Tutus, D., Pfeiffer, E., Rosner, R., Sachser, C., Goldbeck, L.

Sustainability of Treatment Effects of Trauma-Focused Cognitive-Behavioral Therapy for Children and Adolescents: Findings from 6- and 12-Month Follow-Ups

Psychotherapy and Psychosomatics, 86(6) : 379- 381

Rosenblum, K. L., Muzik, M., Morelen, D. M., Alfafara, E. A., Miller, N. M., Waddell, R. M., Schuster, M. M., Ribaudo, J.

A community-based randomized controlled trial of Mom Power parenting intervention for mothers with interpersonal trauma histories and their young children

We conducted a study to evaluate the effectiveness of Mom Power, a multifamily parenting intervention to improve mental health and parenting among high-risk mothers with young children in a community-based randomized controlled trial (CB-RCT) design. Participants (N = 122) were high-risk mothers (e.g., interpersonal trauma histories, mental health problems, poverty) and their young children (age <6 years), randomized either to Mom Power, a parenting intervention (treatment condition), or weekly mailings of parenting information (control condition). In this study, the 13-session intervention was delivered by community clinicians trained to fidelity. Pre- and post-trial assessments included mothers' mental health symptoms, parenting stress and helplessness, and connection to care. Mom Power was delivered in the community with fidelity and had good uptake (>65%) despite the risk nature of the sample. Overall, we found improvements in mental health and parenting stress for Mom Power participants but not for controls; in contrast, control mothers increased in parent-child role reversal across the trial period. The benefits of Mom Power treatment (vs. control) were accentuated for mothers with interpersonal trauma histories. Results of this CB-RCT confirm the effectiveness of Mom Power for improving mental health and parenting outcomes for high-risk, trauma-exposed women with young children. ClinicalTrials.gov Identifier: NCT01554215. Copyright © 2017, Springer- Verlag Wien.

Archives of Women's Mental Health, 20(5) : 673- 686

De-Roos, C., Van-der-Oord, S., Zijlstra, B., , Lucassen, S., Perrin, S., Emmelkamp, P., De-Jongh, A.

Comparison of eye movement desensitization and reprocessing therapy, cognitive behavioral writing therapy, and wait-list in pediatric posttraumatic stress disorder following single-incident trauma: a multicenter randomized clinical trial

BACKGROUND: Practice guidelines for childhood posttraumatic stress disorder (PTSD) recommend trauma-focused psychotherapies, mainly cognitive behavioral therapy (CBT). Eye movement desensitization and reprocessing (EMDR) therapy is a brief trauma-focused, evidence-based treatment for PTSD in adults, but with few well-designed trials involving children and adolescents. METHODS: We conducted a single-blind, randomized trial with three arms (n = 103): EMDR (n = 43), Cognitive Behavior Writing Therapy (CBWT; n = 42), and wait-list (WL; n = 18). WL participants were randomly reallocated to CBWT or EMDR after 6 weeks; follow-ups were conducted at 3 and 12 months posttreatment. Participants were treatment-seeking youth (aged 8-18 years) with a DSM-IV diagnosis of PTSD (or subthreshold PTSD) tied to a single trauma, who received up to six sessions of EMDR or CBWT lasting maximally 45 min each. RESULTS: Both treatments were well-tolerated and relative to WL yielded large, intent-to-treat effect sizes for the primary outcomes at posttreatment: PTSD symptoms (EMDR: d = 1.27; CBWT: d = 1.24). At posttreatment 92.5% of EMDR, and 90.2% of CBWT no longer met the diagnostic criteria for PTSD. All gains were maintained at follow-up. Compared to WL, small to large (range d = 0.39-1.03) intent-to-treat effect sizes were obtained at posttreatment for negative trauma-related appraisals, anxiety, depression, and behavior problems with these gains being maintained at follow-up. Gains were attained with significantly less therapist contact time for EMDR than CBWT (mean = 4.1 sessions/140 min vs. 5.4 sessions/227 min). CONCLUSIONS: EMDR and CBWT are brief, trauma-focused treatments that yielded equally large remission rates for PTSD and reductions in the severity of PTSD and comorbid difficulties in children and adolescents seeking treatment for PTSD tied to a single event. Further trials of both treatments with PTSD tied to multiple traumas are warranted. Copyright © 2017 Association for Child and Adolescent Mental Health.

Journal of child psychology and psychiatry, and allied disciplines, 58(11) : 1219-1228

Eloranta, S. J., Peltonen, K., Palosaari, E., Qouta, S. R., Punamaki, R. L.

