Disorders - Post Traumatic Stress Disorder
Callinan, S., Johnson, D., Wells,
A.
Attention Training (ATT) is a technique used in metacognitive therapy but it has also
been shown to produce stand-alone effects. The present study replicates and extends an earlier study of the effects of ATT on traumatic-stress
symptoms. A sample of 60 university students who reported a traumatic life event were randomly assigned to either an ATT group (n = 29) or a control
group (n = 31). They were exposed to a recorded narrative of their stressful experience before and after the intervention and the primary outcomes
were frequency of intrusions and negative affect reported. Secondary outcomes included self-report and performance-based measures of attention
flexibility. ATT significantly reduced intrusions and improved negative affect in individuals who had experienced a stressful life event. The
technique also appeared to reduce self-focused attention, increase attention flexibility and modified performance on an emotional attention set
shifting task. The results suggest that ATT can be beneficial in reducing specific traumatic stress symptoms. (PsycINFO Database Record (c) 2015 APA,
all rights reserved) (journal abstract).
Cognitive Therapy & Research, 39(1) : 4-
13
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Attention/cognitive bias
modification
Konanur,
S., Muller, R. T., Cinamon, J. S., Thornback, K., Zorzella, K. P. M.
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a widely used treatment model for trauma-exposed children
and adolescents ( Cohen, Mannarino, & Deblinger, 2006). The Healthy Coping Program (HCP) was a multi-site community based intervention carried out in
a diverse Canadian city. A randomized, waitlist-control design was used to evaluate the effectiveness of TF-CBT with trauma-exposed school-aged
children ( Muller & DiPaolo, 2008). A total of 113 children referred for clinical services and their caregivers completed the Trauma Symptom
Checklist for Children ( Briere, 1996) and the Trauma Symptom Checklist for Young Children ( Briere, 2005). Data were collected pre-waitlist, pre-
assessment, pre-therapy, post-therapy, and six months after the completion of TF-CBT. The passage of time alone in the absence of clinical services
was ineffective in reducing children's posttraumatic symptoms. In contrast, children and caregivers reported significant reductions in children's
posttraumatic stress (PTS) following assessment and treatment. The reduction in PTS was maintained at six month follow-up. Findings of the current
study support the use of the TF-CBT model in community-based settings in a diverse metropolis. Clinical implications are discussed. Copyright © 2015
Elsevier Ltd.
Child Abuse and
Neglect, 50 : 159-170
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Trauma-focused cognitive behavioural therapy (TF-
CBT)
Langley, A. K., Gonzalez, A., Sugar, C.
A., Solis, D., Jaycox, L.
Objective: To evaluate the
feasibility and acceptability of a school-based intervention for diverse children exposed to a range of traumatic events, and to examine its
effectiveness in improving symptoms of posttraumatic stress, depression, and anxiety. Method: Participants were 74 schoolchildren (Grades 1-5) and
their primary caregivers. All participating students endorsed clinically significant posttraumatic stress symptoms. School clinicians were trained to
deliver Bounce Back, a 10-session cognitive-behavioral group intervention. Children were randomized to immediate or delayed (3-month waitlist)
intervention. Parent-and child-report of posttraumatic stress and depression, and child report of anxiety symptoms, were assessed at baseline, 3
months, and 6 months. Results: Bounce Back was implemented with excellent clinician fidelity. Compared with children in the delayed condition,
children who received Bounce Back immediately demonstrated significantly greater improvements in parent-and child-reported posttraumatic stress and
child-reported anxiety symptoms over the 3-month intervention. Upon receipt of the intervention, the delayed intervention group demonstrated
significant improvements in parent-and child-reported posttraumatic stress, depression, and anxiety symptoms. The immediate treatment group
maintained or showed continued gains in all symptom domains over the 3-month follow-up period (6-month assessment). Conclusions: Findings support the
feasibility, acceptability, and effectiveness of the Bounce Back intervention as delivered by school-based clinicians for children with traumatic
stress. Implications are discussed.
Journal of Consulting & Clinical
Psychology, 83(5) : 853-865
- Year: 2015
- Problem: Anxiety Disorders (any), Post Traumatic Stress Disorder, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Pfefferbaum, B., Jacobs, A. K., Nitiema, P., Everly, G. S.
