VanWestrhenen, N., Fritz, E., Vermeer, A., Boelen, P., Kleber, R.

Creative arts in psychotherapy for traumatized children in South Africa: An evaluation study

Aim To evaluate the feasibility and effect of a 10 -session creative arts in psychotherapy group programme on posttraumatic stress symptoms, behavioural problems, and posttraumatic growth, in children who experienced a traumatic event. Design A multicentre non-randomized controlled trial with a treatment and a control condition conducted in South Africa (4 sites). Methods 125 children aged 7 to 13 years were assigned either to the treatment condition receiving creative arts in psychotherapy or a control condition with a low-level supportive programme without treatment. Attrition rates were 63.4% and in total 47 children completed the programme and questionnaires assessing posttraumatic stress, posttraumatic growth and behaviour problems both at baseline and follow-up; 23 in the treatment group and 24 in the control group. Adjusted mean differences were analysed using ANCOVA with bootstrapping. Results Results showed that both hyperarousal symptoms (d = 0.61) and avoidance symptoms (d = 0.41) decreased more in the treatment group compared to the control group. There was no significant effect of the intervention found for reported levels of behavioural problems and posttraumatic growth. Conclusion In spite of severe challenges implementing and executing this pioneering study in underprivileged areas of South Africa, support was found for creative arts in psychotherapy reducing hyperarousal and avoidance symptoms, but not for other symptoms. Valuable lessons were learned on feasibility of implementing this intervention in a developing context. Copyright © 2019 van Westrhenen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PLoS ONE, 14 (2)(e0210857) :

Sun, M., Rith-Najarian, L. R., Williamson, T. J., Chorpita, B. F.

Treatment Features Associated with Youth Cognitive Behavioral Therapy Follow-Up Effects for Internalizing Disorders: A Meta-Analysis

Our aim was to investigate whether four treatment features (i.e., the inclusion of parental involvement, goal-setting strategies, maintenance/relapse prevention sessions, the addition of booster sessions) were associated with posttreatment and follow-up effect size of youth cognitive behavioral therapies (yCBTs) for anxiety, depression, posttraumatic stress disorder, and obsessive-compulsive disorder in age groups spanning young children to adolescents. We conducted a random-effects meta-analysis of 106 yCBTs tested in 76 randomized clinical trials from the PracticeWise Database to examine average effects of yCBTs posttreatment and at a later follow-up assessment. We coded the use of parental involvement, goal setting, booster sessions, and maintenance/relapse prevention in each yCBT and conducted random-effects meta-regression analyses to investigate whether these treatment features were associated with yCBT effects at posttreatment as well as at follow-up. Overall, yCBTs produced large pre- to posttreatment effects (d = 1.05), 95% confidence interval [0.94, 1.15], and larger pre- to follow-up effects (d = 1.29), 95% confidence interval [1.18, 1.40]. Metaregression results indicated that parental involvement was significantly associated with larger pre- to posttreatment effect sizes as well as pre- to follow-up effect sizes. Booster sessions, goal setting, and maintenance/relapse prevention were not significantly related to effect sizes at posttreatment or follow-up. Parental involvement may be helpful for maximizing long-term effectiveness of yCBT. Future studies should investigate for whom and under what conditions inclusion of yCBT treatment features is related to the durability of treatment gains.

Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 48(Supplement1) : S269-S283

Unterhitzenberger, J., Wintersohl, S., Lang, M., Konig, J., Rosner, R.

Providing manualized individual trauma-focused CBT to unaccompanied refugee minors with uncertain residence status: A pilot study

