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Ljungman, Lisa
Publications (10 of 25) Show all publications
Carlsson, T., Kukkola, L., Ljungman, L., Hovén, E. & von Essen, L. (2019). Psychological distress in parents of children treated for cancer: An explorative study. PLoS ONE, 14(6), Article ID e0218860.
Open this publication in new window or tab >>Psychological distress in parents of children treated for cancer: An explorative study
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2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 6, article id e0218860Article in journal (Refereed) Published
Abstract [en]

Objective

To explore psychological distress experienced by parents who express a need for psychotherapy after curative treatment for their child's cancer.

Methods

15 parents (eight mothers and seven fathers) of children treated for cancer (median time since end of curative treatment: two years) were recruited via a pediatric oncology center. Each parent was interviewed twice and data was analyzed with inductive latent qualitative content analysis.

Results

Two overarching themes emerged. One theme, An unfamiliar and frightening situation during treatment, portrayed experiences during the treatment period, and included the sub-themes Initial reactions to the uncontrollable situation, Adjustment to the situation, and Focus on supporting the child. Another theme, Emotional struggles after end of curative treatment, portrayed experiences following curative treatment, and included the sub-themes Transitioning back to life as it was before the diagnosis, Emotional scars, Uncontrollable fears and worries of diseases, and New perspectives on life.

Conclusions

Parents of children with cancer experience existential, physical, psychological, and social struggles. They describe an unstable situation after diagnosis and having focused their attention towards protecting their child during treatment. After the end of curative treatment, they experience challenges with transitioning back to life as it was before the diagnosis and dealing with their own emotional scars and fears related to the child's cancer. The findings indicate an unmet need for psychological support among parents of children treated for cancer.

National Category
Psychology Cancer and Oncology
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-390743 (URN)10.1371/journal.pone.0218860 (DOI)000484894700047 ()31226159 (PubMedID)
Funder
Swedish Research Council, K2015-99X-20836-08-4Swedish Cancer Society, 140790
Available from: 2019-08-14 Created: 2019-08-14 Last updated: 2019-12-06Bibliographically approved
Ljungman, L., Cernvall, M., Ghaderi, A., Ljungman, G., von Essen, L. & Ljótsson, B. (2018). An open trial of individualized face-to-face cognitive behavior therapy for psychological distress in parents of children after end of treatment for childhood cancer including a cognitive behavioral conceptualization. PeerJ, 6, Article ID e4570.
Open this publication in new window or tab >>An open trial of individualized face-to-face cognitive behavior therapy for psychological distress in parents of children after end of treatment for childhood cancer including a cognitive behavioral conceptualization
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2018 (English)In: PeerJ, ISSN 2167-8359, E-ISSN 2167-8359, Vol. 6, article id e4570Article in journal (Refereed) Published
Abstract [en]

Objective

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.

Methods

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.

Results

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 d = 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.

Conclusion

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.

National Category
Cancer and Oncology Psychology
Identifiers
urn:nbn:se:uu:diva-349407 (URN)10.7717/peerj.4570 (DOI)000429852600001 ()29666751 (PubMedID)
Funder
Swedish Research Council, VR521-2010-3042; VR521-2014-3337Swedish Cancer Society, CAN2013/580;CAN2014/613
Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2018-06-19Bibliographically approved
Wikman, A., Ljungman, L., Pingel, R., Hagedoorn, M., Sanderman, R., von Essen, L. & Cernvall, M. (2017). The interdependence of posttraumatic stress symptoms in parental dyads during and after their child’s treatment for cancer. Acta Oncologica, 56(12), 1698-1704
Open this publication in new window or tab >>The interdependence of posttraumatic stress symptoms in parental dyads during and after their child’s treatment for cancer
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2017 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 56, no 12, p. 1698-1704Article in journal (Refereed) Published
Abstract [en]

Background: Cancer in a child is highly distressing and some parents are at increased risk for developing posttraumatic stress symptoms (PTSS). However, the interdependence of PTSS in parental dyads has rarely been accounted for. The aim was to explore the dyadic relationship of PTSS in parents of children diagnosed with cancer.

