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Parents of adolescents with autism spectrum disorder (ASD) and severe emotional dysregulation (ED) often experience trauma symptoms related to their child's behaviour, including aggression, self-injury and suicide attempts. These traumatic experiences can lead to parental posttraumatic stress symptoms, which are linked to heightened parental stress, reduced capacity for mentalisation, and difficulties co-regulating their child. These challenges have the potential to intensify pre-existing emotional dysregulation, thereby undermining the effectiveness of treatment for the adolescent. Nevertheless, child-related PTSD is rarely addressed in mental health services. This study aims to address this gap in mental health by examining the effects of trauma-focused treatment for these parents. This single-case design study involved seven parents (five mothers and two fathers) of six adolescents (aged 16-21) diagnosed with ASD and emotional dysregulation (ED). Parents received EMDR-therapy and were assessed weekly during a randomised baseline (3-5 weeks), treatment phase (4-6 weeks), post-intervention (3 weeks), and follow-ups at 6 weeks and 3 months. All parents showed a reduction of PTSD-symptoms after EMDR-therapy, with none of the parents meeting PTSD criteria after treatment and follow-up. A significant reduction in parental stress was reported by all parents at post-treatment and follow-up. Furthermore, five out of seven parents reported reduced ED in their adolescents after treatment, an effect maintained in three cases at follow-up. This study demonstrates the value of trauma-focused treatment for parents coping with PTSD as a result of exposure to child-related traumatic events. The findings of this study provide valuable insights into the possible nature of parental stress in parents of adolescents with severe ED, as well as how this can be effectively addressed. The results support the hypothesis that when parents feel emotionally regulated, they may exhibit increased engagement and support for their adolescents' treatment, potentially leading to improved treatment outcomes.

Background Post-traumatic stress disorder (PTSD) in the postpartum period is a prevalent yet under-researched mental health condition. To date, many women who suffer from postpartum PTSD remain unrecognized and untreated. To enhance the accessibility of help for these women, it is crucial to offer tailored treatment and counselling services that align with their needs. This study aimed to understand how support preferences differ between women with and without postpartum PTSD, considering the two subgroups of postpartum PTSD: childbirth-related PTSD (CB-PTSD) and general PTSD (gPTSD). Methods This study used data from the cross-sectional INVITE study, comprising telephone interviews with N  = 3,874 women conducted six weeks to six months after childbirth. The City Birth Trauma Scale (City BiTS) was used to assess CB-PTSD, while the Primary Care Posttraumatic Stress Disorder Screen for DSM-5 (PC-PTSD-5) was used to assess gPTSD. Service preferences and preferred modes of service provision were measured with self-developed questionnaires. Analyses of variance were used to identify differences between groups. Results The support services (family-)midwives and family, friends, or colleagues and the service provision mode as in person communication were preferred most by women across groups. The analyses revealed that women with CB-PTSD had lower overall preferences for services compared to women without postpartum PTSD. Women with CB-PTSD also showed less preference for psychotherapeutic services (e.g. outpatient treatment, inpatient clinics) compared to women without postpartum PTSD. Regarding modes of service provision, women with gPTSD had a higher preference for all service modes compared to women with CB-PTSD and those without postpartum PTSD, with a stronger preference for both direct (e.g. in person, video conference) and delayed communication (e.g. chat, e-mail). Conclusion This study was the first to explore the support preferences of women experiencing symptoms of postpartum PTSD. Findings suggest that women differ in their preferences, contingent upon the subgroup of postpartum PTSD. According to women's overall preferences, the expansion and further training of (family-)midwife services is recommended. By tailoring support services accordingly to women’s preferences, it may be possible to bridge the treatment gap for postpartum PTSD and to improve the well-being of affected women and their families.

Background: Paediatric illness, injury and medical procedures are potentially traumatic experiences with a range of possible negative psychosocial consequences. To prevent psychosocial impairment and improve medical adherence, evidence-based psychotherapy should be offered if indicated. Eye movement desensitization and reprocessing (EMDR) has been found to reduce symptoms of posttraumatic stress disorder (PTSD) in adults. The evidence for the use with children is promising. Furthermore, recent studies indicate its effectiveness for the treatment of other psychological symptomatology. However, the effectiveness of EMDR in children with subthreshold PTSD after medically related trauma has not yet been investigated. Objective: Investigating the short-term effectiveness of EMDR on posttraumatic stress, anxiety, depression and sleep problems in children with subthreshold PTSD after hospitalization through a randomized controlled trial (RCT). Method: Following baseline screening of 420 children from various Dutch hospitals, 74 children (4-15 years old) with medically related subthreshold PTSD were randomized to EMDR (n = 37) or care-as-usual (CAU; n = 37). Follow-up assessment took place after M = 9.7 weeks. Generalized Estimating Equation (GEE) analyses were performed to examine the effectiveness of EMDR compared to CAU. Results: Children in both groups improved significantly over time on all outcomes. However, the EMDR group improved significantly more as to child-reported symptoms of blood-injection-injury (BII) phobia and depression, and child-, and parent-reported sleep problems of the child. There was no superior effect of EMDR compared to CAU on subthreshold PTSD symptom reduction. Conclusions: EMDR did not perform better than CAU in reducing PTSD symptoms in a paediatric sample of children with subthreshold PTSD after hospitalization. However, the study results indicate that EMDR might be superior in reducing symptoms of blood-injection-injury phobia, depression and sleep problems.