Background: Unaccompanied refugee minors (URMs) seeking asylum show high rates of posttraumatic stress disorder (PTSD), depression and anxiety. In addition, they experience post-migration stressors like an uncertain residence status. Therefore, psychotherapeutic interventions for URMs are urgently needed but have scarcely been investigated up to now. This study aimed to examine manualized individual trauma-focused cognitive behavioural therapy (TF-CBT) for URMs with PTSD involving their professional caregivers (i.e. social workers in child and adolescent welfare facilities). Method(s): We conducted an uncontrolled pilot study with three follow-up assessments (post-intervention, 6 weeks, and 6 months). Participants who met the PTSD diagnostic criteria were treated in a university psychotherapeutic outpatient clinic in Germany with a mean of 15 sessions of TF-CBT. All participants (n = 26) were male UM (Mage = 17.1, SD = 1.0), predominately from Afghanistan (n = 19, 73.1%) and did not have a residence permit. The sample was severely traumatized according to the number of traumatic event types reported (M = 11.3, SD = 2.8). The primary outcome was PTSD measured with the Child and Adolescent Trauma Screen (CATS) and the Diagnostic Interview for Mental Disorders in Childhood and Adolescence (Kinder-DIPS). Secondary outcomes were depression, behavioural and somatic symptoms. All but the somatic symptoms were assessed in both self-report and proxy report. Result(s): At post-intervention the completer sample (n = 19) showed significantly decreased PTSD symptoms, F(1, 18) = 11.41, p =.003, with a large effect size (d = 1.08). Improvements remained stable after 6 weeks and 6 months. In addition to PTSD symptoms, their caregivers reported significantly decreased depressive and behavioural symptoms in participants. According to the clinical interview, 84% of PTSD cases recovered after TF-CBT treatment. After 6 months, youths whose asylum request had been rejected showed increased PTSD symptoms according to individual trajectories in the Kinder-DIPS. The effect was, however, non-significant. Conclusion(s): Intervention studies are feasible with URMs. This pilot study presents preliminary evidence for the efficacy of an evidence-based intervention like TF-CBT in reducing PTSD symptoms in URMs. Stressors related to asylum proceedings after the end of therapy have the potential to negatively influence psychotherapy outcomes. Copyright © 2019 The Author(s).

Child and Adolescent Psychiatry and Mental Health, 13 (1) (no pagination)(22) :

Morina, N., Sterr, T. N.

Lack of evidence for the efficacy of psychotherapies for PTSD and depression in child and adolescent refugees

World Psychiatry, 18(1) : 107- 108

Levinson, J., Kohl, K., Baltag, V., Ross, D. A.

Investigating the effectiveness of school health services delivered by a health provider: A systematic review of systematic reviews

Schools are the only institution regularly reaching the majority of school-age children and adolescents across the globe. Although at least 102 countries have school health services, there is no rigorous, evidence-based guidance on which school health services are effective and should be implemented in schools. To investigate the effectiveness of school health services for improving the health of school-age children and adolescents, a systematic review of systematic reviews (overview) was conducted. Five databases were searched through June 2018. Systematic reviews of intervention studies that evaluated school-based or school-linked health services delivered by a health provider were included. Review quality was assessed using a modified Ballard and Montgomery four-item checklist. 1654 references were screened and 20 systematic reviews containing 270 primary studies were assessed narratively. Interventions with evidence for effectiveness addressed autism, depression, anxiety, obesity, dental caries, visual acuity, asthma, and sleep. No review evaluated the effectiveness of a multi-component school health services intervention addressing multiple health areas. From the limited amount of information available in existing systematic reviews, the strongest evidence supports implementation of anxiety prevention programs, indicated asthma education, and vision screening with provision of free spectacles. Additional systematic reviews are needed that analyze the effectiveness of comprehensive school health services, and specific services for under-researched health areas relevant for this population. Copyright © 2019 Levinson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PLoS ONE, 14 (6) (no pagination)(e0212603) :

Kangaslampi, S., Peltonen, K.

Changes in Traumatic Memories and Posttraumatic Cognitions Associate with PTSD Symptom Improvement in Treatment of Multiply Traumatized Children and Adolescents

Refinement, targeting, and better dissemination of trauma-focused therapies requires understanding their underlying mechanisms of change. Research on such mechanisms among multiply traumatized children and adolescents is scarce. We examined the role of improvements in problematic qualities of traumatic memories and maladaptive posttraumatic cognitions in PTSD symptom reduction, in a randomized, pragmatic trial of narrative exposure therapy vs. treatment as usual with 40 participants 9-17 years old (48% female, 75% refugee background) repeatedly exposed to war or family violence related trauma. Posttraumatic cognitions, quality of traumatic memories and PTSD symptoms were assessed by self-report before and after treatment. Improvements in both quality of traumatic memories (rMI =.36) and posttraumatic cognitions (rMI =.46) correlated with symptom reduction. However, improvement during treatment was only significant for quality of traumatic memories (FMI(11,333.56) = 4.77), not for posttraumatic cognitions. We detected no difference in effects of narrative exposure therapy and treatment as usual on cognitions or memories. We tentatively suggest problematic, overly sensory and incoherent quality of traumatic memories may be a useful target in the treatment of PTSD symptoms among multiply traumatized children and adolescents. Changing maladaptive posttraumatic cognitions, though important, may be challenging among those with severe, repeated trauma. Copyright © 2019, The Author(s).

