Contact
info@wonsa.org
Address
Anders Reimers väg 18
117 50 Stockholm
Research
Knowledge and continous and collaborative development are necessary to reduce the suffering from sexual abuse. Here you can read about the studies WONSA has conducted with Karolinska Institutet and others.
Some of our research findings
70% of participants no longer had PTSD after one 2-hour treatment
A randomized controlled trial (RCT) conducted by Karolinska Institutet at the WONSA clinic explored a new PTSD protocol based on a modified Lifespan Integration protocol, developed for individuals with PTSD following a single incident of rape.
The findings showed that 70% of participants no longer met the criteria for PTSD after a single two-hour session, with improvements appearing to be maintained at six-month follow-up.
26x Higher risk of attempted suicide after sexual abuse
Reaching out for help does not reduce the risk. For sexually abused girls, the likelihood of a suicide attempt is 16 times higher than peers at first contact with healthcare — and 26 times higher in the year that follows.
Our published studies
Diagnoses of sexual abuse and their common registered co-morbidities in the total population of Stockholm
In this study, we look at how common different diagnoses are among people who have had a sexual abuse registered in the healthcare system, in comparison to people who have not. The data is based on all children and adults who lived in Stockholm between 2008-2014. Here we see that it is more than 10 times as common for a person who has had a sexual abuse registered in the healthcare system to have stress-related illnesses, anxiety and substance abuse problems, among other things.
- By Rajan G, Ljunggren G, Wändell P. et al., 2017
Health care consumption among adolescent girls prior to diagnoses of sexual abuse, a case–control study in the Stockholm Region
In this study, we further looked at the use of healthcare for girls aged 12-17, who were the most vulnerable group in the study above, one and two years before a sexual abuse is registered in the healthcare system. We conducted this study because we know that children rarely tell and that abuse affects health, and we wanted to know if there were patterns that could mean that these girls could be identified and helped earlier? There were. Among other things, it was 15 times more common for these girls to seek healthcare due to suicide attempts than other girls of the same age in the same residential area, that they sought healthcare much more often than their peers, and that it was almost 10 times as common for them to receive medication for anxiety and sleep problems. One conclusion from the study is that there is a need for increased knowledge within Swedish healthcare about how to identify and treat young people who have been subjected to or are at risk of being subjected to sexual abuse.
- By Rajan G, Ljunggren G, Wändell P. et al., 2020
Healthcare consumption and psychiatric diagnoses among adolescent girls 1 and 2 years after a first-time registered child sexual abuse experience /.../
In this study, we investigate what happens one and two years after the health care system has registered that sexual abuse has occurred, in the girls from the previous study. Among other things, what we wanted to know was whether the health care system could reduce the risk of suicide attempts when there was knowledge of the sexual abuse. What we saw was that the health care system could not reduce the risk of suicide attempts. Instead, the risk of these girls seeking health care due to suicide attempts rose to 26 times higher than for girls of the same age in the same residential area. One conclusion is that there is a need for increased knowledge and understanding of which interventions and processes within the health care system improve or worsen health and well-being, and increase or decrease the risk of suicide attempts and suicide in young people who have been subjected to sexual abuse.
