Disorders - Post Traumatic Stress Disorder
Purgato, M., Gastaldon, C., Papola, D., van-Ommeren, M., , Barbui, C., Tol, W.
A.
BACKGROUND: People living in humanitarian settings
in low- and middle-income countries (LMICs) are exposed to a constellation of stressors that make them vulnerable to developing mental disorders.
Mental disorders with a higher prevalence in these settings include post-traumatic stress disorder (PTSD) and major depressive, anxiety, somatoform
(e.g. medically unexplained physical symptoms (MUPS)), and related disorders. A range of psychological therapies are used to manage symptoms of
mental disorders in this population.\rOBJECTIVES: To compare the effectiveness and acceptability of psychological therapies versus control conditions
(wait list, treatment as usual, attention placebo, psychological placebo, or no treatment) aimed at treating people with mental disorders (PTSD and
major depressive, anxiety, somatoform, and related disorders) living in LMICs affected by humanitarian crises.\rSEARCH METHODS: We searched the
Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR), the Cochrane Central Register of Controlled Trials (Wiley), MEDLINE (OVID),
Embase (OVID), and PsycINFO (OVID), with results incorporated from searches to 3 February 2016. We also searched the World Health Organization (WHO)
trials portal (ICTRP) and ClinicalTrials.gov to identify any unpublished or ongoing studies. We checked the reference lists of relevant studies and
reviews.\rSELECTION CRITERIA: All randomised controlled trials (RCTs) comparing psychological therapies versus control conditions (including no
treatment, usual care, wait list, attention placebo, and psychological placebo) to treat adults and children with mental disorders living in LMICs
affected by humanitarian crises.\rDATA COLLECTION AND ANALYSIS: We used standard Cochrane procedures for collecting data and evaluating risk of bias.
We calculated standardised mean differences for continuous outcomes and risk ratios for dichotomous data, using a random-effects model. We analysed
data at endpoint (zero to four weeks after therapy); at medium term (one to four months after therapy); and at long term (six months or longer).
GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) was used to assess the quality of evidence for post-traumatic stress
disorder (PTSD), depression, anxiety and withdrawal outcomes.\rMAIN RESULTS: We included 36 studies (33 RCTs) with a total of 3523 participants.
Included studies were conducted in sub-Saharan Africa, the Middle East and North Africa, and Asia. Studies were implemented in response to armed
conflicts; disasters triggered by natural hazards; and other types of humanitarian crises. Together, the 33 RCTs compared eight psychological
treatments against a control comparator.Four studies included children and adolescents between 5 and 18 years of age. Three studies included mixed
populations (two studies included participants between 12 and 25 years of age, and one study included participants between 16 and 65 years of age).
Remaining studies included adult populations (18 years of age or older).Included trials compared a psychological therapy versus a control
intervention (wait list in most studies; no treatment; treatment as usual). Psychological therapies were categorised mainly as cognitive-behavioural
therapy (CBT) in 23 comparisons (including seven comparisons focused on narrative exposure therapy (NET), two focused on common elements treatment
approach (CETA), and one focused on brief behavioural activation treatment (BA)); eye movement desensitisation and reprocessing (EMDR) in two
comparisons; interpersonal psychotherapy (IPT) in three comparisons; thought field therapy (TFT) in three comparisons; and trauma or general
supportive counselling in two comparisons. Although interventions were described under these categories, several psychotherapeutic elements were
common to a range of therapies (i.e. psychoeducation, coping skills).In adults, psychological therapies may substantially reduce endpoint PTSD
