| 1. |
- Hales, Susie A., et al.
(författare)
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Imagery-Focused Cognitive Therapy (ImCT) for Mood Instability and Anxiety in a Small Sample of Patients with Bipolar Disorder : a Pilot Clinical Audit
- 2018
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Ingår i: Behavioural and Cognitive Psychotherapy. - : CAMBRIDGE UNIV PRESS. - 1352-4658 .- 1469-1833. ; 46:6, s. 706-725
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite the global impact of bipolar disorder (BD), treatment success is limited. Challenges include syndromal and subsyndromal mood instability, comorbid anxiety, and uncertainty around mechanisms to target. The Oxford Mood Action Psychology Programme (OxMAPP) offered a novel approach within a cognitive behavioural framework, via mental imagery-focused cognitive therapy (ImCT). Aims: This clinical audit evaluated referral rates, clinical outcomes and patient satisfaction with the OxMAPP service. Method: Eleven outpatients with BD received ImCT in addition to standard psychiatric care. Mood data were collected weekly from 6 months pre-treatment to 6 months post-treatment via routine mood monitoring. Anxiety was measured weekly from start of treatment until 1 month post-treatment. Patient feedback was provided via questionnaire. Results: Referral and treatment uptake rates indicated acceptability to referrers and patients. From pre- to post-treatment, there was (i) a significant reduction in the duration of depressive episode relapses, and (ii) a non-significant trend towards a reduction in the number of episodes, with small to medium effect size. There was a large effect size for the reduction in weekly anxiety symptoms from assessment to 1 month follow-up. Patient feedback indicated high levels of satisfaction with ImCT, and underscored the importance of the mental imagery focus. Conclusions: This clinical audit provides preliminary evidence that ImCT can help improve depressive and anxiety symptoms in BD as part of integrated clinical care, with high patient satisfaction and acceptability. Formal assessment designs are needed to further test the feasibility and efficacy of the new ImCT treatment on anxiety and mood instability.
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| 2. |
- Holmes, Emily A., et al.
(författare)
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Can We Develop a “Cognitive Therapeutic Vaccine” for the Early Hours After Trauma to Prevent the Recurrence of Intrusive Memories of Trauma?
- 2020
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Ingår i: Risk Management of Terrorism Induced Stress. - Amsterdam, The Netherlands : IOS Press. ; , s. 66-71
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Bokkapitel (refereegranskat)abstract
- Intrusive memories of a traumatic event are distressing, vivid mental images that spring to mind unbidden, and the core clinical symptom in PTSD (Posttraumatic Stress Disorder) and ASD (Acute Stress Disorder). We propose that a brief science-derived intervention can be delivered in the first few hours after a traumatic event as a so-called “cognitive therapeutic vaccine” to prevent the recurrence of intrusive memories of trauma. Our approach differs from traditional talking therapies in various ways including: a) focusing on one core clinical symptom as a treatment target, rather than a whole disorder; b) deriving a novel type of intervention technique informed by neuroscientific insights and experimental research, rather than adapting existing psychotherapy techniques; c) aiming for scalability from the onset, rather than an adaptation of face-to face therapy. The behavioural intervention technique was developed in the laboratory with a focus on perceptual intrusive memory. It uses cognitive task interference as a hypothesised blockade of sensory mental imagery during trauma memory consolidation to reduce the frequency of intrusive memories of trauma. In early tests of clinical translation from the laboratory to real-world single event trauma, the technique has involved a 25-minute, single-session procedure (including Tetris computer game play), delivered in a hospital within 6 hours of a traumatic event. Results of two proof-of-concept trials provide initial support for the efficacy of the intervention: there were fewer intrusive memories compared to control when delivered in hospital within 6 hours following both traumatic motor vehicle accidents (Iyadurai et al., 2018) and traumatic childbirth (Horsch et al., 2017). Both studies indicated that the intervention was met with acceptability. Future trials are warranted as well as mechanistic research with cultural adaptability in mind.
