Take Your Sexuality Back - a Feasibility Study of a New Intervention for Sexually Traumatized Women: Preliminary Evaluations of Efficacy and Outcome Measurements
Phase: NA
Conditions: Posttraumatic Stress Symptoms, Sexual Abuse, Sexual Trauma
Sponsor: Sykehuset Telemark

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Take your sexuality back - a feasibility study of a new intervention for sexually traumatized 
women  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
1. Scientific background and significance 
Traumatized sexuality is a significant women's health issue. According to a Norwegian study 
from 2023, 1 in 5 women report being subjected to rape by force or coercion, rape during 
sleep, or both (1). The risk of developing Post-Traumatic Stress Disorder (PTSD) following 
sexual abuse is higher than that associated with other types of traumas (2, 3), underscoring 
the severe impact on victims. Sexual abuse, characterized by violations of personal 
boundaries, can profoundly affect individual`s relationship with their body and sexuality (4, 5). 
Common sexual symptoms post-trauma include dissociation or intrusive memories during 
sexual activity, shame and guilt concerning the body and sexuality, a perceived obligation to 
satisfy the partner's needs, engagement in high-risk sexual behaviors, relational difficulties, 
and sexual dysfunctions (4, 6, 7). For many abused women, intimacy with a partner is so 
closely associated with pain and trauma that it leads to dysfunctional relational patterns and 
sexual challenges within a partnership (8, 9).  
 
Traditional approaches to trauma treatment have shown minimal improvement in sexual 
dysfunctions after abuse (10). Researchers and advocacy groups have emphasized the 
necessity of integrating a focus on intimacy and sexuality within psychological therapies to 
facilitate the rehabilitation of clients' sexual health and to include eventual partners in the 
process (8, 11-14). A growing body of research underscores that sexual shame plays a 
critical role in maintaining sexual dysfunctions, prompting researchers and clinicians to call 
for interventions that can resolve sexual shame (15-17). Group therapy has been suggested 
as a particularly effective intervention for targeting sexual shame, creating a space where it is 
possible to talk about both natural and traumatized sexuality, normalizing sexual trauma 
symptoms, and enabling connection with others in similar situations (13, 15, 18). 
 
Gewirtz-Meydan's review of empirical research on the treatment of sexual dysfunctions after 
sexual abuse identified six therapeutic approaches (13). Only one of them was designed for 
use in a group setting; however, it was only tested and validated on a non-clinical population, 
included only two group sessions, relied on participants practicing on their own and did not 
involve partners (13, 19). This highlights a significant gap in evidence-based practices that 
integrate trauma-focused and sex therapy techniques for treating survivors of sexual trauma 
in a clinical population of patients with high symptom pressure (10, 13, 20). Consequently, to 
be able to respond to the needs of the large number of sexually traumatized women referred 
to Telemark Hospital Trust (STHF), we developed a new group-based intervention named 
"Take Your Sexuality Back" (TYSB), tailored to the needs of these women. Many of them 
had experienced long-term complex childhood traumas and had profound sexual post-
traumatic symptoms that prevented them from experiencing intimacy as something positive. 
Our goal of this PhD project is to establish a scientific foundation for a novel group-
based treatment intervention to rehabilitate the sexuality of women who have 
experienced sexual trauma. There is an urgent need to gather insights into the 
experiences of participants and their partners in order to identify necessary 
improvements, evaluate the intervention's potential efficacy and gain a more 
comprehensive understanding of treatment outcomes before initiating a larger 
randomized controlled trial, and implementing the intervention in the healthcare system. 
We will obtain data from interviews with group participants and their partners, as well as 
from measurements taken before, after, and at follow-up. This feasibility study has the 
potential to improve the quality of health services, and benefit patients in specialist 
healthcare, sexually traumatized women and their partners in general, and the research 
community. Our research group has extensive experience and expertise in this field, 
and the project aligns with the research strategies of both STHF and HSØ.   