- By Rajan G, Syding S, Ljunggren G. et al., 2020
A One-Session Treatment of PTSD After Single Sexual Assault Trauma. A Pilot Study of the WONSA MLI Project: A Randomized Controlled Trial
This study uses a new PTSD protocol, based on Lifespan Integration, for the treatment of PTSD after sexual abuse. 70% of participants were free of their PTSD diagnosis after a two-hour treatment, and the results were maintained after 6 months. A conclusion is that new perspectives on PTSD and PTSD treatment can shorten the treatment time for PTSD after sexual abuse. The study is a pilot study and several and larger studies are planned. Below are some of the comments from reviewers: "Strong design for a pilot study and I appreciate the decision to examine a single session intervention specifically for individuals with a single traumatic event in the relatively recent past." "The findings are promising and have potentially very important implications for the field" "The possible explanations of the efficacy of the MLI section is incredibly interesting"
- By Rajan G, Wachtler C, Lee S. et al., 2020
Delayed healthcare access among victims of sexual abuse, understood through internal and external gatekeeping mechanisms
This study analyzes the symptoms, diagnoses and types of abuse that occur among patients seeking help at WONSA's specialist clinic, as well as how they have experienced access to healthcare. Among other things, it is seen that: the majority of patients have been exposed to penetrating sexual abuse in childhood. 80% have tried to seek help at other clinics before coming to WONSA. 90% meet the criteria for PTSD and/or depression when they come to WONSA, regardless of whether they have had contact with another healthcare provider before coming to WONSA. The average time between the first onset of sexual abuse and the patient telling someone about the sexual abuse for the first time is 16 years. The average number of diagnoses upon enrollment at WONSA was 6 diagnoses. The factors that had the strongest connection to suicide attempts were: number of ACEs number of perpetrators and biological father as the first perpetrator. The study also presents a gatekeeping model for how knowledge of factors that hinder or facilitate access to care for victims of sexual offenses can be used to evaluate access to care for victims of sexual offenses.
- By Rajan G, Wahlström L, Philips B, et al., 2021
Sexual violence, mental health, and suicidality - Results from a survey in cooperation with idea‐driven organizations and their social media platform followers
Results: Of the participants exposed to penetrating sexual violence, 49% stated that they had or had been diagnosed with depression, compared with 16% in the group not exposed to sexual violence. Similar findings were found for anxiety: 45% versus 12%; fatigue syndrome 28% versus 9%; post traumatic stress disorder 30% versus <0.1% and suicide attempts, 29% versus 3%. More participants in the group exposed to sexual violence had grown up in families with alcohol problems, suicide attempts, or where they have witnessed violence.
Conclusion: Steps should be taken to adapt the national suicide prevention strategy to the association between sexual violence and suicide attempts, which has been so clearly demonstrated earlier in both international and national studies, and which is again shown in the present study.
- By Carlsson AC, Owen U, Rajan G. et al., 2022
“Though frightening, these attacks..... remind us that creating a protected space where survivors can speak their truth is an act of liberation...bearing witness... is an act of solidarity... Those who stand with the victim will inevitably have to face the perpetrator's unmasked fury. For many of us, there can be no greater honour.”
- Judith Lewis Herman, M.D
Swedish publications within our network
Lifespan Integration as a treatment method for PTSD in a natural setting
Sexual abuse is a widespread social problem that produces large societal costs and great suffering for those affected, and it is one of the leading causes of PTSD globally. Lifespan Integration (LI) has been shown in a randomised controlled trial (RCT) to be a gentle and cost-effective treatment for PTSD. It has not, however, been studied in an ordinary clinical setting.
The aim of this study was to examine the effectiveness of LI in a naturalistic clinical setting — that is, without the rigorous participant selection that characterises RCTs.
A patient group at the WONSA clinic in Stockholm (n = 28) was surveyed. On average, the patients had been exposed to 2 Adverse Childhood Experiences (ACEs) and to close to 2 sexual assaults; 85.7% were women and 14.3% were men. Of the 28 patients, 16 completed all pre- and post-treatment measurements on the IES-R and MADRS scales. Two t-tests were performed on this completer sample (n = 16) to analyse symptom reduction in PTSD and depression respectively.
The t-test on IES-R showed a large effect size (d = 2.09); approximately 80% of the completer group fell below the cut-off for clinical PTSD after treatment. In addition, 75% of the completer group had reduced their depressive symptoms to none or mild depression after treatment.
Symptoms were significantly reduced in those who underwent Lifespan Integration. Further research on methods such as Lifespan Integration for the treatment of PTSD is needed.
- By Joakim Brådenmark and Maria Järvare, 2024
Sexual trauma & healthcare
Sexual trauma has a high prevalence both globally and in Sweden. Compared with other traumatic events, it produces more serious consequences for the mental health of those affected. Many affected individuals are in care, but according to a previous study (Rajan et al., 2021), a large proportion feel they have not been helped enough.
