Ljungman Lisa, Cernvall Martin, Ghaderi Ata, Ljungman Gustaf, von Essen Louise, Ljótsson Brjánn
Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
PeerJ. 2018 Apr 11;6:e4570. doi: 10.7717/peerj.4570. eCollection 2018.
A subgroup of parents of children who have been treated for childhood cancer report high levels of psychological distress. To date there is no empirically supported psychological treatment targeting cancer-related psychological distress in this population. The aim of the current study was to test the feasibility and preliminarily evaluate the effect of individualized face-to-face cognitive behavior therapy (CBT) for parents of children after the end of treatment for childhood cancer. A secondary aim was to present a cognitive behavioral conceptualization of cancer-related distress for these parents.
An open trial was conducted where 15 parents of children who had completed successful treatment for cancer three months to five years earlier and who reported psychological distress related to a child's previous cancer disease were provided CBT at a maximum of 15 sessions. Participants were assessed at baseline, post-intervention, and three-month follow-up using self-reported psychological distress (including posttraumatic stress symptoms (PTSS), depression, and anxiety) and the diagnostic Mini-International Neuropsychiatric Interview. Feasibility outcomes relating to recruitment, data collection, and delivery of the treatment were also examined. Individual case formulations for each participant guided the intervention and these were aggregated and presented in a conceptualization detailing core symptoms and their suggested maintenance mechanisms.
A total of 93% of the participants completed the treatment and all of them completed the follow-up assessment. From baseline to post-assessment, parents reported significant improvements in PTSS, depression, and anxiety with medium to large effect sizes (Cohen's = 0.65-0.92). Results were maintained or improved at a three-month follow-up. At baseline, seven (47%) participants fulfilled the diagnostic criteria for major depressive disorder and four (29%) fulfilled the criteria for posttraumatic stress disorder, compared to none at a post-assessment and a follow-up assessment. The resulting cognitive behavioral conceptualization suggests traumatic stress and depression as the core features of distress, and avoidance and inactivity is suggested as the core maintenance mechanisms.
The treatment was feasible and acceptable to the participants. Significant improvements in distress were observed during the study. Overall, results suggest that the psychological treatment for parents of children after end of treatment for childhood cancer used in the current study is promising and should be tested and evaluated in future studies.
曾接受儿童癌症治疗的患儿家长中有一部分报告称存在高度心理困扰。迄今为止，尚无针对该人群中与癌症相关心理困扰的经实证支持的心理治疗方法。本研究的目的是测试个体化面对面认知行为疗法（CBT）对儿童癌症治疗结束后患儿家长的可行性，并初步评估其效果。次要目的是为这些家长呈现与癌症相关困扰的认知行为概念化。
进行了一项开放试验，为15名患儿家长提供了最多15次的CBT，这些家长的孩子在三到五年前已成功完成癌症治疗，且报告了与孩子先前癌症疾病相关的心理困扰。在基线、干预后和三个月随访时，使用自我报告的心理困扰（包括创伤后应激症状（PTSS）、抑郁和焦虑）以及诊断性迷你国际神经精神访谈对参与者进行评估。还检查了与招募、数据收集和治疗实施相关的可行性结果。针对每位参与者的个案制定指导干预措施，并将这些措施汇总并呈现为一个概念化内容，详细说明核心症状及其建议的维持机制。
共有93%的参与者完成了治疗，且所有人都完成了随访评估。从基线到评估后，家长报告PTSS、抑郁和焦虑有显著改善，效应大小为中到大型（科恩d值 = 0.65 - 0.92）。在三个月随访时结果保持或有所改善。在基线时，7名（47%）参与者符合重度抑郁症的诊断标准，4名（29%）符合创伤后应激障碍的标准，而在评估后和随访评估时均无符合标准者。由此产生的认知行为概念化表明，创伤应激和抑郁是困扰的核心特征，回避和不活动被认为是核心维持机制。
该治疗对参与者来说是可行且可接受的。在研究期间观察到困扰有显著改善。总体而言，结果表明本研究中使用的针对儿童癌症治疗结束后患儿家长的心理治疗方法很有前景，应在未来研究中进行测试和评估。