symptoms compared to control conditions (standardised mean difference (SMD) -1.07, 95% confidence interval (CI) -1.34 to -0.79; 1272 participants; 16
studies; low-quality evidence). The effect is smaller at one to four months (SMD -0.49, 95% CI -0.68 to -0.31; 1660 participants; 18 studies) and at
six months (SMD -0.37, 95% CI -0.61 to -0.14; 400 participants; five studies). Psychological therapies may also substantially reduce endpoint
depression symptoms compared to control conditions (SMD -0.86, 95% CI -1.06 to -0.67; 1254 participants; 14 studies; low-quality evidence). Similar
to PTSD symptoms, follow-up data at one to four months showed a smaller effect on depression (SMD -0.42, 95% CI -0.63 to -0.21; 1386 participants; 16
studies). Psychological therapies may moderately reduce anxiety at endpoint (SMD -0.74, 95% CI -0.98 to -0.49; 694 participants; five studies; low-
quality evidence) and at one to four months' follow-up after treatment (SMD -0.53, 95% CI -0.66 to -0.39; 969 participants; seven studies). Dropout
rates are probably similar between study conditions (19.5% with control versus 19.1% with psychological therapy (RR 0.98 95% CI 0.82 to 1.16; 2930
participants; 23 studies, moderate quality evidence)).In children and adolescents, we found very low quality evidence for lower endpoint PTSD
symptoms scores in psychotherapy conditions (CBT) compared to control conditions, although the confidence interval is wide (SMD -1.56, 95% CI -3.13
to 0.01; 130 participants; three studies;). No RCTs provided data on major depression or anxiety in children. The effect on withdrawal was uncertain
(RR 1.87 95% CI 0.47 to 7.47; 138 participants; 3 studies, low quality evidence).We did not identify any studies that evaluated psychological
treatments on (symptoms of) somatoform disorders or MUPS in LMIC humanitarian settings.\rAUTHORS' CONCLUSIONS: There is low quality evidence that
psychological therapies have large or moderate effects in reducing PTSD, depressive, and anxiety symptoms in adults living in humanitarian settings
in LMICs. By one to four month and six month follow-up assessments treatment effects were smaller. Fewer trials were focused on children and
adolescents and they provide very low quality evidence of a beneficial effect of psychological therapies in reducing PTSD symptoms at endpoint.
Confidence in these findings is influenced by the risk of bias in the studies and by substantial levels of heterogeneity. More research evidence is
needed, particularly for children and adolescents over longer periods of follow-up.
Cochrane Database of Systematic
Reviews, 7 : CD011849
- Year: 2018
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Narrative exposure therapy (NET), Trauma-focused cognitive behavioural therapy (TF-
CBT)
Thompson, S.R., Dobbins, S.
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
- Year: 2018
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Huang, J., Nigatu, Y. T., Smail-Crevier, R., Zhang, X., Wang, J.
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
- Year: 2018
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Depressive Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions, Mindfulness based
therapy
Rossouw, J., Yadin, E., Alexander, D., Seedat, S.
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
- Year: 2018
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Exposure therapy, Exposure
and response prevention, Supportive
therapy
Kohut, S. A., Jelen, A., Ruskin, D., Stinson, J.
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
- Year: 2018
- Problem: Anxiety Disorders (any), Post Traumatic Stress Disorder, Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Mindfulness based
therapy
Purgato, M., Gastaldon, C., Papola, D., van-
Ommeren, M., , Barbui, C., Tol, W. A.
BACKGROUND: People living in humanitarian settings
in low- and middle-income countries (LMICs) are exposed to a constellation of stressors that make them vulnerable to developing mental disorders.
