department context and a positive appreciation from staff. The study protocol was tested with 8 participants. Tasks both in the intervention and control condition were readily delivered via patients' own smartphones.CONCLUSION: Recruitment of patients and smartphone delivery of the intervention indicates initial feasibility. Researcher presence and administration of study procedures was successfully fitted to emergency department routines and well received by staff. Further pilot work is warranted, underscoring the importance of our collaboration between nursing and psychology.
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| 7. |
- Lauri, Klara Olofsdotter, et al.
(författare)
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Long-term effect of stepped-care vs in-person cognitive behavioral therapy for pediatric obsessive-compulsive disorder
- 2023
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 32
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Tidskriftsartikel (refereegranskat)abstract
- Long-term follow-up data from trials of digital mental health interventions are rare. This study reports 2-year follow-up data from a non-inferiority trial (N = 152) comparing stepped-care (internet-delivered cognitive behavioral therapy [CBT] followed by traditional in-person CBT if needed) vs in-person CBT for pediatric obsessive-compulsive disorder. Both treatment groups had comparable long-term effects, with the majority of participants being responders (stepped-care 66 %; in-person CBT 71 %) 2 years after the end of treatment.
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| 8. |
- Olofsdotter Lauri, Klara
(författare)
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Am I mad, bad or dangerous? : A novel intervention approach for unwanted intrusive thoughts
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Unwanted intrusive thoughts (UITs) containing unacceptable and taboo themes is regarded as a common and, for most, transient cognitive phenomenon. However, these thoughts can become so frequent and distressing that the individual’s daily functioning and well-being are impaired, even to the extent that the individual fulfils the criteria for obsessivecompulsive disorder (OCD). Among parents of infants and toddlers, distressing and impairing UITs, mainly of infant-related harm, are a very common symptom. Patients who suffer from OCD with taboo obsessions as well as parents with UITs of infant-related harm are reluctant to reveal their thoughts to healthcare personnel, due to the shame or stigma related to the thought content. Some OCD patients with taboo obsessions avoid seeking treatment and may respond less well to standard psychological treatment for OCD. There are no recommended treatment options for the larger population of parents who suffer from UITs. Therefore, there is a need to develop alternative treatments targeting both taboo obsessions among OCD patients and UITs among parents of infants and toddlers. Aims: The overall aim of this thesis was to develop and evaluate the effect and the mechanism of change of a novel, online intervention approach for OCD patients with taboo obsessions and for parents of infants and toddlers with distressing UITs of infant-related harm. Method: The online intervention developed and investigated in this thesis was based on the cognitive model of obsessions, and was evaluated among patients with OCD and taboo obsessions and parents of infants and toddlers with distressing UITs of infant-related harm. Study I was a pilot study including 19 patients with OCD, primarily taboo obsessions. The participants received therapist-supported online cognitive therapy (I-CT) for 10 weeks. Study II was a randomized controlled trial with a mediation analysis including 68 OCD patients with taboo obsessions. Participants were randomized to either the therapist-supported I-CT for eight weeks or control condition containing online general psychological support. Study III was a cross-sectional survey study including 594 parents of infants and toddlers. Study IV was a randomized controlled pilot trial with a mediation analysis including 43 parents of infants and toddlers who reported daily distressing UITs about intentionally harming their child. Participants were randomized to either eight-week self-guided I-CT or waiting-list control. Study V was a qualitative interview study using thematic analysis to investigate parents’ experiences of taking part in the self-guided I-CT for parents with excessive levels of UITs. Results: Results from Study I showed that intervention completion was high and that most participants were satisfied with the I-CT intervention. I-CT was associated with a large reduction in OCD-symptom severity (bootstrapped within-group d = 1.67 [95% CI; 0.67 to 2.66]). The effect was driven mainly by the participants who understood and were able to apply the cognitive model to their own situation. A time-series analysis indicated that the reduction of OCD-symptom severity was preceded by a reduction in negative appraisals of the taboo obsessions. In Study II, participants in both the I-CT group and the control condition had a significant reduction of OCD-symptoms from pre- to post-intervention. The reduction of OCD-symptoms was significantly larger in the I-CT group, with a moderate effect size (bootstrapped betweengroup d = 0.69 [95% CI; 0.20 to 1.19]). The mediation analysis revealed that 55% of the treatment effect was mediated by a reduction in negative appraisals. In Study III, 56% of the parents’ reported experiencing or previously having experienced UITs about intentionally harming their child. For around one fifth of the parents the UITs were difficult to control and/or had a negative impact on their relationship or attachment to the child. Positive attitudes toward internet-delivered interventions for UITs were endorsed by 51% of the parents. Study IV showed that participants randomized to the self-guided I-CT had a significantly larger reduction of UITs compared to participants in the waiting-list control condition (bootstrapped between-group d = 0.99 [95% CI; 0.56 to 1.43]). The effect of the intervention was mediated by a reduction in negative appraisals. The thematic analysis conducted in Study V divided the parents’ experiences of the selfguided I-CT into two main themes: (1) Changed perception of the unwanted intrusive thoughts, and (2) Different paths to recovery. Overall, results showed that the parents believed that the intervention was helpful by changing the way they interpreted their thoughts, and they reported experiencing several benefits in their daily life due to the intervention. Conclusions: I-CT targeting UITs is an acceptable and feasible intervention, both delivered in a therapist-guided format for OCD patients with taboo obsessions and in a self-guided format for parents with UITs of infant-related harm. Results from Studies I, II and VI suggest that the intervention is effective in reducing distressing and impairing taboo obsessions and UITs. The effect appears to be mediated by a change in negative appraisals. The online cognitive intervention is therefore a promising complementary intervention alternative to standard psychological treatments for OCD patients with taboo obsessions, and an easily accessible, scalable intervention for the large population of parents suffering from UITs.