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We designed the TYSB intervention to be trauma-sensitive, focusing on traumatized 
sexuality and incorporating regulatory skills to prevent re-traumatization when addressing 
sex-positive themes, thus accommodating a wide range of trauma-related symptoms, sexual 
shame, sexual dysfunctions, and regulation difficulties (21-24). 
 
We have continually evaluated and developed TYSB since 2019. A collaboration between 
the Norwegian Women's Sanitary Association (NKS) and STHF resulted in a 
psychoeducational book (23) and dissemination of knowledge about traumatized sexuality 
across women's health centers nationwide (25). The TYSB intervention consists of 12 weekly 
sessions (2.5 hours each) and a half-hour video session with repetition of exercises two days 
after each session. The treatment integrates psychoeducation, exercises, reflections, and 
sharing in a group (table 1). Examples of exercises include strengthening personal 
boundaries, self-regulation, awakening the senses, handling triggers, body awareness, and 
reflecting on sexual schemas. In sessions 4 and 10, we invite partners to participate. 
Participants without partners also join these sessions to gain valuable rehearsal and insight 
into how to communicate with a future partner.  
Textbox 1: Overview of central themes covered in the TYSB intervention  
Session  Theme 
Session  Theme 
1 
The history of sexuality 
How to rebuild personal boundaries 
7 
Sexual arousal patterns and fantasies. 
The dynamics of change processes. 
2 
Reflecting over one´s own sexual history. 
Strengthening self-compassion and selfcare 
8 
Relationships, communication skills and 
steps to overcome fear of intimacy. 
3 
Common aftereffects of sexual trauma.  
Sexual shame and self-regulation. 
9 
Ways to restart couple sexuality. 
Building sexual intimacy step by step. 
4 
Session with partners.  
Repetition and deepening of session 3  
10 
Session with partners. Repetition and 
deepening of sessions 8 and 9. 
5 
Handling of outer and inner triggers. 
The female body and functions of the vulva. 
11 
Deepening of themes from all sessions.  
New insights and experiences. 
6 
Self-touching, masturbation, and orgasm. 
Steps to overcome hindrances. 
12 
Further integration of themes. Plans for 
continued practice at home. 
 
The next critical step in the development of TYSB is to conduct a comprehensive feasibility 
study. This will assess its potential efficacy and appropriateness for the target group before 
we can write a final course manual and proceed to a larger Randomized Control Study 
(RCT).  
 
1.1 Innovations elements and improvements 
 
Despite sexuality being a central aspect of human life and an important health factor, 
interventions targeting traumatized sexuality are missing in public healthcare. The TYSB 
intervention emerges thus as a novel contribution to this field, eliciting significant interest 
from mental health clinics and sexologists both within Norway and internationally.  
 
Traditional trauma treatment has a limited effect on sexual symptoms, which leads to 
unsatisfactory treatment results and a poorer quality of life for victims of abuse (10, 20)  . 
Furthermore, traumatized sexuality affects partners and the overall dynamics of the 
relationship, which can further complicate the healing process (9). There is very little 
research on partners' experiences in the context of treatment for traumatized sexuality, 
leaving a critical gap in the understanding of how to support both abused women and their 
partners in recovery. Consequently, there is a critical need for innovative treatment 
approaches that specifically address rehabilitation of traumatized sexuality, and which take 
partners and the relational context into account. Furthermore, with many sexually abused 
women seeking treatment in specialized mental health care, there is a need for efficient and 
cost-effective group treatment interventions that can accommodate women with a wide range 
of trauma-related symptoms and sexual problems. The novel TYSB intervention seeks to fill 
the gap concerning transdiagnostic, group-based approaches that integrate trauma-focused 

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therapy with a sex-positive framework and include partners in the treatment (20, 23, 25). 
There is an urgent requirement to collect in-depth understanding of how participants 
and their partners experience the TYSB intervention to identify required 
improvements, investigate the potential efficacy of the intervention and to broaden the 
research on therapeutic methods for addressing sexual dysfunctions following sexual 
abuse.  
 