Material and methods: The sample includes 150 parents (75 dyads) of 75 children diagnosed with cancer in Sweden during 2002–2004, with follow-up until one year after end of treatment. Data on PTSS from six assessments were included. The first three assessments were carried out during treatment and the remaining after end of treatment. Actor-partner interdependence models were estimated using a structural equation modeling approach to explore the dyadic relationship of PTSS. Actor effects refer to intra-individual dependency over time, and partner effects refer to inter-individual dependency over time, i.e., how much an individual’s symptom levels are affected by their partner’s symptom levels at the previous assessment.

Results: Results show both actor and partner effects during the child’s treatment. Only an actor effect remained following end of treatment where level of PTSS at one assessment was associated with the level of PTSS at the subsequent assessment. The association between mothers’ and fathers’ PTSS did not remain after end of treatment.

Conclusions: Parents appear to react as an interdependent emotional system during the child’s treatment but this effect disappears after end of treatment. Results suggest psychological interventions for parents during the child’s cancer treatment should also be sensitive to and address the influence that distress in one partner may have on the other.

National Category
Psychology Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-327201 (URN)10.1080/0284186X.2017.1355562 (DOI)000418118800005 ()28760061 (PubMedID)
Funder
Swedish Research Council, K2008-70X-20836-01-3K; 2011-70X-20836-04-4; K2015-99X-20836-08-4Swedish Cancer Society, 2007/1015; 2010/726; 2013/580; 2014/613Swedish Childhood Cancer Foundation, PROJ08/010
Available from: 2017-08-07 Created: 2017-08-07 Last updated: 2018-01-22Bibliographically approved
Cernvall, M., Carlbring, P., Wikman, A., Ljungman, L., Ljungman, G. & von Essen, L. (2017). Twelve-Month Follow-Up of a Randomized Controlled Trial of Internet-Based Guided Self-Help for Parents of Children on Cancer Treatment. Journal of Medical Internet Research, 19(7), Article ID e273.
Open this publication in new window or tab >>Twelve-Month Follow-Up of a Randomized Controlled Trial of Internet-Based Guided Self-Help for Parents of Children on Cancer Treatment
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2017 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 19, no 7, article id e273Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: A substantial proportion of parents of children on cancer treatment report psychological distress such as symptoms of post-traumatic stress (PTSS), depression, and anxiety. During their child's treatment many parents also experience an economic burden.

OBJECTIVE: The aim of this study was to evaluate the long-term efficacy of Internet-based guided self-help for parents of children on cancer treatment.

METHODS: This study was a parallel randomized controlled trial comparing a 10-week Internet-based guided self-help program, including weekly support from a therapist via encrypted email, with a wait-list control condition. The intervention was based on cognitive behavior therapy (CBT) and focused on psychoeducation and skills to cope with difficult thoughts and feelings. Primary outcome was self-reported PTSS. Secondary outcomes were self-reported symptoms of depression, anxiety, health care consumption, and sick leave during the past month. Outcomes were assessed pre- and postintervention and at 12-month follow-up. Parents of children on cancer treatment were invited by health care personnel at pediatric oncology centers, and parents meeting the modified symptom criteria on the PCL-C were included in the study. Self-report assessments were provided on the Web.

RESULTS: A total of 58 parents of children on cancer treatment (median months since diagnosis=3) were included in the study (intervention n=31 and control n=27). A total of 18 participants completed the intervention, and 16 participants in each group participated in the 12-month follow-up. Intention-to-treat analyses revealed significant effects in favor of the intervention on the primary outcome PTSS, with large between-group effect sizes at postassessment (d=0.89; 95% CI 0.35-1.43) and at 12-month follow-up (d=0.78; 95% CI 0.25-1.32). Significant effects in favor of the intervention on the secondary outcomes depression and anxiety were also observed. However, there was no evidence for intervention efficacy on health care consumption or sick leave.