INTRODUCTION: Debriefing, a controversial crisis intervention delivered in the early aftermath of a
disaster, has not been well evaluated for use with children and adolescents. This report constitutes a review of the child debriefing evidence base.
\rMETHODS: A systematic search of selected bibliographic databases (EBM Reviews, EMBASE, ERIC, Medline, Ovid, PILOTS, PubMed, and PsycINFO) was
conducted in the spring of 2014 using search terms related to psychological debriefing. The search was limited to English language sources and
studies of youth, aged 0 to 18 years. No time limit was placed on date of publication. The search yielded 713 references. Titles and abstracts were
reviewed to select publications describing scientific studies and clinical reports. Reference sections of these publications, and of other literature
known to the authors that was not generated by the search, were used to locate additional materials. Review of these materials generated 187
publications for more thorough examination; this assessment yielded a total of 91 references on debriefing in children and adolescents. Only 15
publications on debriefing in children and adolescents described empirical studies. Due to a lack of statistical analysis of effectiveness data with
youth, and some articles describing the same study, only seven empirical studies described in nine papers were identified for analysis for this
review. These studies were evaluated using criteria for assessment of methodological rigor in debriefing studies.\rRESULTS: Children and adolescents
included in the seven empirical debriefing studies were survivors of motor-vehicle accidents, a maritime disaster, hostage taking, war, or peer
suicides. The nine papers describing the seven studies were characterized by inconsistency in describing the interventions and populations and by a
lack of information on intervention fidelity. Few of the studies used randomized design or blinded assessment. The results described in the reviewed
studies were mixed in regard to debriefing's effect on posttraumatic stress, depression, anxiety, and other outcomes. Even in studies in which
debriefing appeared promising, the research was compromised by potentially confounding interventions.\rCONCLUSION: The results highlight the small
empirical evidence base for drawing conclusions about the use of debriefing with children and adolescents, and they call for further dialogue
regarding challenges in evaluating debriefing and other crisis interventions in children.
Prehospital & Disaster Medicine, 30(3) : 306-
315
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Psychological debriefing
Pityaratstian, N., Piyasil, V., Ketumarn, P., Sitdhiraksa, N., Ularntinon, S., Pariwatcharakul, P.
Background: Post-traumatic stress disorder (PTSD) is a
common and debilitating consequence of natural disaster in children and adolescents. Accumulating data show that cognitive behavioural therapy (CBT)
is an effective treatment for PTSD. However, application of CBT in a large-scale disaster in a setting with limited resources, such as when the
tsunami hit several Asian countries in 2004, poses a major problem. Aims: This randomized controlled trial aimed to test for the efficacy of the
modified version of CBT for children and adolescents with PSTD. Method: Thirty-six children (aged 10-15 years) who had been diagnosed with PSTD 4
years after the tsunami were randomly allocated to either CBT or wait list. CBT was delivered in 3-day, 2-hour-daily, group format followed by 1-
month posttreatment self-monitoring and daily homework. Results: Compared to the wait list, participants who received CBT demonstrated significantly
greater improvement in symptoms of PTSD at 1-month follow-up, although no significant improvement was observed when the measures were done
immediately posttreatment. Conclusions: Brief, group CBT is an effective treatment for PTSD in children and adolescents when delivered in conjunction
with posttreatment self-monitoring and daily homework. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Behavioural & Cognitive Psychotherapy, 43(5) : 549-
561
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Martsenkovsky, I., Martsenkovska, I., Martsenkovsky, D.
Introduction:
Military action in Ukraine led to increasing in the number of patients with PTSD among children. Open-label studies demonstrated the efficacy of
SSRI's for the treatment of PTSD, primarily paroxetine. Feasibility of using of these drugs in children and adolescents is controversial [1-2].