Trauma patients exhibit a wide range of symptom profiles, making it essential to evaluate 
appropriate measures for assessing treatment outcomes (26). This heterogeneity is evident 
in the varying patterns of neural activation observed among patients. Incorporating 
physiological measurements provides objective indices to investigate treatment responses 
more accurately (27). The complexity of trauma-related symptoms cannot be fully 
captured through quantitative data alone and there is a need to assess a more 
comprehensive understanding of treatment outcomes (26). Employing a mixed 
methods design that includes participants' own interpretations and understandings of 
quantitative results adds significant value and is a novel contribution to the research 
community (28). Given the centrality of personal meaning in recovery-oriented practice, our 
application of a phenomenological perspective in researching this treatment represents a 
significant innovation (29).  
 
2. Hypotheses, aims and objectives  
The overall goal of this project is to ensure the quality of the novel TYSB intervention and lay 
the ground for a larger-scale RCT of the intervention. The project’s overall goal is dispersed 
into three main aims, each in correspondence with a sub-study (study A, B and C): 
 
Aim 1 (Study A): To investigate the lived experiences of participants in the 
intervention groups to evaluate the acceptability of the TYSB intervention and identify 
modifications required to improve the intervention.  
Research question (RQ)1: What are the participants lived experiences and perceptions of the 
intervention, and how do they react to any positive or negative impacts attributed to it? 
 
Aim 2 (Study B): To explore the experiences and perspectives of partners of the 
participants in the intervention groups, with the aim of identifying areas for potential 
improvement in the intervention and specifically how partners can best be involved in 
the rehabilitation process. 
RQ2: What are the partners' experiences of participating in the intervention and of being 
witness to and taking part in their partners (participants) process during the intervention? 
 
Aim 3 (Study C): To establish foundational data, methodologies, and effect sizes for a 
subsequent full-scale RCT.  
RQ3: What are the changes in patient-reported levels of PTSD symptoms, sexual 
satisfaction, sexual shame, interoceptive awareness and reactions to touch from pre 
intervention to post-intervention and at a 3-month follow-up?  
RQ4: How do the capabilities for regulating the autonomic nervous system measured by 
cardiovascular measurement (ECG) during a script-driven imagery (SDI) procedure change 
from before to after treatment and at follow-up? 
RQ5: What is the adherence rate (recruitment, dropout, and attendance rates among 
participants) to the intervention?  
RQ6: How do the participants interpret and reflect on the quantitative data collected at pre-
post intervention and follow-up, with a specific focus on data that stands out or are 
unexpected in relation to their lived experiences? 
Hypothesis (H1): Measurements will show improvements in PTSD symptoms, sexual 
satisfaction, sexual shame, interoceptive awareness and capability to enjoy touch after the 
intervention and at follow-up compared to baseline. 

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H2: Cardiovascular measurement (ECG) during a script-driven imagery (SDI) is a promising 
method for testing in a RCT. 
H3: The study will demonstrate that it is feasible to recruit participants and that at least 80% 
of them complete the intervention and the study  
H4: Participants' reflections will generate new knowledge concerning trauma treatment 
evaluation identifying relevant primary outcome measures for a larger-scale RCT study.   
 
3. Approach 
 
3.1. Methods, analyses and technologies 
The adoption of a mixed methods design is pivotal for a comprehensive exploration of the 
feasibility and potential challenges associated with a larger-scale randomized controlled trial 
(RCT) of the effects of an intervention (28). Employing multiple perspectives allows for a 
more complete understanding and facilitates a nuanced assessment of the 
acceptability of the TYSB intervention. It is crucial to incorporate the voices of sexually 
traumatized women and their eventual partners when the research project focuses on a 
treatment intervention to which they are subjected (29). A mixed methods study employs 
both qualitative and quantitative methods to collect and analyze data, as well as to organize 
procedures for investigating research questions. We have described the study design in 
Figure 1. 
 