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| 9. |
- Olofsdotter Lauri, Klara, et al.
(författare)
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An online self-guided cognitive intervention for unwanted intrusive thoughts about harming infants in new parents : initial randomised controlled trial with mediation analysis
- 2023
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Ingår i: Cognitive Behaviour Therapy. - 1650-6073 .- 1651-2316. ; 52:6, s. 585-602
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Tidskriftsartikel (refereegranskat)abstract
- Approximately one-fifth of new parents struggle with unwanted intrusive thoughts (UITs) about intentionally harming their child. This study evaluated the initial efficacy, feasibility and acceptability of a novel online self-guided cognitive intervention for new parents with distressing UITs. Self-recruited parents (N = 43, 93% female, age 23–43 years) of children 0–3 years reporting daily distressing and impairing UITs were randomized to the 8-week self-guided online cognitive intervention or to waiting-list. The primary outcome was change on the Parental Thoughts and Behaviour Checklist (PTBC) from baseline to week 8 (post-intervention). The PTBC and negative appraisals (mediator) were assessed at baseline, weekly, post-intervention and at the 1-month follow-up. Results showed that the intervention led to statistically significant reductions in distress and impairment associated with UITs at post-intervention (controlled between-group d = 0.99, 95% CI 0.56 to 1.43), which were maintained at the 1-month follow-up (controlled between-group d = 0.90, 95% CI 0.41 to 1.39). The intervention was deemed to be feasible and acceptable by the participants. Change in negative appraisals mediated reductions in UITs but the model was sensitive to mediator-outcome confounders. We conclude that this novel online self-guided cognitive intervention can potentially reduce the distress and impairment associated with UITs in new parents. Large-scale trials are warranted. Abbreviations: UITs: Unwanted Intrusive Thoughts PTBC: Parental Thoughts and Behaviour Checklist.
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| 10. |
- Olofsdotter Lauri, Klara, et al.
(författare)
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Perceived need of psychological support for taboo obsessions in new parents : A cross-sectional survey
- 2022
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Ingår i: Journal of Obsessive-Compulsive and Related Disorders. - : Elsevier BV. - 2211-3649. ; 34
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Tidskriftsartikel (refereegranskat)abstract
- Research has shown that many new parents experience taboo obsessions, which can lead to increased anxiety, depression, negative impact on parental function and quality of life. Many parents do not seek help due to shame or stigma. This cross-sectional survey study with self-recruited parents of infants and toddlers in Sweden explored: 1) the frequency and 2) impact of taboo obsessions, 3) whether negative appraisals could be a relevant factor for intervention, and 4) the perceived need for an intervention for taboo obsessions in this population. A total of 594 new parents filled out an online survey about taboo obsessions and the perceived need for psychological support. Fifty six percent reported currently experiencing or having previously experienced taboo obsessions and 54% responded that the taboo obsessions had a negative impact on their self-image. Additionally, 18–19% reported that the obsessions were difficult to control and/or had a negative impact on the relationship to the child. Importantly, 51% responded that they would absolutely or probably like to try online treatments for these intrusive thoughts. Keeping the limitations of a non-probabilistic online survey in mind, the results suggest that an online intervention targeting taboo obsessions in new parents could be well received.
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