CONCLUSIONS: Using the Internet to provide psychological interventions shows promise as an effective mode of delivery for parents reporting an increased level of PTSS and who consider Internet-based interventions as a viable option. Future research should corroborate these findings and also develop and evaluate interventions and policies that may help ameliorate the economic burden that parents may face during their child's treatment for cancer.

Keywords
Internet, PTSS, anxiety, cancer, clinical trial, depression, parents
National Category
Psychology Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-327203 (URN)10.2196/jmir.6852 (DOI)000409234200001 ()28751300 (PubMedID)
Funder
Swedish Research Council, K2008-70X-20836-01-3Swedish Research Council, K2011-70X-20836-04-4Swedish Cancer Society, 2010/276Swedish Cancer Society, 2014/613Swedish Childhood Cancer Foundation, PROJ08/010Swedish Childhood Cancer Foundation, PRO12/028
Available from: 2017-08-07 Created: 2017-08-07 Last updated: 2018-01-11Bibliographically approved
Ljungman, L., Cernvall, M., Ghaderi, A., Ljungman, G., von Essen, L. & Ljotsson, B. (2016). A Cognitive Behavioural Conceptualization of Psychological Distress in Parents of Children Previously Treated for Cancer. Psycho-Oncology, 25(SP. S3), 65-65
Open this publication in new window or tab >>A Cognitive Behavioural Conceptualization of Psychological Distress in Parents of Children Previously Treated for Cancer
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2016 (English)In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 25, no SP. S3, p. 65-65Article in journal, Meeting abstract (Other academic) Published
National Category
Cancer and Oncology Psychology
Identifiers
urn:nbn:se:uu:diva-309576 (URN)000385942700144 ()
Note

Meeting Abstract: 196

Available from: 2016-12-13 Created: 2016-12-05 Last updated: 2017-11-29Bibliographically approved
Kukkola, L., Ljungman, L., Börjesson, H., Cernvall, M., Grönqvist, H., Wikman, A. & von Essen, L. (2016). Development of an online, guided, psychological self-help program for parents of children previously treated for cancer, together with end-users according to Participatory Action Research. In: : . Paper presented at 18th International Psycho Oncology Society Congress (pp. 64-64). , 25(SP. S3)
Open this publication in new window or tab >>Development of an online, guided, psychological self-help program for parents of children previously treated for cancer, together with end-users according to Participatory Action Research
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2016 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Cancer and Oncology Psychology
Identifiers
urn:nbn:se:uu:diva-309575 (URN)000385942700142 ()
Conference
18th International Psycho Oncology Society Congress
Note

Meeting Abstract: 194

Available from: 2017-01-09 Created: 2016-12-05 Last updated: 2017-03-23Bibliographically approved
Cernvall, M., Ljungman, L., Wikman, A., Carlbring, P., Ljungman, G. & von Essén, L. (2016). Dimensions of Posttraumatic Stress Symptoms and their Relationships with Depression, Anxiety, and Quality of Life in Parents of Children Recently Diagnosed with Cancer. Psycho-Oncology, 25(SP. S3), 76-76
Open this publication in new window or tab >>Dimensions of Posttraumatic Stress Symptoms and their Relationships with Depression, Anxiety, and Quality of Life in Parents of Children Recently Diagnosed with Cancer
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2016 (English)In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 25, no SP. S3, p. 76-76Article in journal, Meeting abstract (Other academic) Published
National Category
Psychology Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-309577 (URN)000385942700169 ()
Available from: 2016-12-14 Created: 2016-12-05 Last updated: 2017-11-29Bibliographically approved
Cernvall, M., Skogseid, E., Carlbring, P., Ljungman, L., Ljungman, G. & von Essen, L. (2016). Experiential Avoidance and Rumination in Parents of Children on Cancer Treatment: Relationships with Posttraumatic Stress Symptoms and Symptoms of Depression. Paper presented at Conference of the Association-of-Psychologists-in-Academic-Health-Centers (APAHC), FEB, 2015, Atlanta, GA, USA. Journal of clinical psychology in medical settings, 23(1), 67-76
Open this publication in new window or tab >>Experiential Avoidance and Rumination in Parents of Children on Cancer Treatment: Relationships with Posttraumatic Stress Symptoms and Symptoms of Depression
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2016 (English)In: Journal of clinical psychology in medical settings, ISSN 1068-9583, E-ISSN 1573-3572, Vol. 23, no 1, p. 67-76Article in journal (Refereed) Published
Abstract [en]