Recruitment of participants 
To gain access to data that can shed light on the research questions, two groups will be 
conducted according to the TYSB intervention described above, each consisting of ten 
women (N=20). We will recruit participants from patients referred to specialized mental 
health care and the TYSB intervention at STHF. The recruitment process follows standard 
clinical practice to ensure the selection of appropriate participants for the study. Inclusion 
criteria: a) A history of sexual trauma, b) Experience trauma-related sexual problems, c) Age 
between 18 and 65 years, d) Enough competence in Norwegian to participate in a 
psychoeducational group. Exclusion criteria: a) Acute suicidality, b) Serious substance abuse 
interfering with treatment, c) Severe dissociative or psychotic disorders, d) Current life crisis 
interfering with treatment e) Living in an abusive relationship.  
 
Data collection 
Study A and study B: These are qualitative studies where we collect data from exploratory 
semi-structured in-depth interviews with participants (including possible dropouts) and 
partners post intervention. We will use interview guides to provide a framework to ensure that 
all participants are asked about the same core topics. 
 
Study C: This is an explanatory sequential mixed methods study where we collect and 
analyze quantitative data from self-report forms and physiological measurements pre-post 
and 3- month follow-up, followed by collecting and analyzing qualitative data from semi-
structured in-depth interviews with participants, focusing on how they understand quantitative 
data that stands out or are experienced as unexpected. Finally, we interpret how qualitative 
data can explain the quantitative data.  
 
Self-report measurements: The international trauma questionnaire (ITQ) is a well-validated 
instrument that assess symptoms of post-traumatic stress disorder (PTSD) and complex 
PTSD (CPTSD) (30); The Sexual Satisfaction Scale for Women (SSS-W) is a widely used 
instrument with good psychometric properties designed to measure sexual satisfaction 
among women (31); Sexual shame Index-revised (SSI-R) is a 10-item scale used to measure 
sexual shame. Cronbach’s alpha has been shown to range from 0.76 to 0.82, indicating an 
acceptable level of internal consistency for the SSI-R (32); Multidimensional Assessment of 
Interoceptive Awareness (MAIA 2) is a measure with robust psychometric properties, 
designed to assess interoceptive awareness, which is the ability to perceive internal bodily 

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signals (33); Touch Body Map is an instrument for mapping how the body reacts to touch, 
which is used in the TYSB intervention to deepen the reflection around personal experiences 
of touch (34). Participants color the outlines of a human figure with three colors to mark how 
different areas of the body react to touch. The body map gives a non-verbal expression of 
how trauma is embodied. The percentage of the different colors will be calculated to assess 
possible changes through the process; Responses to script driven imagery (RSDI) is an 
assessment tool to measure self-reported emotional, cognitive, and physiological responses 
in the script-driven imagery procedure (SDI) described below (35).  
 
Physiological measurements: Cardiovascular measurement (ECG) recorded during a script-
driven imagery (SDI) can give valuable and complementary data when investigating 
treatment response in trauma patients (36, 37). A ‘Root mean square of successive 
differences of adjacent inter-beat intervals’ (RMSSD) reflecting Heart Rate Variability (HRV) 
will be used to index changes in cardiac vagal tone. HRV is influenced by the balance 
between sympathetic and parasympathetic nervous system activity and can give information 
about perceived stress and emotional regulation. Sample Entropy (SampEn) is a measure of 
cardiac entropy, which can give information beyond linear HRV. Lower SampEn has been 
linked with psychopathology while a higher value of SampEn indicates a less regular, more 
complex signal fine-tuned to the needs of the internal and external environment (38).   
 
Script-driven Imagery procedure (SDI) 
This study will use a modified protocol of the original script-driven imagery procedure (35), 
described by Rudstam et al. (39). Participants will be instructed to write down two memories, 
one traumatic and one peaceful. The main researcher then prepares two scrips of three 
minutes each, based on participants’ texts. The physiological measurements will be done 
approximately one week later, after participants have completed the self-rating scales. The 
main researcher read the two scripts aloud in the following order: 5 min. relaxation baseline 
(BL) – 3 min. peaceful memory script – 3 min. break – 3 min. trauma script – 3 min break – 3 
min. peaceful memory script – 3 min break. Following the psychophysiological recording, the 
participants will complete the RSDI questionnaire.  
 
