To Repeat or Not to Repeat - Preventing Intergenerational Transfer of Adverse Childhood Experiences

To Repeat or Not Repeat - A Mixed Methods Pilot Study of Patients' and Therapists' Experience With Prenatal Psychotherapy to Prevent Intergenerational Transfer of Adverse Childhood Experiences

The main aim of the study is to examine patients' and therapists' experiences with prenatal psychotherapy provided to pregnant women with adverse childhood experiences and how this may influence intergenerational transmission of risk. The investigators will explore a) participants' perspectives on what promoted or prevented change in psychotherapy, b) how the mothers' reflective function changes and possible factors associated with change in reflective function. Up to 20 clinically referred women in gestational week 20-30 will be included and assessed with qualitative interviews and questionnaires at the beginning of treatment and when the baby is 4 months old. The quality of the mother-infant relationship will be assessed. Seven therapists will be interviewed with a qualitative interview schedule. Outcomes of the study will inform individual tailoring of psychotherapy for a high risk group of patients and provide increased knowledge about how intergenerational risk factors change during treatment.

Study Overview

• Status: Unknown
• Conditions: Psychological Trauma
• Intervention / Treatment: Other: prenatal psychotherapy

Detailed Description

Even with the best evidence-based treatments, one is often unsuccessful in stopping intergenerational transfer of trauma, abuse, and neglect. The implications for the next generation are severe, affecting physical and emotional health, cognitive development, and relational functioning. The perinatal phase may provide a window of opportunity in efforts to prevent intergenerational transfer of risk factors associated with adverse childhood events. There is a great need for more knowledge about how generational patterns develop and are affected by psychotherapy during pregnancy, infancy and early childhood. Little is known about patients' experiences with prenatal psychotherapy and such knowledge can inform better tailoring of treatment. The present study is the first step of a planned longitudinal study to explore the role of mothers' adverse childhood experiences and child development.

The primary aim of the study is to explore patients' experiences with prenatal psychotherapy provided to pregnant women with adverse childhood experiences and their perspectives of what promotes or hinders change in treatment. Second, aims of the study are to explore a) therapists' experiences with psychotherapy for mothers with adverse childhood experiences, and b) explore the development of intergenerational risk factors. Additionally the investigators will explore the mothers' reflective function during the course of treatment, the role of adverse and benevolent childhood memories, and mother-infant interaction when the infant is four months old. Reflective function seems to be a key factor associated with quality of care in spite of adverse events. Understanding factors associated with possible change in reflective function is thus highly important. Up to 20 clinically referred women in gestational week 20-30 will be recruited. Participants will be assessed at the beginning of therapy and when the child is four months old. A combination of quantitative measures and qualitative interviews will be used. The infant will be assessed with the neonatal assessement scale at age 4-8 weeks and the quality of the mother-infant relationship will be assessed using Parent-Child Relation Assessment at four months. In addition, seven therapists will be interviewed about their experiences providing psychotherapy for this group of high risk patients.

• Study Type: Observational
• Enrollment (Anticipated): 27

Contacts and Locations

• Study Contact: Name: Marianne Aalberg, Phd; Phone Number: +4741123534; Email: marianne.aalberg@ahus.no
• Study Contact Backup: Name: Heidi Fjeldheim, MA; Phone Number: +4767960000; Email: heidi.fjeldheim@ahus.no

Study Locations

• Norway
  • Jessheim, Norway
    • Recruiting
    • BUP Øvre Romerike
    • Contact: Hege S Syversen, M.A.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

• Sampling Method: Non-Probability Sample

Study Population

Mothers: Clinically referred pregnant women with adverse childhood experiences. Therapists: Therapists providing prenatal psychotherapy to women with adverse childhood experiences

Description

Inclusion Criteria:

• Clinically referred women in gestational week 20-30
• Adverse Childhood Experiences Questionnaire (ACE) score of 2 or more

Exclusion Criteria:

• Known IQ below 70
• Ongoing substance abuse
• Planned referral to mother-child center after birth

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Mothers; Women with adverse childhood experiences referred for treatment in gestational week 20-30	Other: prenatal psychotherapy; Prenatal psychotherapy to break intergenerational risk of adverse childhood events
Therapists; Clinicians with experience of providing psychotherapy to women with adverse childhood experiences referred for treatment during pregnancy

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Experiences with prenatal psychotherapy	Qualitative interview conducted 4 months after birth examining the mothers' experiences with the treatment	4 months after birth

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Maternal Reflective functioning - Parent Development Interview	Assessment of change in mother's reflective functioning	Gestational week 20-30 to 4 months after birth
Therapists' experiences with providing psychotherapy for women with adverse childhood events	A qualitative interview examining positive and negative experiences with providing prenatal psychotherapy to women to prevent intergenerational transmission of adverse childhood events	Through study completion, an average of 1 year

Collaborators and Investigators

• Sponsor: University Hospital, Akershus
• Collaborators: South-Eastern Norway Regional Health Authority
• Investigators: Principal Investigator: Marianne Aalberg, Phd, University Hospital, Akershus

Study record dates

Study Major Dates

• Study Start (Actual): August 24, 2020
• Primary Completion (Anticipated): October 31, 2021
• Study Completion (Anticipated): October 31, 2021

Study Registration Dates

• First Submitted: July 16, 2020
• First Submitted That Met QC Criteria: August 24, 2020
• First Posted (Actual): August 27, 2020

Study Record Updates

• Last Update Posted (Actual): August 27, 2020
• Last Update Submitted That Met QC Criteria: August 24, 2020
• Last Verified: August 1, 2020

More Information

Terms related to this study

• Keywords: psychotherapy; parenting; child development; reflective function; Mother-child relations
• Additional Relevant MeSH Terms: Mental Disorders; Trauma and Stressor Related Disorders; Stress Disorders, Traumatic; Psychological Trauma
• Other Study ID Numbers: 97191

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No