The Role of Attachment and Emotion Regulation in the Psychosocial Intervention Among War-Affected Children

This study examined (1) how attachment style predicts changes in mental health, and (2) whether change in emotion regulation (ER) intensity mediates that association in the context of psychosocial intervention among war-affected children. Participants were 482 Palestinian children whose school classes were randomized to either intervention (Teaching Recovery Techniques, TRT) or waiting-list groups. Attachment style, emotion regulation, and mental health were measured. The children with secure attachment were more likely to gain improved mental health in both conditions, but also preoccupied-insecure children showed improved mental health in the TRT. In the control group, instead, children with more attachment avoidance reported deteriorated mental health, and no changes in mental health was found among preoccupied children. Changes in the ER intensity did not mediate the association between attachment style and mental health in either groups. Discussion focuses on attachment- specific mechanisms underlying recovery from war trauma. Copyright © 2016, Springer International Publishing.

Journal of Child and Adolescent Trauma, 10(4) : 301-314

Chorpita, B. F., Daleiden, E. L., Park, A. L., Ward, A. M., Levy, M. C., Cromley, T., Chiu, A. W., Letamendi, A. M., Tsai, K. H., Krull, J. L.

Child STEPs in California: A cluster randomized effectiveness trial comparing modular treatment with community implemented treatment for youth with anxiety, depression, conduct problems, or traumatic stress

OBJECTIVE: This study reports outcomes from a randomized effectiveness trial testing modular treatment versus multiple community-implemented evidence-based treatments for youth.\rMETHOD: An ethnoracially diverse sample of 138 youth ages 5 to 15 (62 girls, 76 boys) whose primary clinical concerns involved diagnoses or clinical elevations related to anxiety, depression, disruptive behavior, and/or traumatic stress were treated by community therapists randomly assigned to 1 of 2 conditions: (a) modular treatment, which involved a single modular protocol (i.e., modular approach to therapy for children; MATCH) that allowed flexible selection and sequencing of procedures to fit the chosen treatment focus in the context of measurement feedback, and (b) community-implemented treatment (CIT), which was a county-supported implementation of multiple evidence-based practices for youth.\rRESULTS: Youth treated with MATCH showed significantly faster rates of improvement over time on clinical and functional outcomes relative to youth in the CIT condition and required significantly fewer sessions delivered over significantly fewer days. Caregiver-reported clinical improvement rates were significantly greater for MATCH (60%) versus CIT (36.7%). Further, youth in the CIT condition were significantly more likely to receive additional psychosocial treatment services and were significantly more likely to use a variety of psychotropic medications during the active treatment phase.\rCONCLUSIONS: These results extend prior findings, supporting the effectiveness and efficiency of a modular, multifocus approach that incorporates monitoring and feedback relative to community implementation of evidence-based treatments. (PsycINFO Database Record

Journal of Consulting & Clinical Psychology, 85(1) : 13 -25

Auslander, W., McGinnis, H., Tlapek, S., Smith, P., Foster, A., Edmond, T., Dunn, J.

Adaptation and implementation of a trauma-focused cognitive behavioral intervention for girls in child welfare

This study describes the process of adapting and implementing Girls Aspiring toward Independence (GAIN), a trauma-focused, group-based therapy adapted from Cognitive Behavioral Intervention for Trauma in Schools (CBITS) for girls in child welfare. Descriptive data were examined on 3 outcomes: posttraumatic stress disorder (PTSD), depression, and social problem-solving skills among adolescent girls in the child welfare system. Qualitative and quantitative methods were utilized to inform the adaptation of the CBITS intervention, evaluate feasibility, treatment fidelity, and acceptability, and to test the effects of the intervention. Girls ages 12 to 18 (N = 27) were randomly assigned to the experimental and usual care conditions. Participants' symptoms of PTSD and depression and social problem-solving skills were evaluated at pre, post- (3 months), and follow-up (6 months) assessments. Adaptations for GAIN were primarily related to program structure. Data indicated that the program was receptive to girls in child welfare and that it was feasible to recruit, randomize, assess outcomes, and implement with adequate fidelity. Retention was more successful among younger girls. Descriptive initial data showed greater reductions in the percentage of girls with PTSD and depression, and modest increases in social problem-solving skills in the experimental versus usual care condition. Despite the growth of knowledge in dissemination and implementation research, the application of trauma-focused empirically supported treatment to child welfare populations lags behind. A large-scale RCT is needed to determine if GAIN is effective in reducing mental health problems and social problem-solving in the child welfare population. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

American Journal of Orthopsychiatry, 87(3) : 206-215

Dorsey, S., McLaughlin, K. A., Kerns, S. E. U., Harrison, J. P., Lambert, H. K., Briggs, E. C., Revillion Cox, J., Amaya-Jackson, L.