Background: Although giving birth is a positive experience for many, some 10% of pregnant Swedish women suffer from severe fear of childbirth (FOC), which impairs their daily functioning and poses a risk for a negative delivery experience. This thesis focuses on the mental and health-economic effects of severe FOC, and explores new treatment options for childbirth-related anxiety. Aims: (i) to investigate the prevalence of and variables associated with severe FOC, (ii) to estimate the cost of illness of severe FOC and (iii) to explore whether Internet-based cognitive behaviour therapy (ICBT) is feasible for treating pregnant women with severe FOC and those with childbirth-related symptoms of posttraumatic stress disorder (PTSD). Design and Results: Study 1: In a cross-sectional study 1635 pregnant women were asked about their FOC via the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), and provided socio-demographic data and information of their preferred mode of delivery. It was found that 15.6% of the participants had a severe FOC, which also strongly correlated with the preference of a caesarean section. Study 2: In a prospective case-control cohort study we mapped all visits, in-patient care, sick leave and delivery variables from medical records and estimated the societal costs in two groups of women; one group with severe FOC and one with low FOC. The costs for the group with severe FOC were 38% higher than for the low FOC group. Study 3: Twenty-eight nulliparous women with severe FOC were self-recruited to an eight weeks ICBT program for severe FOC. Fifteen women followed the entire program. Their FOC decreased significantly after treatment (Cohen’s d=0.95, p<0.0001), which means that ICBT is feasible and an option for treating women with severe FOC. Study 4: Fifteen participants in Study 3 wrote narratives of the imminent delivery before as well as after therapy. After treatment, the women had a more realistic attitude towards childbirth, more self-confidence and more active coping strategies. Partners and staff were perceived as more helpful, and the women were more aware of the child they were bearing. Study 5: Fifty-six women with a traumatic delivery experience were included in a randomized wait-list controlled study (RCT) of the effects of an eight week long ICBT program for childbirth-related PTSD symptoms. These symptoms decreased in both groups during active therapy, while the between-group effect size varied depending on measurements. Psychiatric comorbidity decreased in both groups after active treatment. Conclusion: Severe FOC is prevalent among Swedish pregnant women, and the cost of illness of this marker of peripartum psychological vulnerability is considerable when treated using standard care. A new treatment option for this group with ICBT seems feasible and is associated with more realistic attitudes towards the imminent delivery. An RCT with eight weeks of ICBT for parous women with PTSD symptoms also had promising results. As severe FOC is prevalent and associated with mental and economic burdens for the individual and the society, there is an urgent need to expand the research field. It is important to find feasible and effective treatments that can be applied on a large scale.

Free-text analysis using machine learning (ML)-based natural language processing (NLP) shows promise for diagnosing psychiatric conditions. Chat Generative Pre-trained Transformer (ChatGPT) has demonstrated preliminary initial feasibility for this purpose; however, whether it can accurately assess mental illness remains to be determined. This study evaluates the effectiveness of ChatGPT and the text-embedding-ada-002 (ADA) model in detecting post-traumatic stress disorder following childbirth (CB-PTSD), a maternal postpartum mental illness affecting millions of women annually, with no standard screening protocol. Using a sample of 1295 women who gave birth in the last six months and were 18+ years old, recruited through hospital announcements, social media, and professional organizations, we explore ChatGPT’s and ADA’s potential to screen for CB-PTSD by analyzing maternal childbirth narratives. The PTSD Checklist for DSM-5 (PCL-5; cutoff 31) was used to assess CB-PTSD. By developing an ML model that utilizes numerical vector representation of the ADA model, we identify CB-PTSD via narrative classification. Our model outperformed (F1 score: 0.81) ChatGPT and six previously published large text-embedding models trained on mental health or clinical domains data, suggesting that the ADA model can be harnessed to identify CB-PTSD. Our modeling approach could be generalized to assess other mental health disorders.

Background: Three in every 10 children and adolescents admitted to a hospital or undergoing medical treatment develop subthreshold symptoms of posttraumatic stress disorder (PTSD). When untreated, subthreshold PTSD can have a serious impact on psychosocial functioning, quality of life and long-term psychopathology. However, research investigating subthreshold PTSD and its treatment following paediatric medical interventions and/or hospitalization is scarce. Eye Movement Desensitization and Reprocessing (EMDR) is a fast and non-invasive psychosocial treatment for posttraumatic stress complaints. However, the effectiveness of EMDR in paediatric patients with subthreshold PTSD has not previously been systematically investigated. Objective: Describing the design of a randomized controlled trial (RCT) set up to evaluate the effectiveness of EMDR in children with subthreshold PTSD after hospitalization. Method: Children aged 4-15 years who have undergone a one-time (trauma type I) or repeated (trauma type II) hospitalization up to five years ago will be included. Participating children will be first screened with a standardized questionnaire for PTSD-symptoms. Subsequently, children with subthreshold PTSD will be randomly assigned to (1) approximately six sessions of standardized EMDR or (2) care as usual (CAU). Children with full diagnostic PTSD do not participate in the RCT, but are referred for direct treatment. Follow-up measurements will take place after eight weeks and eight months. Discussion: Considering the scarce evidence for the effectiveness of EMDR in children with medically related trauma, clinicans, researchers and children treated in hospitals can benefit from this study. Potential strengths and limitations of this study are discussed. Trial Registration: Netherlands Trial Register NTR5801

Synthesizing insights from psychology and philosophy with his own wide-ranging, experiences around the world, Dr. James Garbarino takes readers on a personalized journey into the dark side of human experience as it is lived by children.