Data from journal: The following data will be collected from the intake interview, documented 
in participants´ journal; age, marital status, type and extent of sexual trauma and other 
relational traumas, degree of support after trauma(s), prior treatment exposure, sexual 
problems and current social support network.   
 
Data analysis 
Qualitative data analysis (study A, study B and the qualitative part of study C): Qualitative 
data will be analyzed using Giorgi’s descriptive phenomenological method: (1) reading 
descriptions to grasp the whole, (2) dividing into meaning units, (3) identifying invariant, 
general meanings in psychological terms, and (4) synthesizing them into a general meaning 
structure (40). To ensure that the results are reliable, valid and credible, both supervisors will 
read all the interviews, critically assess the PhD candidate’s analysis, and discuss and 
resolve any discrepancies in interpretation. 
 
Quantitative data analyses (study C):  
Quantitative data will be analyzed through linear mixed model analysis (procedure MIXED in 
SPSS) for statistical comparison of pre-post and follow-up changes in psychometric variables 
and physiological reactivity. Paired samples t test (two- tailed) will be used for statistical 
comparison. Due to the small sample size and explorative nature of the study, no statistical 
correction for multiple testing will be applied. To ensure a 95% confidence interval, analyzes 
will be performed with a bootstrapping technique. Missing responses will be handled through 
multiple imputation techniques. Overall significance level set at .05. 
 
Figure 1: The projects study design 

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The doctoral thesis will utilize collected data and results to draw comprehensive conclusions 
about the TYSB interventions overall feasibility and associated risks and complications. 
These conclusions will inform the design of a future RCT, including power calculations, as 
well as primary outcomes, generating hypotheses, and providing insights into necessary 
modifications to optimize the TYSB intervention and its protocol, thereby improving validity 
and reliability.  
 
Potential weaknesses and risks  
We recognize the potential risk of participant drop-out. To ensure enough participants there 
will be conducted an interim analysis post intervention. A third group will be included in 
autumn 2026 if there is a larger dropout of women (>3) or less partners (<10) than expected 
or if the interim analysis reveals that a larger N is needed for designing an adequately 
powered future study. A potential source of bias in this study stems from the dual role of the 
PhD candidate, who is also developer of the treatment intervention. This overlap can 
introduce bias, affecting the impartiality of the study. To mitigate these risks, several 
strategies have been implemented: Independent therapists conduct the intervention groups, 
eliminating direct involvement from the researcher. In studies A and B, interviews are 
conducted by a co-researcher and user participant unconnected to the intervention, 
safeguarding impartial data collection and encouraging honest feedback. The analysis of the 
qualitative data will be done by the PhD candidate in close collaboration with the main 
supervisor and the co-supervisor who have no connection to the development of the 

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intervention and no financial interests in the project. It is considered that the PhD candidate´s 
in-depth knowledge of both the intervention and the topic will strengthen the quality of the 
analysis. The independent supervisors will thoroughly review all interviews, offering new 
perspectives and critical reflections. They will validate and challenge methodological choices 
throughout the entire process to ensure that the results are reliable, valid, and credible. 
Statistical analyzes of the quantitative data will be carried out by the main supervisor in 
collaboration with an independent statistician at STHF, who has no connection to the 
intervention. Quantitative data from the questionnaires will be compared with objective 
physiological measures and participants own understanding of the results. This triangulation 
of data sources helps to strengthen the dataset and offers a more robust an unbiased 
objective assessment of the feasibility and acceptability of the intervention. Collectively, 
these strategies are essential for ensuring the study’s reliability and reducing the likelihood 
that results will be influenced by the researcher’s personal interests or expectations. 
 
3.2. Participants, organization and collaborations 
The TYSB intervention and the research project are developed and rooted in STHF. The 
project leader and the PhD-candidate are employed at STHF where the TYSB intervention is 
carried out. The project builds on collaboration with University in Agder (UiA), Norwegian 
University of Science and Technology (NTNU), Modum Bad Trauma Clinic in Oslo and three 
user participants. The PhD candidate will be responsible for day-to day organizing of the 
project, in close collaboration with the project group. She will have the main responsibility for 
collecting self-report measurements and physiological measurements, conducting the 
interviews exploring participants understanding of quantitative data (study C), analysis of 
qualitative data and dissemination of results. The project group will meet monthly, and the 
meeting minutes will be documented. The steering committee will meet regularly.      
 
