| 1. |
- Lotzin, Annett, et al.
(author)
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A longitudinal study of risk and protective factors for symptoms of adjustment disorder during the COVID-19 pandemic
- 2024
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In: European Journal of Psychotraumatology. - : Taylor & Francis. - 2000-8198 .- 2000-8066. ; 15:1
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Journal article (peer-reviewed)abstract
- Background: The COVID-19 pandemic caused multiple stressors that may lead to symptoms of adjustment disorder.Objective: We longitudinally examined relationships between risk and protective factors, pandemic-related stressors and symptoms of adjustment disorder during the COVID-19 pandemic, as well as whether these relationships differed by the time of assessment.Method: The European Society for Traumatic Stress Studies (ESTSS) ADJUST Study included N = 15,169 participants aged 18 years and above. Participants from 11 European countries were recruited and screened three times at 6-month intervals from June 2020 to January 2022. Associations between risk and protective factors (e.g. gender), stressors (e.g. fear of infection), and symptoms of adjustment disorder (AjD, ADNM-8) and their interaction with time of assessment were examined using mixed linear regression.Results: The following predictors were significantly associated with higher AjD symptom levels: female or diverse gender; older age; pandemic-related news consumption >30 min a day; a current or previous mental health disorder; trauma exposure before or during the pandemic; a good, satisfactory or poor health status (vs. very good); burden related to governmental crisis management and communication; fear of infection; restricted social contact; work-related problems; restricted activity; and difficult housing conditions. The following predictors were associated with lower AjD levels: self-employment or retirement; working in healthcare; and face-to-face contact ≥ once a week with loved ones or friends. The effects of the following predictors on AjD symptoms differed by the time of assessment in the course of the pandemic: a current or previous mental disorder; burden related to governmental crisis management; income reduction; and a current trauma exposure.Conclusions: We identified risk factors and stressors predicting AjD symptom levels at different stages of the pandemic. For some predictors, the effects on mental health may change at different stages of a pandemic.
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| 2. |
- Lotzin, Annett, et al.
(author)
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Risk and protective factors, stressors, and symptoms of adjustment disorder during the COVID-19 pandemic – First results of the ESTSS COVID-19 pan-European ADJUST study
- 2021
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In: European Journal of Psychotraumatology. - : Taylor & Francis. - 2000-8198 .- 2000-8066. ; 12:1
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Journal article (peer-reviewed)abstract
- BackgroundThe COVID-19 pandemic exposes individuals to multiple stressors, such as quarantine, physical distancing, job loss, risk of infection, and loss of loved ones. Such a complex array of stressors potentially lead to symptoms of adjustment disorder.Objective This cross-sectional exploratory study examined relationships between risk and protective factors, stressors, and symptoms of adjustment disorder during the first year of the COVID-19 pandemic.MethodsData from the first wave of the European Society of Traumatic Stress Studies (ESTSS) longitudinal ADJUST Study were used. N = 15,563 participants aged 18 years and above were recruited in eleven countries (Austria, Croatia, Georgia, Germany, Greece, Italy, Lithuania, the Netherlands, Poland, Portugal, and Sweden) from June to November 2020. Associations between risk and protective factors (e.g. gender, diagnosis of a mental health disorder), stressors (e.g. fear of infection, restricted face-to-face contact), and symptoms of adjustment disorder (ADNM-8) were examined using multivariate linear regression.ResultsThe prevalence of self-reported probable adjustment disorder was 18.2%. Risk factors associated with higher levels of symptoms of adjustment disorder were female gender, older age, being at risk for severe COVID-19 illness, poorer general health status, current or previous trauma exposure, a current or previous mental health disorder, and longer exposure to COVID-19 news. Protective factors related to lower levels of symptoms of adjustment disorder were higher income, being retired, and having more face-to-face contact with loved ones or friends. Pandemic-related stressors associated with higher levels of symptoms of adjustment disorder included fear of infection, governmental crisis management, restricted social contact, work-related problems, restricted activity, and difficult housing conditions.ConclusionsWe identified stressors, risk, and protective factors that may help identify individuals at higher risk for adjustment disorder.
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| 3. |
- Bragesjö, Maria, et al.
(author)
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Condensed internet-delivered prolonged exposure provided soon after trauma : A randomised pilot trial
- 2021
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In: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 23
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Journal article (peer-reviewed)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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| 4. |
- Bragesjö, Maria, et al.
(author)
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Condensed Internet-delivered prolonged exposure provided soon after trauma : a randomised trial
- 2021
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In: Psychological Medicine. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; , s. 1-10
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Journal article (peer-reviewed)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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| 5. |
- Bragesjö, Maria, et al.
(author)
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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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In: European Journal of Psychotraumatology. - : Informa UK Limited. - 2000-8198 .- 2000-8066. ; 12:1
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Journal article (peer-reviewed)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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| 6. |
- Bragesjö, Maria, et al.