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| 3. |
- Holmes, Emily A., et al.
(författare)
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Erasing trauma memories
- 2010
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Ingår i: British Journal of Psychiatry. - : CAMBRIDGE UNIV PRESS. - 0007-1250 .- 1472-1465. ; 197:5, s. 414-415
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 4. |
- Horsch, Antje, et al.
(författare)
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Reducing intrusive traumatic memories after emergency caesarean section : A proof-of-principle randomized controlled study
- 2017
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Ingår i: Behaviour Research and Therapy. - : PERGAMON-ELSEVIER SCIENCE LTD. - 0005-7967 .- 1873-622X. ; 94, s. 36-47
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Tidskriftsartikel (refereegranskat)abstract
- Preventative psychological interventions to aid women after traumatic childbirth are needed. This proof of-principle randomized controlled study evaluated whether the number of intrusive traumatic memories mothers experience after emergency caesarean section (ECS) could be reduced by a brief cognitive intervention. 56 women after ECS were randomized to one of two parallel groups in a 1:1 ratio: intervention (usual care plus cognitive task procedure) or control (usual care). The intervention group engaged in a visuospatial task (computer-game 'Tetris' via a handheld gaming device) for 15 min within six hours following their ECS. The primary outcome was the number of intrusive traumatic memories related to the ECS recorded in a diary for the week post-ECS. As predicted, compared with controls, the intervention group reported fewer intrusive traumatic memories (M = 4.77, SD = 10.71 vs. M = 9.22, SD = 10.69, d = 0.647 [95% CI: 0.106,1.182]) over 1 week (intention-to-treat analyses, primary outcome). There was a trend towards reduced acute stress re-experiencing symptoms (d = 0.503 [95% CI: -0.032, 1.033]) after 1 week (intention-to-treat analyses). Times series analysis on daily intrusions data confirmed the predicted difference between groups. 72% of women rated the intervention "rather" to "extremely" acceptable. This represents a first step in the development of an early (and potentially universal) intervention to prevent postnatal posttraumatic stress symptoms that may benefit both mother and child. Clinical trial registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT02502513. (C) 2017 The Authors. Published by Elsevier Ltd.
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| 5. |
- Iyadurai, Lalitha, et al.
(författare)
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Intrusive memories of trauma : A target for research bridging cognitive science and its clinical application.
- 2019
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Ingår i: Clinical Psychology Review. - : Elsevier BV. - 0272-7358 .- 1873-7811. ; 69, s. 67-82
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Tidskriftsartikel (refereegranskat)abstract
- Intrusive memories of a traumatic event can be distressing and disruptive, and comprise a core clinical feature of post-traumatic stress disorder (PTSD). Intrusive memories involve mental imagery-based impressions that intrude into mind involuntarily, and are emotional. Here we consider how recent advances in cognitive science have fueled our understanding of the development and possible treatment of intrusive memories of trauma. We conducted a systematic literature search in PubMed, selecting articles published from 2008 to 2018 that used the terms "trauma" AND ("intrusive memories" OR "involuntary memories") in their abstract or title. First, we discuss studies that investigated internal (neural, hormonal, psychophysiological, and cognitive) processes that contribute to intrusive memory development. Second, we discuss studies that targeted these processes using behavioural/pharmacological interventions to reduce intrusive memories. Third, we consider possible clinical implications of this work and highlight some emerging research avenues for treatment and prevention, supplemented by new data to examine some unanswered questions. In conclusion, we raise the possibility that intrusive memories comprise an alternative, possibly more focused, target in translational research endeavours, rather than only targeting overall symptoms of disorders such as PTSD. If so, relatively simple approaches could help to address the need for easy-to-deliver, widely-scalable trauma interventions.
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| 6. |
- Iyadurai, Lalitha, et al.
