Maria Bragesjö wants to help more people with PTSD
Treatment for post-traumatic stress disorder (PTSD) is effective and can cure the majority of those affected, according to psychologist and researcher Maria Bragesjö, who introduced the treatment method to Sweden. Through her research, she hopes even more people will receive help.
Text: Cecilia Odlind, first published in Medicinsk Vetenskap nr 2 2025
Maria Bragesjö's very first patient during her psychology training suffered from post-traumatic stress disorder, (PTSD), following traumatic experiences of war. Her supervisor was alarmed - PTSD was considered a difficult condition to treat, and certainly not suitable for a beginner. Nor did the supervisor have a good method to recommend.
“But at the library I found the book “Treating the trauma of rape”, which had just been published, and it described a method based on cognitive behavioural therapy," says Maria Bragesjö.
She began treatment following the book's instructions. After eight sessions, the patient wanted to cease the treatment.
“She no longer had intrusive flashbacks. She could move about in public. She no longer jumped at the sound of a car starting. She could also see that what was happening was not about her as a person," Maria Bragesjö recalls.
The patient simply no longer met the citeria of PTSD.
“She said: 'You have given me my life back. I no longer need you'. That was a real eye-opener for me," says Maria Bragesjö.
The idea that PTSD is a difficult-to-treat condition that easily becomes chronic is still a widespread misconception, especially among psychologists, she says.
“Many think they risk making the patient worse if they treat it incorrectly, and that you need to be some kind of super-herapist. But that is not true. On the contrary, there is an effective treatment and clear instructions on how to carry it out," she says.
The method Maria Bragesjö tried early on in her psychology training is called ‘prolonged exposure’ and was developed by the professor and therapist Edna Foa, based in the US. Maria Bragesjö trained in the method and brought it to Sweden. The treatment is similar to phobia training and aims to break avoidance behaviours, both in thoughts and actions.
“The traumatic event is associated with great danger and intense discomfort. This often leads to people trying to avoid thinking about what happened and avoiding situations, places or reminders that trigger the memory, much like someone with a spider phobia avoids spiders. The problem is that the avoidance itself reinforces the sense of danger - it's like telling the brain 'this is dangerous'," explains Maria Bragesjö.
In treatment, the patient first learns how the body reacts and functions in traumatic situations, what PTSD is, and how it has affected their life - for example, through limited mobility, avoidance of important places or situations, increased anxiety, and negative thoughts about oneself.
“When it becomes crystal clear how much PTSDS has affected you and what the suffering results in, it becomes easier to find the motivation to challenge the avoidance and start moving towards the things you long to be able to do again," says Maria Bragesjö.
“Hot spots” are identified
The patient also revisits and retells the traumatic memory. They are asked to close their eyes and describe the sequence of events in detail, using the present tense, in order to emotionally connect with the memory and begin to process it. This is then repeated several times. Eventually, the most distressing parts of the memory, known as “hot spots”, can be identified and revisited specifically.
After 8-15 sessions, the intense emotional charge of the memory has often diminished, negative beliefs about the event have been challenged, and the patient can begin to reclaim important parts of life that were previously restricted by fear.
By recounting the event in detail, the patient often gains a new perspective, for example, realising they were alone and helpless rather than responsible.
“When that insight lands, feelings of guilt and shame usually lessen, which is an important part of the healing process," explains Maria Bragesjö.
Around 80 per cent of those who complete the treatment fully recover, and a further 10 per cent experience partial improvement. These figures apply even to people who have lived with PTSD for many years.
“But there is a group of around 20 per cent who do not complete the treatment, and we need to find ways to reach them. For some, the treatment is too long or difficult to fit into everyday life. Digital formats can increase accessibility and lower the threshold for seeking help, while intensive treatments - where several sessions are given over a shorter period - can reduce the risk of dropout. "There is less time for obstacles to arise, and avoidance behaviours do not have get the same chance to take over," she says.