Journal of Child and Adolescent Trauma., 13 : 103 - 112

Thompson, S.R., Dobbins, S.

The applicability of resilience training to the mitigation of trauma-related mental illness in military personnel

Background: Ongoing participation by the United States in military operations around the world places military personnel at an increased potential for exposure to trauma, which may directly result in an increased risk for mental health issues. It is important to develop and test new approaches to prevent and mitigate the effects of trauma in military personnel. One such area of research is focused on psychological resilience to prevent the sequelae of trauma. Objectives: This article examines empirical research of resilience training in military personnel and discusses the potential applicability of such training in this population. Design: In this literature review, four randomized control trials and one retrospective, parallel group study were reviewed. Results: Each intervention had the goal of mitigating behavioral health issues after trauma exposure. The results of the various interventions were wide- ranging from no measurable difference in treatment groups to significant differences in outcomes. Conclusions: Despite the inconclusive results of our review, we have determined that resilience training for active duty service members to help prevent the deleterious effects of trauma on mental health is a compelling and necessary avenue for further research. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Journal of the American Psychiatric Nurses Association, 24(1) : 23- 34

Huang, J., Nigatu, Y. T., Smail-Crevier, R., Zhang, X., Wang, J.

Interventions for common mental health problems among university and college students: A systematic review and meta-analysis of randomized controlled trials

Common mental health problems (CMHPs), such as depression, anxiety disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) are internalizing disorders with high comorbidity. University and college students are under many stressors and transitional events, and students fall within the age range when CMHPs are at their developmental peak. Compared to the expanded effort to explore and treat CMHPs, there has been no a meta-analysis that comprehensively reviewed the interventions for CMHPs and examined the effects of interventions for CMHPs in college students. The objective of this review is to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) examining interventions for CMHPs among university and college students and to estimate their post-intervention effect size (ES), as well as follow-up ES, for depression, anxiety disorder, OCD and PTSD separately. Meta- analytic procedures were conducted in accordance with PRISMA guidelines. We reviewed 7768 abstracts from which 331 full-text articles were reviewed and 51 RCTs were included in the analysis. We found moderate effect sizes for both depression (Hedges' g = -0.60) and anxiety disorder (Hedges' g = -0.48). There was no evidence that existing interventions for OCD or PTSD were effective in this population. For interventions with high number of papers, we performed subgroup analysis and found that cognitive behavioral therapy (CBT) and mindfulness-based interventions were effective for both depression and generalized anxiety disorder (GAD), and attention/perception modification was effective for GAD; other interventions (i.e. art, exercise and peer support) had the highest ES for both depression and GAD among university and college students. Copyright © 2018 Elsevier Ltd

Journal of Psychiatric Research, 107 : 1-10

Lewey, J. H., Smith, C. L., Burcham, B., Saunders, N. L., Elfallal, D., O-Toole, S. K.

Comparing the Effectiveness of EMDR and TF-CBT for Children and Adolescents: a Meta-Analysis

Efficacy of EMDR and TF-CBT for posttraumatic stress symptoms (PTSS) was explored through meta-analysis. A comprehensive search yielded 494 studies of children and adolescents with PTSS who received treatment with these evidence-based therapeutic modalities. Thirty total studies were included in the meta-analysis. The overall Cohen's d was small (-0.359) and statistically significant (p < 0.05), indicating EMDR and TF-CBT are effective in treating PTSS. Major findings posit TF-CBT is marginally more effective than EMDR; those with sub-clinical PTSS responded more favorably in treatment than those with PTSD; and greater reductions in PTSS were observed with presence of comorbidity in diagnosis. Assessment of publication bias with Classic fail-safe N revealed it would take 457 nonsignificant studies to nullify these findings. Copyright © 2018, Springer International Publishing AG, part of Springer Nature.

Journal of Child and Adolescent Trauma, 11(4) : 457-472

Lewey, J. H., Smith, C. L., Burcham, B., Saunders, N. L., Elfallal, D., O-Toole, S. K.