(författare)
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Reducing intrusive memories after trauma via an imagery-competing task intervention in COVID-19 intensive care staff : a randomised controlled trial
- 2023
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Ingår i: Translational Psychiatry. - : Springer Nature. - 2158-3188. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Intrusive memories (IMs) after traumatic events can be distressing and disrupt mental health and functioning. We evaluated the impact of a brief remotely-delivered digital imagery-competing task intervention on the number of IMs for intensive care unit (ICU) staff who faced repeated trauma exposure during the COVID-19 pandemic using a two-arm, parallel-group, single-blind randomised controlled trial, with the comparator arm receiving delayed access to active treatment (crossover). Eligible participants worked clinically in a UK NHS ICU during the pandemic and had at least 3 IMs of work-related traumatic events in the week before recruitment. Participants were randomly assigned (1:1) to immediate (weeks 1-4) or delayed (weeks 5-8) intervention access. Sequential Bayesian analyses to optimise the intervention and increase trial efficiency are reported elsewhere [1]. The primary endpoint for the pre-specified frequentist analysis of the final study population compared the number of IMs experienced in week 4 between the immediate and delayed access arms. Secondary outcomes included clinical symptoms, work functioning and wellbeing. Safety was assessed throughout the trial by scheduled questions and free report. All analyses were undertaken on an intention-to-treat basis (86 randomised participants). There were significantly fewer intrusive memories during week 4 in the immediate (median = 1, IQR = 0-3, n = 43), compared to the comparator delayed arm (median = 10, IQR = 6-17, n = 43), IRR 0.31, 95% CI: 0.20-0.48, p < 0.001. After crossover, the delayed arm also showed a significant reduction in IMs at week 8 compared to week 4. There were convergent findings for symptoms of PTSD, insomnia and anxiety, work engagement and burnout, general functioning and quality of life. The intervention was found safe and acceptable to participants. All adverse events were unrelated to the study. Our study provides the first evidence of a benefit on reducing IMs, improving other clinical symptoms, work functioning and wellbeing, as well as safety of a brief remotely-delivered digital imagery-competing task intervention. An efficacy trial with an active control and longer follow-up is warranted. The trial is registered at ClinicalTrials.gov (NCT04992390).
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| 7. |
- Iyadurai, Lalitha, et al.
(författare)
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Targeting intrusive imagery using a competing task technique : a case study
- 2020
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Ingår i: Behavioural and Cognitive Psychotherapy. - : CAMBRIDGE UNIV PRESS. - 1352-4658 .- 1469-1833. ; 48:6, s. 739-744
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Tidskriftsartikel (refereegranskat)abstract
- Background: Even in cases with complexity, simple techniques can be useful to target a specific symptom. Intrusive mental images are highly disruptive, drive emotion, and contribute to maintaining psychopathology. Cognitive science suggests that we might target intrusive images using competing tasks. Aims: We describe an imagery competing task technique within cognitive behavioural therapy (CBT) with a patient with bipolar disorder and post-traumatic stress disorder (PTSD) symptoms. The intervention - including Tetris computer game-play - was used (1) to target a specific image within one therapy session, and (2) to manage multiple images in daily life. Method: A single case (AB) design was used. (1) To target a specific image, the patient brought the image to mind and, after mental rotation instructions and game-play practice, played Tetris for 10 minutes. Outcomes, pre- and post-technique, were: vividness/distress ratings when the image was brought to mind; reported intrusion frequency over a week. (2) To manage multiple images, the patient used the intervention after an intrusive image occurred. Outcomes were weekly measures of: (a) imagery characteristics; (b) symptoms of PTSD, anxiety, depression and mania. Results: (1) For the target image, there were reductions in vividness (80% to 40%), distress (70% to 0%), and intrusion frequency (daily to twice/week). (2) For multiple images, there were reductions from baseline to follow-up in (a) imagery vividness (38%), realness (66%) and compellingness (23%), and (b) PTSD symptoms (Impact of Events Scale-Revised score 26.33 to 4.83). Conclusion: This low-intensity intervention aiming to directly target intrusive mental imagery may offer an additional, complementary tool in CBT.
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| 8. |
- Kanstrup, Marie, et al.