Evidence Base Update for Psychosocial Treatments for Children and Adolescents Exposed to Traumatic Events

Child and adolescent trauma exposure is prevalent, with trauma exposure-related symptoms, including posttraumatic stress, depressive, and anxiety symptoms often causing substantial impairment. This article updates the evidence base on psychosocial treatments for child and adolescent trauma exposure completed for this journal by Silverman et al. (2008). For this review, we focus on 37 studies conducted during the seven years since the last review. Treatments are grouped by overall treatment family (e.g., cognitive behavioral therapy), treatment modality (e.g., individual vs. group), and treatment participants (e.g., child only vs. child and parent). All studies were evaluated for methodological rigor according to Journal of Clinical Child & Adolescent Psychology evidence-based treatment evaluation criteria (Southam-Gerow & Prinstein, 2014), with cumulative designations for level of support for each treatment family. Individual CBT with parent involvement, individual CBT, and group CBT were deemed well-established; group CBT with parent involvement and eye movement desensitization and reprocessing (EMDR) were deemed probably efficacious; individual integrated therapy for complex trauma and group mind-body skills were deemed possibly efficacious; individual client-centered play therapy, individual mind-body skills, and individual psychoanalysis were deemed experimental; and group creative expressive + CBT was deemed questionable efficacy. Advances in the evidence base, with comparisons to the state of the science at the time of the Silverman et al. (2008) review, are discussed. Finally, we present dissemination and implementation challenges and areas for future research.

Journal of Clinical Child & Adolescent Psychology, 46(3) : 303-330

Meiser-Stedman, R., Smith, P., McKinnon, A., Dixon, C., Trickey, D., Ehlers, A., Clark, D. M., Boyle, A., Watson, P., Goodyer, I., Dalgleish, T.

Cognitive therapy as an early treatment for post-traumatic stress disorder in children and adolescents: A randomized controlled trial addressing preliminary efficacy and mechanisms of action

Background: Few efficacious early treatments for post-traumatic stress disorder (PTSD) in children and adolescents exist. Previous trials have intervened within the first month post-trauma and focused on secondary prevention of later post-traumatic stress; however, considerable natural recovery may still occur up to 6-months post-trauma. No trials have addressed the early treatment of established PTSD (i.e. 2- to 6-months post-trauma). Methods: Twenty-nine youth (8-17 years) with PTSD (according to age-appropriate DSM-IV or ICD-10 diagnostic criteria) after a single-event trauma in the previous 2-6 months were randomly allocated to Cognitive Therapy for PTSD (CT-PTSD; n = 14) or waiting list (WL; n = 15) for 10 weeks. Results: Significantly more participants were free of PTSD after CT-PTSD (71%) than WL (27%) at posttreatment (intent-to-treat, 95% CI for difference .04-.71). CT-PTSD yielded greater improvement on child-report questionnaire measures of PTSD, depression and anxiety; clinician-rated functioning; and parent-reported outcomes. Recovery after CT-PTSD was maintained at 6- and 12-month posttreatment. Beneficial effects of CT-PTSD were mediated through changes in appraisals and safety-seeking behaviours, as predicted by cognitive models of PTSD. CT-PTSD was considered acceptable on the basis of low dropout and high treatment credibility and therapist alliance ratings. Conclusions: This trial provides preliminary support for the efficacy and acceptability of CT-PTSD as an early treatment for PTSD in youth. Moreover, the trial did not support the extension of 'watchful waiting' into the 2- to 6-month post-trauma window, as significant improvements in the WL arm (particularly in terms of functioning and depression) were not observed. Replication in larger samples is needed, but attention to recruitment issues will be required. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Journal of Child Psychology and Psychiatry, 58(5) : 623- 633

Meyer-DeMott, M. A., Jakobsen, M., Wentzel-Larsen, T., Heir, T.

A controlled early group intervention study for unaccompanied minors: Can Expressive Arts alleviate symptoms of trauma and enhance life satisfaction?

This is the first controlled study of an expressive arts group intervention with unaccompanied minor asylum seeking children. The aim of the study was to examine whether such an intervention may alleviate symptoms of trauma and enhance life satisfaction and hope. One hundred forty five unaccompanied minor refugee boys with their stated age between 15 and 18 were allocated into a 10 session 5 weeks manualized expressive arts intervention (EXIT) or a life as usual (LAU) control group. The participants were assessed at onset and 4 times over a period of 25 months with a battery of instruments measuring post-traumatic stress symptoms (PTSS), general psychological distress (HSCL-25A), current life satisfaction (CLS) and expected life satisfaction (ELS). The instruments were presented in the participants' native languages, using touch-screen laptops and the computer program Multilingual Computer Assisted Interview (MultiCASI). There were significant time by group interactions in favor of the EXIT group for PTSS and CLS. At the end of the follow up the EXIT group had higher life satisfaction and hope for the future than the LAU group. A manualized EXIT group intervention can have a beneficial effect on helping minor refugee boys to cope with symptoms of trauma, strengthen their life satisfaction and develop hope for the future. Our findings support previous studies showing that the arts may help people in reconstructing meaning and connection with others by focusing on resources and creativity. Copyright © 2017 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

Scandinavian Journal of Psychology, 58(6) : 510-518

Meyer-DeMott, M. A., Jakobsen, M., Wentzel-Larsen, T., Heir, T.