Comparing the Effectiveness of EMDR and TF-CBT for Children and Adolescents: a Meta-Analysis

Efficacy of EMDR and TF-CBT for posttraumatic stress symptoms (PTSS) was explored through meta-analysis. A comprehensive search yielded 494 studies of children and adolescents with PTSS who received treatment with these evidence-based therapeutic modalities. Thirty total studies were included in the meta-analysis. The overall Cohen's d was small (-0.359) and statistically significant (p < 0.05), indicating EMDR and TF-CBT are effective in treating PTSS. Major findings posit TF-CBT is marginally more effective than EMDR; those with sub-clinical PTSS responded more favorably in treatment than those with PTSD; and greater reductions in PTSS were observed with presence of comorbidity in diagnosis. Assessment of publication bias with Classic fail-safe N revealed it would take 457 nonsignificant studies to nullify these findings. Copyright © 2018, Springer International Publishing AG, part of Springer Nature.

Journal of Child and Adolescent Trauma, 11(4) : 457-472

Rossouw, J., Yadin, E., Alexander, D., Seedat, S.

Prolonged exposure therapy and supportive counselling for post-traumatic stress disorder in adolescents: Task-shifting randomised controlled trial

Background: Empirical evidence on the effectiveness of evidence-based treatments for adolescents with post-traumatic stress disorder (PTSD) in low-resource settings is needed. Aims: To evaluate the comparative effectiveness of prolonged exposure and supportive counselling in adolescents with PTSD. Method: Sixty- three adolescents (13-18 years) with PTSD were randomly assigned to receive either of the interventions comprising 7-14 sessions of treatment (trial registration in the Pan African Clinical Trials Registry: PACTR201511001345372). The primary outcome measure was PTSD symptom severity, as independently assessed on the Child PTSD Symptom Scale at pre-treatment, post-treatment, and at 3- and 6-month follow-up. Results: Participants receiving prolonged exposure experienced greater improvement on the PTSD symptom severity scale than those receiving supportive counselling (between group differences at post-intervention, mean 12.49, 95% CI 6.82-18.17, P < 0.001; d = 1.22). A similar effect size was maintained at 3-month (d = 0.85) and 6-month (d = 1.02) follow-up assessments. Conclusions: Adolescents with PTSD experienced greater benefit from prolonged exposure treatment when provided by non-specialist health workers (nurses) in a community setting. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

British Journal of Psychiatry, 213(4) : 587- 594

Kohut, S. A., Jelen, A., Ruskin, D., Stinson, J.

Mindfulness-based interventions in clinical samples of youth with internalizing disorders Systematic review [conference abstract]

Context Mindfulness-based interventions (MBIs) have emerged as a promising strategy for individuals with chronic health conditions, given their versatility in targeting both physical and mental health outcomes. However, research to date has focused on adult or community-based populations. Yet, a recent meta-analysis revealed that MBIs are 3 times more impactful for clinical versus nonclinical pediatric populations and are particularly helpful for internalizing symptoms (eg, depression, anxiety). Objective To summarize and critically appraise the available literature on the feasibility and effectiveness of MBIs for clinical samples of youth diagnosed with internalizing disorders (eg, anxiety, depression, posttraumatic stress). Design A systematic review of the literature with electronic searches conducted by a library information specialist familiar with the feld using EMBASE, PsycINFO, MEDLINE, CINAHL, Web of Science, and EBM Reviews databases. Two reviewers independently selected articles for review and extracted data. Results Of a total of 4710 articles, 5 articles met inclusion criteria. Study designs were primarily randomized controlled trials with 1 prospective pre-post intervention study. Sample sizes varied across studies from 24 to 102 participants. No studies included inpatient participants or participants with comorbid internalizing and physical disorders. The MBIs included in this review were primarily group-based and did not offer remote or online options. All MBIs were feasible, and studies consistently found that following MBI completion, youth reported considerable improvements in internalizing symptoms (eg, anxiety, depression, posttraumatic stress).Conclusion Mindfulness-based interventions are a promising approach to coping with internalizing symptomsin youth. Clinical populations of youth are an essential sample to target for future work in mindfulness owing to the substantial impairment in quality of life and function related to living with mental illness. Future research with rigorous study design is warranted to determine definitive treatment effectiveness of MBIs for internalizing symptoms.

Canadian Family Physician, 64 (2 Supplement 1) : S79