Maria Bragesjö

Research Idea and PurposePost-traumatic stress disorder (PTSD) in children is a severe psychiatric condition that leads to significant suffering, impaired functioning, and an increased risk of suicide. Despite Trauma-focused Cognitive Behavioral Therapy (TF-CBT) being the recommended treatment, many children lack access to it within standard care. This project aims to address this gap by developing and evaluating the efficacy and cost-effectiveness of internet-mediated TF-CBT (iTF-CBT) for children with PTSD, thereby increasing the availability of evidence-based treatment.Work Plan, Methods, and Project RealisationThe primary objective is to evaluate the efficacy and cost-effectiveness of iTF-CBT in a randomized controlled trial (RCT) with 140 participants, compared to an active control group. An internal pilot phase with 20 participants will assess the feasibility and acceptability of recruitment and treatment, as well as gather feedback through interviews with children and their families to refine the intervention.Participants will be recruited nationally through self-registration and clinician referrals. Data collection will occur at baseline, post-treatment, and follow-ups at 1 month (primary endpoint), 6 months, and 12 months. Assessments will be conducted by evaluators blinded to treatment groups, ensuring objective results. The requested funds are specifically to support this pilot phase.Societal Relevance and UtilisationThis project directly supports Forte´s strategic agenda and the UN´s Sustainable Development Goals by addressing the significant unmet need for accessible PTSD treatment in children. The healthcare system is under pressure due to rising costs and a high prevalence of PTSD among refugee children. iTF-CBT offers a cost-effective, evidence-based solution that can be widely implemented, reducing healthcare costs through shorter waiting times and more efficient use of therapist resources.The digital format of iTF-CBT also allows for easy translation into other languages, enhancing accessibility. Its flexibility empowers children to engage in therapy on their own terms, improving adherence and outcomes. If the pilot is successful, we will seek funding for a full-scale RCT to further validate this innovative treatment approach.

Research problem and specific questionsPost-traumatic stress disorder (PTSD) is a debilitating psychiatric condition strongly linked to subsequent psychiatric and medical problems and increased risk to die by suicide. Evidence based treatment such as prolonged exposure are seldom available in regular care.  60% of patients fail to demonstrate clinically significant symptom change. One reason for the low success rate is that a high proportion of patients drop out of treatment. Hence, there is an urgent need for treatments that can decrease dropout rates and increase availability. A more intensive treatment approach has been suggested to achieve faster recovery rate as well as a decreased dropout rate.  Is intensive exposure-based treatment (I-PE) more efficacious than weekly delivered sessions regarding PTSD symptoms, drop out and cost-effectiveness?Data and methodThe main objectives are to investigate long-term efficacy, potential mechanisms of change and cost-effectiveness of intensive exposure-based treatment (I-PE) for PTSD in a randomized controlled trial (N=140) comparing I-PE with weekly delivered exposure-based treatment. Outcome measures will include, but not be limited to, gold-standard clinician rated symptoms of PTSD, dropout rate, speed of recovery, and health economical aspects.Societal relevance and utilizationThe proposed project contributes to Forte’s strategic agenda and UN’s Sustainable Development Goals. There is large gap between need of treatment and supply. I-PE may be a more cost-effective, evidence-based treatment for PTSD that results in a faster recovery rate, decreased dropouts and increased availability of treatment. In addition, it can potentially decrease societal and health care costs through more efficient administration of treatment, reduced waiting times, reduced therapist resources, and less sick leave.Plan for project realizationParticipants will be recruited through referrals to Traumaprogrammet, Psykiatri Sydväst, where a feasibility study (N=35) has showed the intervention and recruitment procedures to be feasible and the treatment to preliminarily be effective. All procedures and treatment have been refined based on interviews with the participants. Clinician and self-administered measures will be used at baseline, during treatment, post-treatment, 1-month (primary endpoint), 6-month, and 12-month follow-up by assessors blinded to treatment allocation. Funding from Forte is sought for three years.