(författare)
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A simple cognitive task intervention to prevent intrusive memories after trauma in patients in the Emergency Department : A randomized controlled trial terminated due to COVID-19
- 2021
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Ingår i: BMC Research Notes. - : BioMed Central (BMC). - 1756-0500. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveThis randomised controlled trial (RCT) aimed to investigate the effects of a simple cognitive task intervention on intrusive memories ("flashbacks") and associated symptoms following a traumatic event. Patients presenting to a Swedish emergency department (ED) soon after a traumatic event were randomly allocated (1:1) to the simple cognitive task intervention (memory cue + mental rotation instructions + computer game "Tetris" for at least 20 min) or control (podcast, similar time). We planned follow-ups at one-week, 1-month, and where possible, 3- and 6-months post-trauma. Anticipated enrolment was N = 148.ResultsThe RCT was terminated prematurely after recruiting N = 16 participants. The COVID-19 pandemic prevented recruitment/testing in the ED because: (i) the study required face-to-face contact between participants, psychology researchers, ED staff, and patients, incurring risk of virus transmission; (ii) the host ED site received COVID-19 patients; and (iii) reduced flow of patients otherwise presenting to the ED in non-pandemic conditions (e.g. after trauma). We report on delivery of study procedures, recruitment, treatment adherence, outcome completion (primary outcome: number of intrusive memories during week 5), attrition, and limitations. The information presented and limitations may enable our group and others to learn from this terminated study.
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| 9. |
- 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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| 10. |
- Kanstrup, Marie, et al.
(författare)
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Reducing intrusive memories after trauma via a brief cognitive task intervention in the hospital emergency department : an exploratory pilot randomised controlled trial
- 2021
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Ingår i: Translational Psychiatry. - : Springer Nature. - 2158-3188. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Intrusive memories are common after trauma, and can cause significant distress. Interventions to prevent/reduce the occurrence of this core clinical feature of posttraumatic stress disorder are needed; they should be easy to deliver, readily disseminated and scalable. A novel one-session intervention by Iyadurai et al. 2018, Molecular Psychiatry, resulted in intrusion reduction over the subsequent week. Its feasibility in a different setting and longer-term effects (>1 month) need investigation. We conducted an exploratory open-label pilot randomised controlled trial (RCT) to investigate the feasibility and effects of a brief behavioural intervention to reduce intrusive memories in trauma-exposed patients in a Swedish hospital emergency department (ED). Participants (final N = 41) were randomly allocated to either intervention (including memory reminder cue then visuospatial cognitive task “Tetris” with mental rotation instructions) or active control (podcast) condition within 72 h of presenting to the ED (both conditions using their smartphone). Findings were examined descriptively. We estimated between-group effect sizes for the number of intrusive memories post-intervention at week 1 (primary outcome) and week 5 (secondary outcome). Compared to the control condition, participants in the intervention condition reported fewer intrusive memories of trauma, both at week 1 and week 5. Findings extend the previous evaluation in the UK. The intervention was readily implemented in a different international context, with a mixed trauma sample, with treatment gains maintained at 1 month and associated with some functional improvements. Findings inform future trials to evaluate the capacity of the cognitive task intervention to reduce the occurrence of intrusive memories after traumatic events.
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| 11. |
- Luik, Annemarie I, et al.
(författare)
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Sleep disturbance and intrusive memories after presenting to the emergency department following a traumatic motor vehicle accident : an exploratory analysis.