(author)
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Early Psychological Intervention After Rape : A Feasibility Study
- 2020
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In: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 11
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Journal article (peer-reviewed)abstract
- Rape is the most common trauma leading to post-traumatic stress disorder (PTSD) among women, with a conditioned prevalence of up to 50%. PTSD is considered to be a lethal condition associated with increased risk of suicide, drug- and alcohol dependence, neurological- and vascular problems, as well as sick leave. Given the scope of this problem, novel and swiftly delivered interventions for this large vulnerable population are clearly warranted. One previous trial conducted in the United States (N= 137) showed that an adapted brief version of prolonged exposure (PE) to the fearful memory of the event and situations, provided in the immediate aftermath after trauma (<72 h after a traumatic event), was effective in reducing early PTSD symptoms in rape victims. The aims of the present study were to adapt the brief PE protocol to a Swedish context and investigate its feasibility and delivery in 10 executive patients recruited at the Emergency Clinic for Rape Victims in Stockholm. Ten participants were provided with three sessions of early PE with overall successful results in terms of session attendance, home-work compliance, and also symptom reduction of PTSD and depressive symptoms. However, only a fraction of the screened patients at the Emergency Clinic (5.2%) were eligible to be included in the study, where the majority (40%) were excluded due to the time criteria of 72 h. In this article, we will present detailed results of the intervention and elaborate on how to increase feasibility of preventive interventions for rape victims. In the current form, providing PE with the strict time criteria was not feasible in the clinical setting that constitutes the Emergency Department for rape.
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| 7. |
- Bragesjö, Maria
(author)
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Novel intervention approaches after recent exposure to trauma
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Background: The life-time incidence of exposure to traumatic events is high and can have a profound negative impact on mental health. The majority of individuals exposed to trauma will go through a process of natural recovery and experience short-lived reactions. The most widely reported long-term reactions in the traumatic stress literature are acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). After intentional traumatic events, one-third of the exposed will develop PTSD in the first year. That stresses the necessity and importance of early scalable interventions to alleviate initial reactions and change the trajectory away from a chronic course. The key precursor for PTSD is exposure to a specific traumatic event which allows for early identification and intervention. Early psychological interventions based on trauma-focused cognitive behavioural therapy (CBT-T) has shown promising results, especially for those who meet the diagnostic threshold for ASD. Aims: The general aim of this thesis was to develop and evaluate novel early psychological interventions after exposure to a potentially traumatic event(s) (PTE) in order to facilitate recovery and reduce immediate distress. The specific aims of each study in this thesis were to investigate: x The feasibility, acceptability and efficacy of brief prolonged exposure (PE) provided face-to-face in the early aftermath of a potentially traumatic event in an emergency hospital setting and at an emergency department for rape victims (Studies I and II); x The feasibility, acceptability and efficacy of condensed internet-delivered PE (CIPE) in the early aftermath of a potentially traumatic event (Studies III and V); x The participants experience of CIPE in the early aftermath of a potentially traumatic event (Study IV). Methods: Five studies (I-V) that evaluated PE as an early intervention after trauma using different types of methodology in recruitment, assessment and form of delivery were conducted within this doctoral project. Study I and II investigated feasibility, acceptability and efficacy of PE delivered face-to-face within 72 hours of exposure to trauma. Study I was a randomised controlled trial (RCT) with the original aim to allocate 352 participants to three sessions of PE or non-directive support. Study II evaluated feasibility of the same face-to-face protocol for rape victims in a non-randomised pilot study (N=10). In study III, a condensed internetdelivered prolonged exposure intervention was developed and tested for feasibility, acceptability and preliminary effects in a pilot randomised trial (N=33) when provided within the first two months after exposure to trauma. Study IV (N=11) used a qualitative thematic analysis to explore participants experiences of the intervention. Study V was a randomised trial (N=102) with the aim to investigate the effectiveness of CIPE against a waiting list up to 7 weeks from baseline. Results: In study I, we experienced problems with high attrition and low recruitment rate and the trial was terminated beforehand due to unexpected organisational changes at the recruiting site. In study II, the compliance to the intervention in terms of session attendance and homework assignments completion was high. Nevertheless, only a small proportion of patients at the recruiting clinic were eligible for the study. Study III showed that CIPE was feasible, acceptable and preliminary led to greater reductions in post-traumatic stress symptoms compared to the waiting list group. Data from study IV showed that participants found CIPE to be a demanding yet effective intervention. Participants described CIPE as a credible, tolerable and educative intervention that motivated them to engage in exposure. Imaginal exposure was perceived to be both the most important in recovery after trauma and also the most distressing one. Study V demonstrated that CIPE was more effective in reducing symptoms of post-traumatic stress than the waiting list group up to 7 weeks after baseline. The between-group effect size was in the moderate range at intervention completion after 3 weeks (bootstrapped d=0.71 [95% CI; 0.33 to 1.05]) and large at the 1-month follow up (bootstrapped d=0.83; [95% CI 0.46 to 1.19]). Results were maintained after six months. No serious adverse events associated with the intervention were found in either of the studies. Conclusions: The results from the studies in this thesis put the light on that recruiting participants from Swedish emergency hospitals and delivering an early intervention face-toface within the first 72 hours of exposure to trauma was not as feasible as originally expected. A change in methodology was therefore necessary. The time-frame from exposure to trauma and inclusion was extended, an indicated approach to inclusion was used and the recruitment, assessment and intervention procedures were transferred to an online format (CIPE). Results indicate that CIPE was a feasible, acceptable and effective early intervention after trauma when delivered within the first two months after exposure to PTE to symptomatic individuals. CIPE could greatly increase access to this type of intervention and may prove to be a highly scalable intervention with the benefit to be used in the exact moment when needed.