Objective: To evaluate a short and long-term efficacy and tolerability of fluoxetine in the treatment of PTSD in children. Methods: double-blind,
placebo-controlled 12-week study with a fixed dose of fluoxetine (20-40 mg). The trial design consisted of 1-week, single-blind, placebo run-in
period, followed by a 12-week treatment period and a 2-week taper phase. Were randomized 110 children aged from 12 to 18 years (MD = 14,2), that have
been moved from the combat zone in the east of Ukraine and met the DSM-5criterias for PTSD. Drug efficacy was assessed weekly using the CAPS-2; CGI-I
/ CGI-S. Safety assessed: Adverse event (AE) recording, suicidality assessment. Result: The reduction in CAPS-2 scales was statistically significant
among children randomized to fluoxetine treatment compared with placebo in a week 12 endpoint (treatment difference -11.10; 95% Cl- 13.4, -7,38; p
<0.001). Significant greater proportion of fluoxetine-treated patient (52%) than placebo-treated (43%) were defined as treatment responders based on
CGI scale (adjusted odds ratio = 2.28; 95% Cl 1.75, 2.93; p <0.001). The most common adverse effects in fluoxetine group were somnolence, headache
and irritability, each occurring in <20% patients. Conclusion: Fluoxetine at a dose of 20-40 mg / day is more effective than placebo, well-tolerated
and can be recommended in pediatric practice.
European
Psychiatry, 30 : 1537
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Antidepressants
(any)
Martsenkovskyi, D.
Introduction: Military action in Ukraine has led to more than a million displaced persons, many of them
children and adolescents. In these children and adolescents there is an increased diagnosis of PTSD. In addition to PTSD, these children and
adolescents often fulfill the diagnostic criteria for Attention Deficit Hyperactivity Disorder, Depressive and Anxiety disorders, and Disruptive,
Impulse-Control and Conduct Disorders. Open-label studies have demonstrated the efficacy of SSRIs for the treatment of PTSD, primarily paroxetine.
The feasibility of using these drugs in children and adolescents is controversial [1-2]. Objective: To evaluate the short- and long-term efficacy and
tolerability of fluoxetine in the treatment of PTSD in children. Methods: A double-blind, placebo-controlled 12-week study with a fixed dose of
fluoxetine (20-40 mg) was conducted. The trial design consisted of a 1-week, single-blind, placebo run-in period, followed by a 12-week treatment
period and a 2-week taper phase.We randomized 110 children aged from 12 to 18 years (median 14.2 years), who were evacuated from the combat zone in
eastern Ukraine and who met the DSM-5 criteria for PTSD. Drug efficacy was assessed weekly using the Clinician-Administered PTSD Scale Part 2 (CAPS-
2) in clusters (re-experiencing, avoidance/ numbing and hyperarousal), and the Clinical Global Impression Improvement/Severity (CGI-I/CGI-S) scales.
Presence of baseline depression was determined using the M.I.N.I. Safety measures: Adverse event (AE) recording, clinical laboratory measures, vital
signs parameters, electrocardiograms (ECGs), suicidality assessment, and physical examination. Result: The reduction in CAPS-2 score was
significantly different between children randomized to fluoxetine treatment and children receiving placebo in a week-12 endpoint (treatment
difference -11.10; 95% CI -13.4, -7.38; p<0.001). A significantly greater proportion of fluoxetine-treated patients (52%) than placebo-treated
patients (43%) were treatment responders according to the CGI scale (adjusted odds ratio = 2.28; 95% CI 1.75, 2.93; p<0.001). The most common adverse
effects in the fluoxetine group were somnolence, headache and irritability, each occurring in <20% of patients. The effect of fluoxetine in the
treatment of PTSD is not solely due to its effect on comorbid depressive symptoms. Fluoxetine is statistically significantly effective in treating
PTSD in children and adolescents with and without comorbid depression or depressive symptoms (p <0.001). Fluoxetine is effective in treating all
three symptom clusters of PTSD, including the re-experiencing cluster which can be considered to be the most specific for PTSD. Fluoxetine is also
effective in patients with PTSD alone and in patients with PTSD and a comorbid condition. There were no significant differences in therapeutic
response in these patients. Conclusion: Fluoxetine at a dose of 20-40 mg/day is more effective than placebo, well-tolerated and can be recommended in
pediatric practice. More research is needed on the efficacy of combination therapies of fluoxetine and psychological methods of treatment, primarily
Trauma Focused CBT and EMDR - desensitization and processing of eye movement and psychoeducational work with primary support group of child.
European Neuropsychopharmacology, 25 : S643-
S644
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Antidepressants
(any)
Lewis, G.
F., Hourani, L., Tueller, S., Kizakevich, P., Bryant, S., Weimer, B., Strange, L.