- 2019
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Ingår i: European Journal of Psychotraumatology. - : Informa UK Limited. - 2000-8198 .- 2000-8066. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sleep disturbances are common after traumatic events and have been hypothesized to be a risk factor in the development of psychopathology such as that associated with posttraumatic stress disorder (PTSD). Objective: To assess the association between intrusive memories, a core clinical feature of PTSD, and self-reported sleep disturbance shortly after experiencing or witnessing a motor vehicle accident, and whether a brief behavioural intervention (trauma reminder cue and Tetris gameplay) reduced sleep disturbance post-trauma. Method: The exploratory analyses included 71 participants (mean age 39.66, standard deviation 16.32; 37 women, 52.1%) enrolled in a previously published proof-of-concept randomized controlled trial. Participants were recruited from the emergency department after experiencing or witnessing a traumatic motor vehicle accident. Intrusive memories were assessed with a daily paper-and-pen diary for one week post-trauma, and sleep disturbances with three questions from the Impact of Event Scale-Revised assessing problems initiating sleep, problems maintaining sleep and dreams about the event at one week and one month post-trauma. Missing data were imputed 15 times. Results: The total number of intrusive memories during the first week post-trauma suggested weak to moderate pooled intercorrelations with problems initiating and maintaining sleep. An ordinal regression using imputed data suggested that the intervention had no effect on sleep disturbances, while completers only analyses suggested an improvement in problems maintaining sleep at one week. Conclusions: This exploratory study suggested that experiencing early intrusive memories is related to sleep disturbances. Sleep disturbance might be a particularly important construct to assess in studies involving intrusive memories post-trauma.
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| 12. |
- Patel, Priya, et al.
(författare)
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Using a Novel Gameplay Intervention to Target Intrusive Memories After Work-Related Trauma : Iterative Qualitative Analysis of Intensive Care Unit Staff Experiences
- 2024
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Ingår i: JMIR Formative Research. - : JMIR Publications. - 2561-326X. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many intensive care unit (ICU) staff experience intrusive memories following work-related traumatic events, which can lead to long-term mental health outcomes and impact work functioning. There is a need for interventions that target intrusive memories in this population; however, factors such as mental health stigma and difficulty in fitting interventions into busy schedules can pose barriers. The Brief Gameplay Intervention For National Health Service Intensive Care Unit Staff Affected By COVID-19 Trauma (GAINS) study tested a brief, digital imagery-competing task intervention (including computer gameplay) with the aim of reducing the recurrence of intrusive memories, which holds promise for overcoming some of these barriers.Objective: This substudy aims to explore barriers and facilitators to the uptake and practical use of the intervention by ICU staff, along with its acceptability, and iteratively explore the impact of intervention optimizations to further refine the intervention.Methods: The GAINS study is a randomized controlled trial comparing access to a brief digital imagery-competing task intervention for 4 weeks with usual care followed by delayed access to the intervention. The participants were ICU staff who worked during the COVID-19 pandemic and experienced intrusive memories. All participants were sent a questionnaire at 4 weeks to gather data about intervention acceptability. Nested within the randomized controlled trial, a subset of 16 participants was interviewed, and data were analyzed using thematic analysis drawing from a framework approach.Results: Both quantitative and qualitative data indicated high acceptability of the intervention. Intervention use data show that, on average, staff were able to target approximately 73% (3.64/4.88) of their intrusive memories and engaged with the Tetris component for the full 20 minutes per session. Overall, on the acceptability questionnaire, staff found the intervention easy to use, helpful, and highly acceptable. The interviews generated four themes: approach to the intervention, positives of the intervention, negatives of the intervention, and improvements and optimizations. Findings highlighted barriers that ICU staff experienced: stigma, feeling weak for seeking help, not wanting colleagues to know they were struggling, and skepticism. However, they provided suggestions on how barriers could be overcome and discussed the advantages of the intervention when compared with other treatments. Although participants described many positive aspects of the intervention, such as being easy to use, enjoyable, and leading to a reduction in the frequency or intensity of intrusive memories, they also raised practical issues for implementation.Conclusions: The intervention has the potential to overcome stigma and reduce the frequency of intrusive memories after traumatic events among ICU staff. Further refinement is needed to improve the adoption and reach of this intervention. A limitation is that we could not interview the National Health Service staff who were unable or unwilling to take part in the trial.
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| 13. |
- Porcheret, Kate, et al.