Mental disorders with a higher prevalence in these settings include post-traumatic stress disorder (PTSD) and major depressive, anxiety, somatoform
(e.g. medically unexplained physical symptoms (MUPS)), and related disorders. A range of psychological therapies are used to manage symptoms of
mental disorders in this population.\rOBJECTIVES: To compare the effectiveness and acceptability of psychological therapies versus control conditions
(wait list, treatment as usual, attention placebo, psychological placebo, or no treatment) aimed at treating people with mental disorders (PTSD and
major depressive, anxiety, somatoform, and related disorders) living in LMICs affected by humanitarian crises.\rSEARCH METHODS: We searched the
Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR), the Cochrane Central Register of Controlled Trials (Wiley), MEDLINE (OVID),
Embase (OVID), and PsycINFO (OVID), with results incorporated from searches to 3 February 2016. We also searched the World Health Organization (WHO)
trials portal (ICTRP) and ClinicalTrials.gov to identify any unpublished or ongoing studies. We checked the reference lists of relevant studies and
reviews.\rSELECTION CRITERIA: All randomised controlled trials (RCTs) comparing psychological therapies versus control conditions (including no
treatment, usual care, wait list, attention placebo, and psychological placebo) to treat adults and children with mental disorders living in LMICs
affected by humanitarian crises.\rDATA COLLECTION AND ANALYSIS: We used standard Cochrane procedures for collecting data and evaluating risk of bias.
We calculated standardised mean differences for continuous outcomes and risk ratios for dichotomous data, using a random-effects model. We analysed
data at endpoint (zero to four weeks after therapy); at medium term (one to four months after therapy); and at long term (six months or longer).
GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) was used to assess the quality of evidence for post-traumatic stress
disorder (PTSD), depression, anxiety and withdrawal outcomes.\rMAIN RESULTS: We included 36 studies (33 RCTs) with a total of 3523 participants.
Included studies were conducted in sub-Saharan Africa, the Middle East and North Africa, and Asia. Studies were implemented in response to armed
conflicts; disasters triggered by natural hazards; and other types of humanitarian crises. Together, the 33 RCTs compared eight psychological
treatments against a control comparator.Four studies included children and adolescents between 5 and 18 years of age. Three studies included mixed
populations (two studies included participants between 12 and 25 years of age, and one study included participants between 16 and 65 years of age).
Remaining studies included adult populations (18 years of age or older).Included trials compared a psychological therapy versus a control
intervention (wait list in most studies; no treatment; treatment as usual). Psychological therapies were categorised mainly as cognitive-behavioural
therapy (CBT) in 23 comparisons (including seven comparisons focused on narrative exposure therapy (NET), two focused on common elements treatment
approach (CETA), and one focused on brief behavioural activation treatment (BA)); eye movement desensitisation and reprocessing (EMDR) in two
comparisons; interpersonal psychotherapy (IPT) in three comparisons; thought field therapy (TFT) in three comparisons; and trauma or general
supportive counselling in two comparisons. Although interventions were described under these categories, several psychotherapeutic elements were
common to a range of therapies (i.e. psychoeducation, coping skills).In adults, psychological therapies may substantially reduce endpoint PTSD
symptoms compared to control conditions (standardised mean difference (SMD) -1.07, 95% confidence interval (CI) -1.34 to -0.79; 1272 participants; 16
studies; low-quality evidence). The effect is smaller at one to four months (SMD -0.49, 95% CI -0.68 to -0.31; 1660 participants; 18 studies) and at
six months (SMD -0.37, 95% CI -0.61 to -0.14; 400 participants; five studies). Psychological therapies may also substantially reduce endpoint
depression symptoms compared to control conditions (SMD -0.86, 95% CI -1.06 to -0.67; 1254 participants; 14 studies; low-quality evidence). Similar
to PTSD symptoms, follow-up data at one to four months showed a smaller effect on depression (SMD -0.42, 95% CI -0.63 to -0.21; 1386 participants; 16
studies). Psychological therapies may moderately reduce anxiety at endpoint (SMD -0.74, 95% CI -0.98 to -0.49; 694 participants; five studies; low-
quality evidence) and at one to four months' follow-up after treatment (SMD -0.53, 95% CI -0.66 to -0.39; 969 participants; seven studies). Dropout
rates are probably similar between study conditions (19.5% with control versus 19.1% with psychological therapy (RR 0.98 95% CI 0.82 to 1.16; 2930
participants; 23 studies, moderate quality evidence)).In children and adolescents, we found very low quality evidence for lower endpoint PTSD
symptoms scores in psychotherapy conditions (CBT) compared to control conditions, although the confidence interval is wide (SMD -1.56, 95% CI -3.13
to 0.01; 130 participants; three studies;). No RCTs provided data on major depression or anxiety in children. The effect on withdrawal was uncertain
(RR 1.87 95% CI 0.47 to 7.47; 138 participants; 3 studies, low quality evidence).We did not identify any studies that evaluated psychological
treatments on (symptoms of) somatoform disorders or MUPS in LMIC humanitarian settings.\rAUTHORS' CONCLUSIONS: There is low quality evidence that
psychological therapies have large or moderate effects in reducing PTSD, depressive, and anxiety symptoms in adults living in humanitarian settings
in LMICs. By one to four month and six month follow-up assessments treatment effects were smaller. Fewer trials were focused on children and
adolescents and they provide very low quality evidence of a beneficial effect of psychological therapies in reducing PTSD symptoms at endpoint.