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| 8. |
- Bragesjö, Maria, et al.
(author)
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Prevention of post-traumatic stress disorder : Lessons learned from a terminated RCT of prolonged exposure
- 2021
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:5
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Journal article (peer-reviewed)abstract
- The main purpose of the current trial was to test if a brief trauma-focused cognitive-behaviour therapy protocol (prolonged exposure; PE) provided within 72 h after a traumatic event could be effective in decreasing the incidence of post-traumatic stress disorder (PTSD), thus replicating and extending the findings from an earlier trial. After a pilot study (N = 10), which indicated feasible and deliverable study procedures and interventions, we launched an RCT with a target sample size of 352 participants randomised to either three sessions of PE or non-directive support. Due to an unforeseen major reorganisation at the hospital, the RCT was discontinued after 32 included participants. In this paper, we highlight obstacles and lessons learned from our feasibility work that are relevant for preventive psychological interventions for PTSD in emergency settings. One important finding was the high degree of attrition, and only 75% and 34%, respectively, came back for the 2-month and 6-month assessments. There were also difficulties in reaching eligible patients immediately after the event. Based on our experiences, we envisage that alternative models of implementation might overcome these obstacles, for example, with remote delivery of both assessments and interventions via the internet or smartphones combined with multiple recruitment procedures. Lessons learned from this terminated RCT are discussed in depth.
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| 9. |
- Bragesjö, Maria, et al.
(author)
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Primary prevention and epidemiology of trauma and stress related disorders
- 2020. - 3
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In: The New Oxford Textbook of Psychiatry. - Oxford, UK : Oxford University Press. ; , s. 860-868
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Book chapter (peer-reviewed)abstract
- Post-traumatic stress disorder and acute stress disorder are mental health conditions with a known onset, and prevention strategies can therefore be used to try to prevent the emergence of the full-blown disorder. This chapter provides an overview of the current evidence-based prevention strategies for post-traumatic stress disorder and acute stress disorder. In the first part, diagnostic and epidemiological features of these disorders are considered. The second part of the chapter reviews the evidence base of current preventive psychological and pharmacological interventions. Although some early trials on primary intervention have shown promising effects, it appears too soon to provide any definite recommendation in clinical practice. Importantly, many current widely disseminated treatments lack evidence, and some interventions (for example, debriefing) may, in fact, have a negative impact on the natural recovery after trauma. This chapter highlights the importance of using science-driven interventions to prevent post-traumatic stress disorder and acute stress disorder.
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| 10. |
- Eklund, Rakel, 1986-, et al.
(author)
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Daily uplifts during the COVID-19 pandemic : what is considered helpful in everyday life?
- 2022
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In: BMC Public Health. - : Springer Nature. - 1471-2458. ; 22:1
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Journal article (peer-reviewed)abstract
- BackgroundKnowledge of what is uplifting and helpful during pandemics could inform the design of sustainable pandemic recommendations in the future. We have explored individuals’ views on helpful and uplifting aspects of everyday life during the coronavirus disease 2019 (COVID-19) pandemic.MethodsParticipants answered a brief, daily survey via text messages during 14 consecutive days in July–August, 2020. The survey included the question: “During the past 24 hours, is there anything that has made you feel good or helped you in your life?” We used content analysis to compile responses from 693 participants, who provided 4,490 free-text answers, which resulted in 24 categories subsumed under 7 themes.ResultsPositive aspects during the COVID-19 pandemic primarily related to social interactions, in real life or digitally, with family, friends and others. Other important aspects concerning work, colleagues and maintaining everyday life routines. One theme concerning vacations, going on excursions and being in nature. Leisure and recreation activities, such as hobbies and physical exercise, also emerged as important, as did health-related factors. Bodily sensations, thoughts, feelings and activities that benefited well-being were mentioned frequently. Lastly, people commented on the government strategies for containing COVID-19, and whether to comply with restrictions.ConclusionsTo summarize, daily uplifts and helpful aspects of everyday life centered around social relationships. To comply with recommendations on physical distancing, people found creative ways to maintain social connections both digitally and face-to-face. Social interaction, maintenance of everyday life routines, hobbies and physical activity appeared to be important for well-being.
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