The aim of this study was to deepen the understanding of patients' previous experiences of health care, and of the kind of help they were seeking, when they first contacted WONSA.
Intake self-reports from patients on the waiting lists at the WONSA clinics in Stockholm and Gothenburg, were analysed using a qualitative method. Negative experiences of seeking help and support were more common than positive ones. Patients commonly described being poorly met by the care system, and reported that psychotherapeutic treatment remained inaccessible to them. The kinds of help they were seeking centred on their emotional life, their relationships with others, and access to treatment.
There is room for improvement in care for sexually traumatised patients, both in how they are met and in the clinical treatment they receive. National coordination of care for sexually traumatised patients is recommended.
- By Malin Viman, 2022
Modified Lifespan Integration after sexual trauma, a qualitative study on how patients experience treatment
The aim of this study was to understand the patient's experience of Modified Lifespan Integration (MLI) as a treatment for PTSD following sexual trauma.
The recommended first-line treatments for PTSD rest on CBT with exposure, and prolonged exposure (PE) has long been considered the gold standard. A major problem with PE, however, is its high drop-out rate. Modified Lifespan Integration (MLI) is built on minimal exposure and has been sparsely studied. In the only RCT to date, 72% of participants no longer scored for PTSD after a single session, and the drop-out rate was very low. In this qualitative interview study we examined how the participants in that RCT experienced the treatment itself.
Six patients were recruited by consecutive sampling from the pilot RCT of MLI for PTSD after sexual trauma. They underwent semi-structured interviews, transcribed verbatim and analysed qualitatively using constructivist grounded theory, with constant comparative method and negative case analysis.
- The treatment was experienced as tolerable, but emotionally challenging and heavy. Safety with the therapist was experienced as central to the work. A number of interesting aspects of the treatment experience and the surrounding context emerged, several of which point to concrete ways patient experience and tolerability could be improved. MLI is a potentially powerful tool for the treatment of PTSD caused by sexual violence and should be studied further.
Not living life to the fullest: A thematic analysis of mental
health among adults exposed to childhood sexual abuse
Childhood sexual abuse is a global problem and has been linked to a number of negative consequences such as post-traumatic stress disorder (PTSD), suicide attempts and relationship difficulties. Qualitative studies that examine people's own perceptions of how the abuse affects their mental well-being today are few. The aim of the present study was therefore to examine how adults with experience of childhood sexual abuse experience their current mental well-being in a Swedish context. The sample consisted of 71 people who had themselves sought treatment at WONSA, a specialist clinic for sexual abuse. Data were analysed using reflexive thematic analysis (TA) and generated four themes: Mental problems, Relational difficulties, Not living life to the fullest, Ready to face trauma and regain life, with the overarching theme: The present colored by childhood sexual abuse. The participants reported subjective suffering and a desire to feel well again, which led to attempts to obtain adequate treatment for their trauma. Mental well-being and help-seeking behaviors can be understood based on individual and relationship factors, as well as the severity of the abuse.
- By Nancy Nebrin, 2023
Research authors & co-authors
Gita Rajan
Chairman of the Board, Head of Research and Development. PhD, MD, specialist in general medicine. Founder of WONSA, survivor.
Axel C Carlsson
Associate Professor in Epidemiology, Pharmacist, KI, NVS, Section for General Medicine and Primary Care.
Caroline Wachtler
Med. Dr., specialist in general medicine, assistant lecturer at the Section for General Medicine and Primary Care, NVS, KI.
Per Wendell
Senior professor of general medicine, specialist in general medicine, KI, NVS, Section for General Medicine and Primary Care.
Carl-Göran Svedin
Professor emeritus, Ersta Bräcke Sköndal University.
Björn Phillips
Associate Professor in Clinical Psychology, Department of Psychology, Stockholm
University. Licensed psychologist and licensed psychotherapist, psychotherapy researcher with experience in randomized controlled trials.
Lars Wahlström
With Dr., Karolinska Institutet, CPF, Chief Physician, Psychiatry, Stockholm County Health District, VO Psychiatry.
Collaboration
Do you have questions, are you curious about our work or looking to collaborate? Feel free to contact us.