Confidence in these findings is influenced by the risk of bias in the studies and by substantial levels of heterogeneity. More research evidence is
needed, particularly for children and adolescents over longer periods of follow-up.
Cochrane Database of Systematic
Reviews, 7 : CD011849
- Year: 2018
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Narrative exposure therapy (NET), Trauma-focused cognitive behavioural therapy (TF-
CBT)
Woud, M. L., Zlomuzica, A., Cwik, J. C., Margraf, J., Shkreli, L., Blackwell, S. E., Gladwin, T.
E., Ehring, T.
Dysfunctional appraisals are a key factor suggested to be
involved in the development and maintenance of PTSD. Research has shown that experimental induction of a positive or negative appraisal style
following a laboratory stressor affects analogue posttraumatic stress symptoms. This supports a causal role of appraisal in the development of
traumatic stress symptoms and the therapeutic promise of modifying appraisals to reduce PTSD symptoms. The present study aimed to extend previous
findings by investigating the effects of experimentally induced appraisals on reactions to a naturally occurring analogue trauma and by examining
effects on both explicit and implicit appraisals. Participants who had experienced a distressing life event were asked to imagine themselves in the
most distressing moment of that event and then received either a positive or negative Cognitive Bias Modification training targeting appraisals
(CBM-App). The CBM-App training induced training-congruent appraisals, but group differences in changes in appraisal over training were only seen for
explicit and not implicit appraisals. However, participants trained positively reported less intrusion distress over the subsequent week than those
trained negatively, and lower levels of overall posttraumatic stress symptoms. These data support the causal relationship between appraisals and
trauma distress, and further illuminate the mechanisms linking the two. Copyright © 2018 Elsevier Ltd
Journal of Anxiety
Disorders, 56 : 26-34
- Year: 2018
- Problem: Post Traumatic Stress Disorder
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Attention/cognitive bias
modification
Brown, L. A., Davies, C. D., Gerlach, A., Cooper, R., Stevens, S., Craske, M. G.
While several empirically supported treatments for posttraumatic stress disorder (PTSD) have
been developed, these treatments are neither widely available nor universally efficacious. This pilot, proof of concept study evaluated a
computerized imaginal exposure Script-Driven Imagery Training (SDI-T) for individuals with elevated trauma reactivity. The training was supplemented
with two forms of linguistic processing, affect labeling (SDI-T + AL) and distraction (SDI-T + D), to determine whether linguistic inhibitory
regulation augmented the effects of SDI-T. Methods: Participants (n = 64) with trauma-related distress were randomized to SDI-T, SDI-T + AL, or SDI-T
+ D. Physiology and self-reported trauma distress were measured at pre- and post-training. Results: The training was acceptable to participants and
effective at reducing self-reported distress (d = -0.41), and physiological activation from pre- to post-training (d = -0.49, ps <.01), with some
evidence that linguistic processing (SDI-T + AL and SDIT-T + D) conferred a benefit over SDI-T. The linguistic processing groups had significantly
steeper reduction in physiology relative to the non-linguistic processing group (p <.05, d = 0.59). There was no benefit of SDI-T + AL over SDI-T +
D. Conclusions: This pilot study provides initial support for the acceptability and efficacy of computerized imaginal exposure training for PTSD.