We conducted a cross-sectional survey study to investigate whether there is a relationship between experiential avoidance (EA), rumination, post-traumatic stress symptoms (PTSS), and symptoms of depression, in parents of children on cancer treatment. Data from 79 parents (55 mothers) of 79 children with a median of three months since their cancer diagnosis were included in cross-sectional analyses. EA and rumination were positively correlated with PTSS and symptoms of depression. EA and rumination did not provide incremental explained variance in PTSS over and above that explained by symptoms of depression, while controlling for symptoms of anxiety and demographic characteristics. However, EA and rumination provided incremental explained variance in symptoms of depression over and above that explained by PTSS, while controlling for symptoms of anxiety and demographic characteristics. Rumination and EA are important constructs in the understanding of PTSS and symptoms of depression in parents of children on cancer treatment. Future research should delineate the temporal relationships between these constructs.

National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-234500 (URN)10.1007/s10880-015-9437-4 (DOI)000371621600007 ()26462676 (PubMedID)
Conference
Conference of the Association-of-Psychologists-in-Academic-Health-Centers (APAHC), FEB, 2015, Atlanta, GA, USA
Funder
Swedish Research Council, K2008-70X-20836-01-3, K2011-70X-20836-04-4Swedish Cancer Society, 2010/276Swedish Childhood Cancer Foundation, PROJ08/010, PRO12/028
Note

Tidigare titel: Experiential avoidance and rumination in parents of children on cancer treatment: Relationships with posttraumatic stress symptoms and depression

Available from: 2014-10-20 Created: 2014-10-20 Last updated: 2017-12-05Bibliographically approved
Ljungman, L., Boger, M., Ander, M., Ljótsson, B., Cernvall, M., von Essen, L. & Hovén, E. (2016). Impressions that last: Particularly negative and positive experiences reported by parents five years after the end of a child's successful cancer treatment or death. PLoS ONE, 11(6), Article ID e0157076.
Open this publication in new window or tab >>Impressions that last: Particularly negative and positive experiences reported by parents five years after the end of a child's successful cancer treatment or death
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 6, article id e0157076Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To describe the experience of parenting a child diagnosed with cancer by examining particularly negative and positive experiences reported by parents of childhood cancer survivors and parents of children lost to cancer.

METHODS: 168 parents (88 mothers, 80 fathers) participated. Data were collected five years after the end of successful treatment or the child's death. The parents' experiences were identified by open-ended semi-structured questions about particularly negative and positive experiences of the child's cancer. An inductive approach was used in which the manifest verbal content of the answers was analysed using content analysis.

RESULTS: The analysis revealed eight categories of negative experience (child late effects; distressing events; healthcare; impaired relationships; long-term psychological consequences; own reactions; surrounding institutions; the fact that the child got cancer) and seven categories of positive experience (healthcare; improved relationships; long-term consequences for the child; personal development; support systems; treatment outcome; unexpected joy). The categories were related to past events or to the present situation. The findings indicate variations in experiences between parents of survivors and bereaved parents, and between fathers and mothers, as some experiences were only reported by parents of survivors and some experiences were only reported by mothers.

