title: Early avoidance of disease- and treatment-related distress predicts post-traumatic stress in parents of children with cancer.
abstract: OBJECTIVE
  It has previously been demonstrated that parents of children with cancer often exhibit symptoms of post-traumatic stress (PTSS) even though the child's treatment is successfully completed. For the development of interventions we need to identify predictors of PTSS, which are possible to influence. Based on contemporary learning theory, it was hypothesized that early avoidance of disease- and treatment-related distress would predict the development of parental post-traumatic stress after completion of the child's cancer treatment.
  
  
  METHODS
  Parents' cognitive and behavioural avoidance of disease- and treatment-related distressing stimuli during and immediately after a child's cancer treatment and PTSS one year after the end of treatment was investigated. Data was collected with the PTSD Checklist Civilian Version (PCL-C) from 111 mothers and 109 fathers.
  
  
  RESULTS
  As hypothesized, avoidance during (T1-T3) and immediately after (T4) the child's treatment predicted PTSS among parents one year after (T6) completion of the child's treatment. Moreover, avoidance early on during the child's treatment seemed to be a greater risk factor for PTSS and post-traumatic stress disorder (PTSD) for bereaved than non-bereaved parents.
  
  
  CONCLUSIONS
  Avoiding reminders of stressful experiences related to a child's cancer disease during and immediately after the child's treatment seems to increase the risk for parents, mothers and fathers alike, of experiencing symptoms of post-traumatic stress later. Interventions based on cognitive behavioural therapy with elimination of avoidance as a central component may be of use in this population.
authors.affiliation: Department of Public Health and Caring Sciences, Psychosocial Oncology and Supportive Care, Uppsala University, BMC, Uppsala, Sweden. Annika.Lindahl.Norberg@pubcare.uu.se
authors.forename: Annika
authors.initials: A
authors.lastname: Lindahl Norberg
authors.forename: Ulrika
authors.initials: U
authors.lastname: Pöder
authors.forename: Louise
authors.initials: L
authors.lastname: von Essen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001294:Attitude to Health; D001362:Avoidance Learning; D001601:Bereavement; D002648:Child; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000175:diagnosis / Q000628:therapy; D024802:Nurse's Role; D015404:Nursing Methodology Research; D010290:Parents / Q000193:education / Q000523:psychology*; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology*; D013548:Sweden; D013997:Time Factors