Clinical implications and future directions are discussed. Copyright © 2018
Journal of Anxiety Disorders, 57 : 16-
23
- Year: 2018
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Chen, Y. Y., Kao, M. C.
Background: Previous research has revealed mixed findings with regard to the effects of disclosure on trauma recovery. More
recently, studies on psychological trauma have found associations among religion, meaning, and health. This study investigated prior disclosure as a
moderator for the association between religious emotional expression and adaptive trauma processing, as measured by post-traumatic stress disorder
(PTSD) symptoms. Method(s): Using Pennebaker's written emotional expression paradigm, 105 participants were assigned to either a conventional
trauma-writing condition or religious trauma-writing condition. PTSD symptoms were assessed at baseline and again at one-month post writing. Result
(s): A two-way interaction was found between prior disclosure and writing condition on PTSD symptoms at follow-up. For the religious trauma-writing
condition only, there was a significant difference between low versus high disclosure participants in PTSD symptoms at follow-up, such that low prior
disclosure participants registered fewer PTSD symptoms than high prior disclosure participants, while prior disclosure did not have such effect in
the conventional trauma-writing condition. Limitation(s): This two-way interaction may be further qualified by other important psychosocial
variables, such as differences in personality, coping style, social support, or use of prayer as a form of disclosure, which were not assessed in
this study. Conclusion(s): Religious emotional expression may encourage adaptive trauma processing, especially for individuals with low prior
disclosure. These findings encourage further investigation of the conditions under which disclosure and religion may be a beneficial factor in trauma
adaptation and treatment. Copyright © 2017, © The Author(s) 2017.
International Journal of Psychiatry in Medicine, 53(3) : 189-
196
- Year: 2018
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Other Psychological Interventions
Dawson, K., Joscelyne, A., Meijer, C., Steel,
Z., Silove, D., Bryant, R. A.
Objective: To
evaluate the relative efficacies of trauma-focused cognitive behavior therapy and problem-solving therapy in treating post-traumatic stress disorder
in children affected by civil conflict in Aceh, Indonesia. Method: A controlled trial of children with post-traumatic stress disorder (N = 64)
randomized children to either five individual weekly sessions of trauma-focused cognitive behavior therapy or problem-solving therapy provided by
lay-counselors who were provided with brief training. Children were assessed by blind independent assessors at pretreatment, posttreatment and 3-
month follow-up on post-traumatic stress disorder, depression and anger, as well as caregiver ratings of the child's post-traumatic stress disorder
levels. Results: Intent-to-treat analyses indicated no significant linear time x treatment condition interaction effects for post-traumatic stress
disorder at follow-up (t(129.05) = -0.55, p = 0.58), indicating the two conditions did not differ. Across both conditions, there were significant
reductions in post-traumatic stress disorder on self-reported (t(131.26) = -9.26, p < 0.001) and caregiver-reported (t(170.65) = 3.53, p = 0.001)
measures and anger (t(127.66) = -7.14, p < 0.001). Across both conditions, there was a large effect size for self-reported post-traumatic stress
disorder (cognitive behavior therapy: 3.73, 95% confidence interval = [2.75, 3.97]; problem-solving: 2.68, 95% confidence interval = [2.07, 3.29]).
Conclusions: These findings suggest that trauma-focused cognitive behavior therapy and problem-solving approaches are comparably successful in
reducing post-traumatic stress disorder and anger in treating mental health in children in a post-conflict setting. This pattern may reflect the
benefits of non-specific therapy effects or gains associated with trauma-focused or problem-solving approaches. Copyright © 2017, © The Royal
Australian and New Zealand College of Psychiatrists 2017.