According to a World Health Organization survey conducted in 24 countries, about 70 per cent of people have experienced an event in life that could potentially lead to PTSD. But far fewer actually develop the condition. Around 5-6 per cent of Swedes are affected by PTSD at some point in their lives, but many recover naturally by talking about the experience with loved ones. PTSD is still one of the most common diagnoses in healthcare, and it is both over- and underdiagnosed, says Maria Bragesjö.
“Many are missed as it is common for patients to seek care for something else, such as pain or depression, because they want to avoid talking about the trauma," says Maria Bragesjö.
Many people want a PTSD diagnosis
At the same time, PTSD has become something of a trendy diagnosis, and there is pressure on healthcare from patients who have experienced something distressing and want a PTSD diagnosis. But the criteria for PTSD are very clear: it is not enough that someone, for example, hurt you deeply; you must have experienced a threat to you own or a loved one’s life.
“Trauma can lead to a variety of psychological reactions, and in some cases, it is more a case of trauma-induced depression, social anxiety or adjustment disorder. Sometimes other factors in a person’s life or personality affect recovery, such as comorbidity with a personality disorder," says Maria Bragesjö.
But receiving a diagnosis that focuses on personal vulnerability rather than the traumatic event can be more emotionally charged.
“A PTSD diagnosis can feel more 'legitimate' because it clearly points to an external threat - a perpetrator, an accident, a war - whereas other diagnoses are sometimes interpreted as meaning there is something ‘wrong’ with you. It is important that we as therapists can keep both perspectives in mind at once and meet the patient's suffering regardless of the diagnosis," says Maria Bragesjö.
In her research, she is currently investigating whether the treatment can be delivered digitally, entirely without face-to-face contact with a psychologist, though the psychologist is available via a chat function a few times per week.
”I was initially sceptical. But when a study we had planned to conduct in person at the clinic was cancelled, the question became relevant. With support from research colleagues who have tested internet-based Cognitive Behavioural Therapy (CBT) for other conditions, I have carried out several studies, and it appears to work just as well when delivered digitally," she says.
This way, many more people can access the treatment.
“It can also lower the threshold for seeking care, as feelings of shame can make it difficult to face a psychologist in person," says Maria Bragesjö.
In a parallel study conducted in collaboration with Save the Children, digital trauma-focused CBT for children and adolescents is being explored. In other projects, the research team is examining the effects of intensive treatment, as well as a treatment programme tailored for migrants.
Maria Bragesjö had worked as a psychologist for about 15 years before she began her research career.
“I think that was a great advantage. I have e met so many patients who have given feedback on their care and treatment they received. That makes my research more relevant," she says.
*The book mentioned is the predecessor to the manual currently used for the prolonged exposure method: “Emotionell bearbetning vid PTSD” (Emotional processing in PTSD) (Natur & Kultur, 2021).
About Maria Bragesjö
Title: Licensed psychologist and researcher at the Department of Clinical Neuroscience, Karolinska Institutet.
Age: 48.
Family: Partner and two daughters, aged 16 and 18.
How I relax: I watch TV series, I love sci-fi. Reality shows do not interest me at all, I get enough reality at work. Physical exercise/training is also a way to unwind, I prefer to do heavy deadlifts.
Role models: Denis Mukwege, who was awarded the Nobel Peace Prize in 2018 alongside Nadia Murad for their work against sexual violence as a weapon in war and conflict. He never gives up and continues working tirelessly to help others.
Motto: I often quote Rocky Balboa: "It ain't about how hard you hit. It's about how hard you can get hit and keep moving forward. How much you can take and keep moving forward. That's how winning is done!"
Maria Bragesjö on...
... repressed memories: That we could successfully repress traumatic memories is unlikely. On the contrary, patients with PTSD, whose memories haunt them 24/7, demonstrate that the brain does not work that way.
... AI: I believe AI may replace some aspects of psychological contact in the future. At the same time, many patients testify to the importance of having a human presence in front of the screen in digital therapy.
... concept creep: The term refers to the dilution of psychological concepts. For example, the word ‘trauma’ is used far too casually by many today. Instead, one could say 'something very stressful'.
... complex PTSD: More research is needed on this diagnosis, which is often caused by multiple traumatic events in childhood. Complex PTSD is not necessarily harder to treat than classic PTSD.