(författare)
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Sleep and intrusive memories immediately after a traumatic event in emergency department patients
- 2020
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Ingår i: Sleep. - : Oxford University Press (OUP). - 0161-8105 .- 1550-9109. ; 43:8
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Tidskriftsartikel (refereegranskat)abstract
- Study objectives: Intrusive memories of psychological trauma are a core clinical feature of posttraumatic stress disorder (PTSD), and in the early period post-trauma may be a potential target for early intervention. Disrupted sleep in the weeks post-trauma is associated with later PTSD. The impact of sleep and intrusive memories immediately post-trauma, and their relation to later PTSD, is unknown. This study assessed the relationship between sleep duration on the first night following a real-life traumatic event and intrusive memories in the subsequent week, and how these might relate to PTSD symptoms at 2 months.Methods: Patients (n = 87) recruited in the emergency department completed a sleep and intrusive memory diary from the day of their trauma and for the subsequent week, with optional actigraphy. PTSD, anxiety, and depression symptoms were assessed at 1 week and 2 months.Results: A U-shaped relationship was observed between sleep duration on the first night and intrusive memories over the subsequent week: sleeping "too little" or "too much" was associated with more intrusive memories. Individuals who met Clinician-Administered PTSD Scale (CAPS) criteria for PTSD at 2 months had three times more intrusive memories in the first week immediately post-trauma than those who did not (M = 28.20 vs 9.96). Post hoc analysis showed that the absence of intrusive memories in the first week post-trauma was only observed in those who did not meet CAPS criteria for PTSD at 2 months.Conclusions: Monitoring intrusive memories and sleep in the first week post-trauma, using a simple diary, may help identify individuals more vulnerable to later psychopathology.
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| 14. |
- Ramineni, Varsha, et al.
(författare)
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Treating intrusive memories after trauma in healthcare workers: a Bayesian adaptive randomised trial developing an imagery-competing task intervention
- 2023
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Ingår i: Molecular Psychiatry. - : Springer Nature. - 1359-4184 .- 1476-5578. ; 28:7, s. 2985-2994
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Tidskriftsartikel (refereegranskat)abstract
- Intensive care unit (ICU) staff continue to face recurrent work-related traumatic events throughout the COVID-19 pandemic. Intrusive memories (IMs) of such traumatic events comprise sensory image-based memories. Harnessing research on preventing IMs with a novel behavioural intervention on the day of trauma, here we take critical next steps in developing this approach as a treatment for ICU staff who are already experiencing IMs days, weeks, or months post-trauma. To address the urgent need to develop novel mental health interventions, we used Bayesian statistical approaches to optimise a brief imagery-competing task intervention to reduce the number of IMs. We evaluated a digitised version of the intervention for remote, scalable delivery. We conducted a two-arm, parallel-group, randomised, adaptive Bayesian optimisation trial. Eligible participants worked clinically in a UK NHS ICU during the pandemic, experienced at least one work-related traumatic event, and at least three IMs in the week prior to recruitment. Participants were randomised to receive immediate or delayed (after 4 weeks) access to the intervention. Primary outcome was the number of IMs of trauma during week 4, controlling for baseline week. Analyses were conducted on an intention-to-treat basis as a between-group comparison. Prior to final analysis, sequential Bayesian analyses were conducted (n = 20, 23, 29, 37, 41, 45) to inform early stopping of the trial prior to the planned maximum recruitment (n = 150). Final analysis (n = 75) showed strong evidence for a positive treatment effect (Bayes factor, BF = 1.25 × 106): the immediate arm reported fewer IMs (median = 1, IQR = 0–3) than the delayed arm (median = 10, IQR = 6–16.5). With further digital enhancements, the intervention (n = 28) also showed a positive treatment effect (BF = 7.31). Sequential Bayesian analyses provided evidence for reducing IMs of work-related trauma for healthcare workers. This methodology also allowed us to rule out negative effects early, reduced the planned maximum sample size, and allowed evaluation of enhancements. Trial Registration NCT04992390 (www.clinicaltrials.gov).
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