Decreased heart rate variability (HRV) is associated
with posttraumatic stress disorder (PTSD) and depression symptoms, but PTSD's effects on the autonomic stress response and the potential influence
of HRV biofeedback in stress relaxation training on improving PTSD symptoms are not well understood. The objective of this study was to examine the
impact of a predeployment stress inoculation training (PRESTINT) protocol on physiologic measures of HRV in a large sample of the military population
randomly assigned to experimental HRV biofeedback-assisted relaxation training versus a control condition. PRESTINT altered the parasympathetic
regulation of cardiac activity, with experimental subjects exhibiting greater HRV, that is, less arousal, during a posttraining combat simulation
designed to heighten arousal. Autonomic reactivity was also found to be related to PTSD and self-reported use of mental health services. Future
PRESTINT training could be appropriate for efficiently teaching self-help skills to reduce the psychological harm following trauma exposure by
increasing the capacity for parasympathetically modulated reactions to stress and providing a coping tool (i.e., relaxation method) for use following
a stressful situation. Copyright © 2015 Society for Psychophysiological Research.
Psychophysiology, 52(9) : 1167-
1174
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Other Psychological Interventions, Relaxation
Fu, C., Underwood, C.
Background: Children and adolescents are among the most vulnerable groups affected by natural and man-made disaster. To better understand
research and practice concerning mental health and psychosocial support efforts in humanitarian settings, the authors conducted a comprehensive
review of all intervention programmes within the past decade that universally targeted children and adolescents who were exposed to a natural and/or
man-made disaster. Methods: We searched PubMed, PsychINFO, Cochrane Library and CINAHL for mental health and psychosocial interventions (MHPSS)
involving children and adolescents. A total of 11 studies, 4 from natural disasters and 7 from conflict-affected areas met the inclusion criteria.
Effect sizes were calculated using a random effects model for studies in post-natural disaster and war/terrorist-affected settings separately.
Results: The weighted mean effect sizes for interventions in both settings were statistically significant: -0.308, 95% CI=-0.54- -0.07, z=-2.58,
p=0.010 after a natural disaster, and -0.514, 95% CI=-0.80 to -0.23, z=-3.57, p<0.001 in conflict areas. This indicates that MHPSS interventions in
both disaster settings resulted in a reduction in PTSD symptoms compared to the control. Conclusions: This review suggests that school-based,
universal programmes that are conducted by teachers or local paraprofessionals are effective in reducing PTSD symptoms in children and adolescents.
The few studies meeting the inclusion criteria of this study demonstrate the need for further expansion of statistical methods and study designs to
test for the effects of interventions in challenging humanitarian settings. Copyright © 2015 NISC Pty Ltd.
Journal of Child
and Adolescent Mental Health, 27(3) : 161-171
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any)
Murray, L.
K., Skavenski, S., Kane, J. C., Mayeya, J., Dorsey, S., Cohen, J.
A., Michalopoulos, L. T. M., Imasiku, M., Bolton, P. A.,
IMPORTANCE: Orphans and vulnerable children
(OVC) are at high risk for experiencing trauma and related psychosocial problems. Despite this, no randomized clinical trials have studied evidence-
based treatments for OVC in low-resource settings. OBJECTIVE: To evaluate the effectiveness of lay counselor-provided trauma-focused cognitive
behavioral therapy (TF-CBT) to address trauma and stress-related symptoms among OVC in Lusaka, Zambia. DESIGN, SETTING, AND PARTICIPANTS: This
randomized clinical trial compared TF-CBT and treatment as usual (TAU) (varying by site) for children recruited from August 1, 2012, through July 31,
2013, and treated until December 31, 2013, for trauma-related symptoms from 5 community sites within Lusaka, Zambia. Children were aged 5 through 18
years and had experienced at least one traumatic event and reported significant trauma-related symptoms. Analysis was with intent to treat.
