Mediators of change in a condensed online exposure-based intervention provided soon after trauma: insights from a randomised controlled trial
Creators: name: Bragesjö, Maria
name: Arnberg, Filip K.
name: Andersson, Erik
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Neuroscience
subject: Biotechnology
subject: Environmental Sciences not elsewhere classified
subject: Sociology
subject: FOS: Sociology
subject: Biological Sciences not elsewhere classified
subject: Mental Health

description: <b>Background:</b> The active mechanisms of change are unclear in early-provided exposure-based interventions for psychological trauma. This study aimed to address this gap by analysing weekly data from a randomised trial involving a 3-week therapist-guided online intervention based on prolonged exposure compared to a waiting-list control group. <b>Method:</b> The objective was to investigate whether changes in each of the four subscales of the Posttraumatic Stress Disorder Checklist, fifth version (PCL-5; i.e. intrusions, avoidance behaviours, negative alternations in cognitions and hyperarousal) during the three-week intervention period mediated subsequent improvements in other post-traumatic stress symptoms at the controlled 1-month follow-up. We included baseline levels of both the mediator and the outcome as well as changes in the outcome from baseline to week 3 as covariates in a mediation model. <b>Results:</b> The results showed that reductions in avoidance during the intervention period mediated reduced symptom levels of intrusions, negative alternations in cognitions, and hyperarousal at week 7 (z-scores of indirect effect estimates = −0.12 to −0.07). No other PCL-5 subscales were found to be mediators of change. <b>Conclusions:</b> The results from this study highlight the importance of addressing avoidance behaviours in online exposure-based interventions provided in the early aftermath of trauma. Sensitivity analysis showed that the mediation effects were sensitive to assumptions related to mediator-outcome confounders, which could be considered a study limitation. <b>Trial registration:</b>ClinicalTrials.gov identifier: NCT03850639. The underlying mechanism of change in early-provided exposure-based interventions for psychological trauma was examined.Reductions in avoidance behaviours during the 3-week online exposure-based intervention mediated improvements in symptoms of intrusions, negative alterations in cognitions/mood, and hyperarousal 1-month follow-up after its completion.The study highlights the significance of addressing avoidance behaviours in early online exposure-based trauma interventions while acknowledging limitations related to mediator-outcome confounders. The underlying mechanism of change in early-provided exposure-based interventions for psychological trauma was examined. Reductions in avoidance behaviours during the 3-week online exposure-based intervention mediated improvements in symptoms of intrusions, negative alterations in cognitions/mood, and hyperarousal 1-month follow-up after its completion. The study highlights the significance of addressing avoidance behaviours in early online exposure-based trauma interventions while acknowledging limitations related to mediator-outcome confounders.