Steering committee 
Kjetil Christensen, chief for the clinic of mental health and substance abuse treatment, 
STHF. Espen Halvorsen, head of DPS department, STHF. Idun Røseth, project leader. 
Malin Wästlund PhD-candidate. Anita Kristine Lindeboom, user participant. 
 
Project group 
Idun Røseth (Co-supervisor), leader of the research group Mental Health at STHF and 
Professor at Department of Psychosocial Health, UiA is project leader and the supervisor in 
qualitative methods. Tor-Ivar Karlsen (main supervisor), Professor at Department of 
Psychosocial Health UiA, is the main supervisor and responsible for statistical analysis of 
quantitative data in collaboration with a statistician at STHF. Malin Wästlund, PhD candidate 
connected to the PhD-program at the Faculty of Health and Sport Sciences at UiA. Wästlund 
is also specialist physiotherapist and psychotherapist working at DPS Notodden, STHF. 
Keson Jaioun, statistician, STHF. Charlotte Fiskum, Associated Professor at Department 
of Psychology, NTNU, is a collaborative partner participating in the project group and will 
supervise regarding the psychophysiological assessments. Ingunn Holbæk, clinical 
psychologist and PhD-candidate at the Research Institute Modum Bad, is a collaborative 
partner with in-depth knowledge of the most vulnerable group of traumatized patients. Anita 
Kristina Lindeboom, Silje Engbråten and Gunn-Marit Uverud, user participators with 
different backgrounds. Gunn-Marit Uverud has research experience and will contribute as an 
interviewer in the study. 
 
 
3.4 Plan for activities, visibility and dissemination  
Activity 
From 
To 
Approval PVO/REK. Planning, recruitment and implementation of study group 1. 
Pre- and post-test QUAN data collection. Recruitment of participants (group 2).  
Jan 2025 
Dec 2025 
Study group 1: QUAL data collection for study A and study B 
Jan 2026 
Feb 2025 
Study group 2: Pre-test QUAN data collection, post-test QUAN data collection and 
QUAL data collection for study A and study B. 
Feb 2026 
May 2026 

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Study group 1: Follow-up QUAN data collection, analyzing pre-post and follow-up 
QUAN data and collecting QUAL data for study C. 
Apr 2026 
Apr 2026 
Study group 2: Follow-up QUAN data collection, analyzing pre-post and follow-up 
QUAN data and collecting QUAL data for study C. 
Aug 2026 
Aug 2026 
Analysis of data study A and complete article study A. 
Feb 2026 
Feb 2027 
Analysis of data study B and complete article study B. Presenting at a conference.  
Jul 2026 
Sep 2027 
Analysis of data study C and complete article study C.  
Jan 2027 
Feb 2028 
Complete mantle. Dissemination of the project at conferences and open lectures.  
Oct 2027 
Dec 2028 
 
Plan for dissemination of results 
We will disseminate the findings from this study through three scientific articles and 
presentations at scientific conferences. Potential titles of articles:  
Study A: Voices of transformation: A deep dive into the struggles and successes of 
reclaiming sexuality after sexual trauma. 
Study B: Healing together: partners' experiences in the journey of sexual trauma recovery 
through the intervention Take your sexuality back for sexually traumatized women. 
Study C: A feasibility mixed methods study of the intervention Take your sexuality back for 
sexually traumatized women: Preliminary evaluations of efficacy and outcome 
measurements.  
 