INTERVENTIONS: The intervention group received 10 to 16 sessions of TF-CBT (n = 131). The TAU group (n = 126) received usual community services
offered to OVC. MAIN OUTCOMES AND MEASURES: The primary outcome was mean item change in trauma and stress-related symptoms using a locally validated
version of the UCLA Posttraumatic Stress Disorder Reaction Index (range, 0-4) and functional impairment using a locally developed measure (range, 0-
4). Outcomes were measured at baseline and within 1 month after treatment completion or after a waiting period of approximately 4.5 months after
baseline for TAU. RESULTS: At follow-up, the mean item change in trauma symptom score was -1.54 (95% CI, -1.81 to -1.27), a reduction of 81.9%, for
the TF-CBT group and -0.37 (95% CI, -0.57 to -0.17), a reduction of 21.1%, for the TAU group. The mean item change for functioning was -0.76 (95% CI,
-0.98 to -0.54), a reduction of 89.4%, and -0.54 (95% CI, -0.80 to -0.29), a reduction of 68.3%, for the TF-CBT and TAU groups, respectively. The
difference in change between groups was statistically significant for both outcomes (P < .001). The effect size (Cohen d) was 2.39 for trauma
symptoms and 0.34 for functioning. Lay counselors participated in supervision and assessed whether the intervention was provided with fidelity in all
5 community settings. CONCLUSIONS AND RELEVANCE: The TF-CBT adapted for Zambia substantially decreased trauma and stress-related symptoms and
produced a smaller improvement in functional impairment among OVC having experienced high levels of trauma. TRIAL REGISTRATION: clinicaltrials.gov
Identifier: NCT01624298.
JAMA Pediatrics, 169(8) : 761-769
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Trauma-focused cognitive behavioural therapy (TF-
CBT), Other service delivery and improvement
interventions
Lenz, A., Hollenbaugh, K.
We evaluated
the effectiveness of trauma-focused cognitive behavioral therapy (TF-CBT) for treating posttraumatic stress disorder and co-occurring depression
symptoms across 21 between-group studies representing the data of 1,860 children and adolescents (1,106 girls and 754 boys). Separate meta-analytic
procedures were conducted for studies that implemented wait-list/no treatment and alternative treatment comparisons to estimate aggregated treatment
effect of TF-CBT and moderators of effect size magnitude. Limitations of our findings and implications for counselors are discussed. (PsycINFO
Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Counseling Outcome Research & Evaluation, 6(1) : 18-32
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Trauma-focused cognitive behavioural therapy (TF-
CBT)
Ruggiero,
K. J., Price, M., Adams, Z., Stauffacher, K., McCauley, J., Danielson, C. K., Knapp, R., Hanson,
R. F., Davidson, T. M., Amstadter, A. B., Carpenter, M. J., Saunders, B. E., Kilpatrick, D. G., Resnick, H. S.
Objective: To assess the efficacy of Bounce Back Now (BBN), a modular, Web-based intervention for disaster-affected
adolescents and their parents. Method: A population-based randomized controlled trial used address-based sampling to enroll 2,000 adolescents and
parents from communities affected by tornadoes in Joplin, MO, and several areas in Alabama. Data collection via baseline and follow-up semi-
structured telephone interviews was completed between September 2011 and August 2013. All families were invited to access the BBN study Web portal
irrespective of mental health status at baseline. Families who accessed the Web portal were assigned randomly to 1 of 3 groups: BBN, which featured
modules for adolescents and parents targeting adolescents' mental health symptoms; BBN plus additional modules targeting parents' mental health
symptoms; or assessment only. The primary outcomes were adolescent symptoms of posttraumatic stress disorder (PTSD) and depression. Results: Nearly
50% of families accessed the Web portal. Intent-to-treat analyses revealed time × condition interactions for PTSD symptoms (B = -0.24, SE = 0.08, p
<.01) and depressive symptoms (B = -0.23, SE = 0.09, p <.01). Post hoc comparisons revealed fewer PTSD and depressive symptoms for adolescents in the
experimental versus control conditions at 12-month follow-up (PTSD: B = -0.36, SE = 0.19, p =.06; depressive symptoms: B = -0.42, SE = 0.19, p =
0.03). A time × condition interaction also was found that favored the BBN versus BBN + parent self-help condition for PTSD symptoms (B = 0.30, SE =
0.12, p =.02) but not depressive symptoms (B = 0.12, SE = 0.12, p =.33). Conclusion: Results supported the feasibility and initial efficacy of BBN as
a scalable disaster mental health intervention for adolescents. Technology-based solutions have tremendous potential value if found to reduce the
mental health burden of disasters. Clinical trial registration information: Web-based Intervention for Disaster-Affected Youth and Families;
http://clinicaltrials.gov; NCT01606514.
Journal of the American Academy of Child & Adolescent Psychiatry, 54(9) : 709-
717
- Year: 2015
- Problem: Anxiety Disorders (any), Post Traumatic Stress Disorder, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Psychoeducation, Self-help, Technology, interventions delivered using technology (e.g. online, SMS)