A controlled early group intervention study for unaccompanied minors: Can Expressive Arts alleviate symptoms of trauma and enhance life satisfaction?

This is the first controlled study of an expressive arts group intervention with unaccompanied minor asylum seeking children. The aim of the study was to examine whether such an intervention may alleviate symptoms of trauma and enhance life satisfaction and hope. One hundred forty five unaccompanied minor refugee boys with their stated age between 15 and 18 were allocated into a 10 session 5 weeks manualized expressive arts intervention (EXIT) or a life as usual (LAU) control group. The participants were assessed at onset and 4 times over a period of 25 months with a battery of instruments measuring post-traumatic stress symptoms (PTSS), general psychological distress (HSCL-25A), current life satisfaction (CLS) and expected life satisfaction (ELS). The instruments were presented in the participants' native languages, using touch-screen laptops and the computer program Multilingual Computer Assisted Interview (MultiCASI). There were significant time by group interactions in favor of the EXIT group for PTSS and CLS. At the end of the follow up the EXIT group had higher life satisfaction and hope for the future than the LAU group. A manualized EXIT group intervention can have a beneficial effect on helping minor refugee boys to cope with symptoms of trauma, strengthen their life satisfaction and develop hope for the future. Our findings support previous studies showing that the arts may help people in reconstructing meaning and connection with others by focusing on resources and creativity. Copyright © 2017 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

Scandinavian Journal of Psychology, 58(6) : 510-518

Shangani, S., Operario, D., Genberg, B., Kirwa, K., Midoun, M., Atwoli, L., Ayuku, D., Galarraga, O., Braitstein, P.

Unconditional government cash transfers in support of orphaned and vulnerable adolescents in western Kenya: Is there an association with psychological wellbeing?

Background Orphaned and vulnerable adolescents (OVA) in sub-Saharan Africa are at greater risk for adverse psychological outcomes compared with their non-OVA counterparts. Social interventions that provide cash transfers (CTs) have been shown to improve health outcomes among young people, but little is known about their impact on the psychological wellbeing of OVA. Objective Among OVA in western Kenya, we assessed the association between living in a household that received monthly unconditional government CTs and psychological wellbeing. Methods We examined the likelihood of depression, anxiety, post-traumatic stress symptoms (PTSS) and positive future outlook among 655 OVA aged between 10 and 18 years who lived in 300 randomly selected households in western Kenya that either received or did not receive unconditional monthly CTs. Results The mean age was 14.0 (SD 2.4) years and 329 (50.2%) of the participants were female while 190 (29.0%) were double orphans whose biological parents were both deceased. After adjusting for socio-demographic, caregiver, and household characteristics and accounting for potential effects of participant clustering by sub-location of residence, OVA living in CT households were more likely to have a positive future outlook (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.08, 1.99), less likely to be anxious (OR 0.57, 95% CI 0.42, 0.78), and less likely to have symptoms of post-traumatic stress (OR 0.50, 95% CI 0.29, 0.89). We did not find statistically significant differences in odds of depression by CT group. Conclusion OVA in CT households reported better psychological wellbeing compared to those in households not receiving CTs. CT interventions may be effective for improving psychological wellbeing among vulnerable adolescents in socioeconomically deprived households. Copyright © 2017 Shangani 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, 12(5) : e0178076

Wald, I., Bitton, S., Levi, O., Zusmanovich, S., Fruchter, E., Ginat, K., Charney, D. S., Pine, D. l S., Bar-Haim, Y.

Acute delivery of attention bias modification training (ABMT) moderates the association between combat exposure and posttraumatic symptoms: A feasibility study

Combat deployment enhances risk for posttraumatic stress symptoms. We assessed whether attention bias modification training (ABMT), delivered immediately prior to combat, attenuates the association between combat exposure and stress-related symptoms. 99 male soldiers preparing for combat were randomized to receive either an ABMT condition designed to enhance vigilance toward threat or an attention control training (ACT) designed to balance attention deployment between neutral and threat words. Frequency of combat events, and symptoms of PTSD and depression were measured prior to deployment and at a two-month follow-up. Regression analysis revealed that combat exposure uniquely accounted for 4.6% of the variance in stress-related symptoms change from baseline to follow-up and that the interaction between ABMT and combat exposure accounted for additional 5.4% of the variance. Follow-up analyses demonstrate that ABMT moderated the association between combat exposure and symptoms. ABMT appear to have potential as a preventative intervention to reduce risk for stress-related symptoms associated with combat exposure. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Biological Psychology, 122 : 93- 97