CONCLUSIONS: The results highlight the importance of past and present events to parents, and accordingly the long-lasting impact of paediatric cancer on parents. The results also point to the wide range of negative as well as positive experiences involved in parenting a child diagnosed with cancer, and provide a comprehensive understanding of the overall experience for parents of children with cancer. Specifically, the findings give guidance to healthcare providers by illustrating the need to provide healthcare personnel with continuous training in communication skills, offering parents opportunities to meet other parents in the same situation and increasing the access to psychosocial supportive services and psychological care.

National Category
Applied Psychology
Identifiers
urn:nbn:se:uu:diva-296022 (URN)10.1371/journal.pone.0157076 (DOI)000377561000061 ()27272318 (PubMedID)
Funder
Swedish Research Council, K2008-70X-20836-01- 3 K2011-70X-20836-04-4Swedish Cancer Society, 2007/1015 2010/726Swedish Childhood Cancer Foundation, PROJ08/010
Available from: 2016-06-13 Created: 2016-06-13 Last updated: 2017-11-28Bibliographically approved
Wikman, A., Hovén, E., Cernvall, M., Ljungman, G., Ljungman, L. & von Essen, L. (2016). Parents of children diagnosed with cancer: work situation and sick leave, a five-year post end-of-treatment or a child's death follow-up study. Acta Oncologica, 55(9-10), 1152-1157
Open this publication in new window or tab >>Parents of children diagnosed with cancer: work situation and sick leave, a five-year post end-of-treatment or a child's death follow-up study
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2016 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 55, no 9-10, p. 1152-1157Article in journal (Refereed) Published
Abstract [en]

Background: Cancer in a child is associated with a significant impact on parental employment. We assessed the proportions of parents of survivors and bereaved parents working and reporting sick leave five years after end of successful treatment (ST)/child's death (T7) compared with one year after end of ST/child's death (T6) and the association between partial post-traumatic stress disorder (PTSD) and work situation and sick leave at T7.

Participants and procedure: The sample included 152 parents of survivors (77 mothers, 75 fathers) and 42 bereaved parents (22 mothers, 20 fathers) of children diagnosed with cancer in Sweden.

Results: The proportions of parents working or reporting sick leave did not differ among mothers and fathers of survivors (92% vs. 96% working, 20% vs. 18% on sick leave) or among bereaved mothers and fathers (91% vs. 90% working, 14% vs. 20% on sick leave) at T7. There was no change from T6 to T7 in the proportion of fathers working (fathers of survivors 91% vs. 96%, bereaved fathers 95% vs. 90%). Although more mothers of survivors (92% vs. 82%) and bereaved mothers (91% vs. 77%) worked at T7 than at T6, this increase was not significant. Fewer bereaved mothers reported sick leave at T7 than at T6 (14% vs. 59%, p<0.05). Although more fathers reported sick leave at T7 than at T6 (fathers of survivors 18% vs. 8%, bereaved fathers 20% vs. 15%), this was not significant. Partial PTSD was not associated with parents' work situation or sick leave at T7.

Conclusion: Results suggest little adverse effect on work situation and sick leave among parents of survivors and bereaved parents five years after end of ST/child's death from cancer. However, the pattern of change observed differed between parents, which could potentially indicate possible delayed consequences for fathers not captured in the present paper.

National Category
Cancer and Oncology Psychology
Identifiers
urn:nbn:se:uu:diva-280459 (URN)10.3109/0284186X.2016.1167956 (DOI)000385554200014 ()27159219 (PubMedID)
Funder
Swedish Cancer Society, 01 6368, 02 0274, 03 0228Swedish Research Council, K2008-70X-20836-01-3Swedish Childhood Cancer Foundation, 02/004, 05/030
Available from: 2016-03-10 Created: 2016-03-10 Last updated: 2017-11-30Bibliographically approved
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