Australian and New Zealand
Journal of Psychiatry, 52(3) : 253-261
- Year: 2018
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Problem solving therapy (PST)
Pfeiffer, E., Sachser, C., Rohlmann, F., Goldbeck, L.
Background: As access to evidence-based treatments for young refugees with posttraumatic stress symptoms (PTSS) is limited, we
developed the trauma-focused group intervention Mein Weg to be delivered by trained social workers. A recently published pilot study delivered
preliminary evidence of the intervention with regard to symptom reduction and its feasibility. The aim of this study was, therefore, to determine
whether the intervention, in addition to usual care (UC), is more effective in reducing PTSS (primary outcome) compared to UC alone. Methods: A
parallel group randomized controlled trial was conducted in seven German child and adolescent welfare agencies. Participants were randomly assigned
to either six sessions Mein Weg (n = 50; Mage = 17.00, 94% male) or UC (n = 49; Mage = 16.92, 92% male). Mixed effect models, with fixed effects of
group and time as well as their interaction, were performed on the relevant outcome measures. This trial was registered in the German Clinical Trials
Registry (#DRKS00010915, https://www.d rks.de/drks_web/). Results: Intention-to-treat analyses showed that Mein Weg was significantly superior to UC
regarding symptom improvement of self-reported PTSS (Mein Weg: d = .61, UC: d = .15) and depression (Mein Weg: d = .63, UC: d = .06), but not
regarding caregiver-reported symptoms and self-reported dysfunctional posttraumatic cognitions. Conclusions: MeinWeg is effective for young refugees
according to self-reports and can be viewed as a valuable component in a stepped care approach for this vulnerable population. The findings need to
be replicated with independent clinical assessments. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of Child Psychology and
Psychiatry, 59(11) : 1171-1179
- Year: 2018
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Other Psychological Interventions
Rosenberg, L., Rosenberg, M., Sharp, S., Thomas, C. R., Humphries, H. F., Holzer, C. E., Herndon, D. N., Meyer, W. J.
Objective: This study examined whether acute propranolol treatment prevented posttraumatic
stress disorder (PTSD), anxiety, and depression in children hospitalized in the pediatric intensive care unit for large burns. We hypothesized that
the prevalence of PTSD, anxiety, and depression would be significantly less in the propranolol than nonpropranolol groups. Methods: Children who had
previously participated in a randomized controlled clinical trial of acute propranolol and nonpropranolol controls were invited to participate in
long-term follow-up interviews. Eligible participants from 1997 to 2008 were identified from the electronic medical records, and data were collected
in 2010-2011. Measures included the Missouri Assessment of Genetics Interview for Children to assess lifetime PTSD, Revised Children's Manifest
Anxiety Scale to assess anxiety, and two depression inventories Children's Depression Inventory and Beck Depression Inventory-II. Results: Of 202
participants, 89 were in the propranolol group and 113 were nonpropranolol controls. Children were an average of 7 years postburn. The average total
body surface area burned was 56.4 + 15.1% (range = 24%-99%). The mean dose of propranolol was 3.64 +/- 3.19 mg/kg per day (range = 0.36-12.12). The
duration of propranolol inpatient treatment days varied, mean days 26.5 +/- 19.8. The prevalence of lifetime PTSD in the propranolol group was 3.5%
and controls 7.2%, but this difference was not statistically significant. We controlled for administration of pain medications, anxiolytics, and
antidepressants overall and no significant differences were detected in the rates of PTSD, anxiety, or depression. Conclusions: The prevalence of
PTSD, anxiety, and depression was similar in children who received propranolol acutely and those who did not. This may be influenced by the standard
of care that all children received timely pharmacotherapy for pain and anxiety management and psychotherapy beginning in their acute phase of
treatment. © Copyright 2018, Mary Ann Liebert, Inc.
Journal of Child and Adolescent Psychopharmacology, 28(2) : 117-
123
- Year: 2018
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions