title: Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth-a randomized controlled trial.
abstract: The aim of this study was to analyse the effects of trauma-focused guided Internet-based cognitive behaviour therapy for relieving posttraumatic stress disorder (PTSD) symptoms following childbirth, a problem that about 3% women encounter postpartum. Following inclusion, 56 traumatized women were randomized to either treatment or to a waiting list control group. Primary outcome measures were the Traumatic Event Scale (TES) and Impact of Event Scale-Reversed (IES-R). Secondary measures were Beck depression inventory II, Patient Health Questionnaire (PHQ-9), Beck Anxiety Inventory, Quality Of Life Inventory and the EuroQol 5 Dimensions. The treatment was guided by a clinician and lasted eight weeks and comprised eight modules of written text. The between-group effect size (ES) was d = .82 (p < .0001) for the IES-R. The ES for the TES was small (d = .36) and not statistically significant (p = .09). A small between-group ES (d = .20; p = .02) was found for the PHQ-9. The results from pre- to post-treatment showed large within-group ESs for PTSD symptoms in the treatment group both on the TES (d = 1.42) and the IES-R (d = 1.30), but smaller ESs in the control group from inclusion to after deferred treatment (TES, d = .80; IES-R d = .45). In both groups, the treatment had positive effects on comorbid depression and anxiety, and in the treatment group also on quality of life. The results need to be verified in larger trials. Further studies are also needed to examine long-term effects.
authors.affiliation: a Faculty of Medicine and Health Sciences, Unit of Medical Psychology, Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden.|b Department of Obstetrics and Gynaecology , Vrinnevisjukhuset , County Council of Östergötland, Norrköping , Sweden.
authors.forename: Katri
authors.initials: K
authors.lastname: Nieminen
authors.affiliation: c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden.
authors.forename: Ida
authors.initials: I
authors.lastname: Berg
authors.affiliation: c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden.
authors.forename: Katri
authors.initials: K
authors.lastname: Frankenstein
authors.affiliation: c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden.
authors.forename: Lina
authors.initials: L
authors.lastname: Viita
authors.affiliation: c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden.
authors.forename: Kamilla
authors.initials: K
authors.lastname: Larsson
authors.affiliation: c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Persson
authors.affiliation: c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden.
authors.forename: Loviisa
authors.initials: L
authors.lastname: Spånberger
authors.affiliation: c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Wretman
authors.affiliation: c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden.
authors.forename: Kristin
authors.initials: K
authors.lastname: Silfvernagel
authors.affiliation: c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden.|d Department of Clinical Neuroscience, Division of Psychiatry , Karolinska Institutet , Stockholm , Sweden.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
authors.affiliation: a Faculty of Medicine and Health Sciences, Unit of Medical Psychology, Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden.
authors.forename: Klaas
authors.initials: K
authors.lastname: Wijma
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D020407:Internet; D008875:Middle Aged; D036801:Parturition / Q000523:psychology*; D000073222:Patient Health Questionnaire; D011569:Psychiatric Status Rating Scales; D011644:Puerperal Disorders / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: Childbirth; Internet-based cognitive behaviour therapy (ICBT); posttraumatic stress disorder (PTSD); trauma-focused psychotherapy