3.4 Potential for implementation  
The results will be used to develop a full-scale RCT study and to further develop and use 
TYSB in clinical practice. We experience a great demand for the treatment and receive 
referrals from other admission areas outside STHF. To address this demand, we will carry 
out training for health personnel at other health institutions. This initiative will lay the 
groundwork for a multi-center study and expand the reach and applicability of the TYSB 
intervention. Given the critical need for research on treatment methods for traumatized 
sexuality, the results have the potential to influence future guidelines and recommendations 
for treatment. In the final phase of the research project, the researcher and user participants 
will hold open lectures at women's health centers managed by NKS and NOK/SMISO 
centers. This public engagement is a crucial component of the project, aiming to reduce the 
taboo surrounding traumatized sexuality, share knowledge and foster a more open and 
supportive environment for affected individuals and their partners.  
 
4. Budget  
 
Expenses 
2025 
2026 
2027 
2028 
Total 
Wages and social 
security contributions 
732 000 
761 000 
792 000 
823 000 
3 108 000 
Purchased services/fees 
128 000 
131 000 
115 000 
118 000 
  492 000 
Material/equipment 
190 000 
   10 000 
 
 
  250 000 
Other expenses 
  50 000 
  60 000  
  90 000  
  90 000  
  290 000 
Total 
1 100 000 
962 000 
997 000 
1 031 000 
4 090 000 
 
The researcher will work 25% clinically throughout the project. The PhD project therefore has 
a timeframe of four years, with 75% of the position being dedicated to research. The study 
was funded by internal funds in 2025, and funding is being sought for the remaining years, 
2026–2028.  
 
5. User involvement 
The TYSB intervention has been developed through a collaborative process involving close 
dialogue with participants from the intervention groups. Five user participants, who have 
previously participated in the TYSB intervention, were integral to a preliminary project 
focused on creating a manual for the psychoeducational component of the intervention (25). 
Their firsthand experiences provided valuable insights that shaped the content of the manual. 
Two of these user participants continue to contribute to the research study's project group, 
ensuring continuity and the integration of lived experiences into the project. Additionally, one 

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user participant, with research experience and no prior connection to the intervention, will 
participate in the project group bringing a fresh perspective and enhance the objectivity of the 
research process. The user participants will contribute with interview guides, interviews 
(GMU), input on data analyses and dissemination of results. 
 
6. Ethical considerations 
As standard clinical practice, the patients who are asked to participate in the study have 
undergone a thorough intake interview which can help them make an informed decision 
about whether to participate in the intervention and the study. To avoid any pressure, 
participants are informed about the study by the group therapists, and their decision to 
participate is communicated to a project secretary. Those who choose not to participate in 
the study still can receive the same treatment. Participants in the study are informed about 
their rights to withdraw at any time without needing to explain their reasons. The research 
interviews, self-rating tools, the SDI procedure, and the intervention itself carry potential risks 
causing distress. In order to minimize the burden, a critical assessment has been made of 
which forms and tests are necessary to cover the project's objectives. In accordance with 
standard clinical practice, the participants will have contact with a therapist outside the group 
and can thereby receive individual therapy sessions for issues that arise during the 
interviews, surveys or other assessments. All evaluations and measures will be conducted at 
the treatment site with the researcher, an experienced trauma therapist, available to manage 
any trauma reactions. Participants are informed that they can contact the project leader if 
they need more follow-up. Experiencing ongoing violence is an exclusion criterion for 
participation in the treatment and the research project. If it is nevertheless discovered, the 
woman's safety will be prioritized, and the partner will be excluded from the study. Research 
data will be de-identified, with forms marked by numerical codes. The key linking the codes 
to participant identities will be stored separately from the research data, in an access-
restricted folder at the research server at STHF. All collected data will be stored on Services 
for Sensitive Data (TSD), University of Oslo. Participants in the study will be allowed to 
review the transcript of their interviews to ensure the quality of the transcripts and allow them 
to correct any errors and clarify statements. At the end of the project, de-identified data will 
be securely stored for five years. The results of the study will be communicated in a way that 
anonymizes the participants. As a whole, it is considered that this study will lead to greater 
societal benefit than possible burdens. The project is approved by the Regional Ethics 
Committee (Reknr 829297) and data protection officer (PVO) and its execution will adhere to 
the guidelines of the Helsinki and Madrid declarations.   
 
 
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