Disorders - Post Traumatic Stress Disorder
Stankovic, M., Grbesa, G., Kostic, J., Simonovic, M., Milenkovic, T., Visnjic, A.
Background/Aim. Traumatic stress refers to physical and emotional reactions caused by events which represent a life threat or a disturbance
of physical and phychological integrity of a child, as well as their parents or gaerdians. Car accidents are the main cause of posttraumatic stress
disorder (PTSD) in children. The aim of this study was to preview clinical efficiency of systemic family therapy (SFT) as therapy intervention in
treatment of children with posttraumatic stress disorder (PTSD) traumatized in car accident under identical circumstances of exposure. We pointed out
the importance of specific family factors (family cohesion and adaptability, emotional reaction of the parents) on PTSD clinical outcome. Methods.
The sample of this clinical observational study included 7-sixth grade pupiles - 5 boys and 2 girls, aged 13. All of the pupils were involved in car
accident with one death. Two groups were formed - one group included three children who were involved in 8 SFT sessions together with their families.
The second group included 4 children who received an antidepressant sertraline in the period of three months. Results. Two months after the car
accident, before the beginning of the therapy, all of the children were the members of rigidly enmeshed family systems, considering the high average
cohesion scores and the low average adaptability scores on the FACES III. Three months after the received therapy, having evaluated the results of
the therapeutic approaches, we established that the adaptability scores of the families included in the SFT were higher than the scores of the
families of the children who received pharmacotherapy with one boy still meeting the criteria for PTSD. Conclusion. Systemic family therapy was
efficient in the treatment of children with PTSD, traumatized in car accident. Therapy efficiency was higher when both parents and children were
included in SFT than in the case when they were not included in the family therapy. The change in the functioning of the family systems was not
accidental or simply time-dependant, but it depended on the therapy which was applied and the increased level of family adaptability as the main risk
factor of retraumatization.
Vojnosanitetski Pregled, 70(2) : 149-
154
- Year: 2013
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Marsac, M. L., Hildenbrand, A. K., Kohser, K. L., Winston, F. K., Li, Y., Kassam-Adams, N.
The study objective is to
evaluate the feasibility and efficacy of a web-based intervention for parents (AfterTheInjury.org [ATI]) in promoting emotional recovery following
pediatric injury. 100 children with injuries requiring medical attention and their parents were randomly assigned to the intervention or usual care.
Efficacy outcomes included parent knowledge and child and parent posttraumatic stress symptoms (PTSS). All parents in the intervention group
completed the intervention (directed use of ATI) in the hospital. 56% reported using ATI online post-discharge, and 100% of these parents found it
helpful. Parent knowledge increased immediately post-intervention, but there was no significant intervention impact on parent knowledge or PTSS at a
6-week follow-up. Relationships between knowledge and PTSS were identified. Brief web-based interventions introduced during child hospitalization are
a feasible strategy to reach many parents following pediatric injury. Preventing psychological symptoms may require more than parental education
alone.
Journal of pediatric psychology, 38(10) : 1101-
1111
- Year: 2013
- 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), Psychoeducation, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Wu, S., Zhu, X., Zhang, Y., Liang, J., Liu, X., Yang, Y., Yang, H., Miao, D.
We
sought to compare the efficacy of the \"512 Psychological Intervention Model\" (that is, \"512 PIM\", a new psychological intervention) with
debriefing on symptoms of post-traumatic stress disorder (PTSD), anxiety and depression of Chinese military rescuers in relation to a control group
that had no intervention. We conducted a randomized controlled trial with 2,368 military rescuers 1 month after this event and then at follow-up 1, 2
and 4 months later to evaluate changes in symptoms of PTSD, anxiety and depression based on DSM-IV criteria, respectively. Baseline analysis
suggested no significant differences between the study groups. Severity of PTSD, anxiety and depression decreased over time in all three groups, with
significant differences between the groups in symptoms of PTSD (P < 0.01). Compared with the debriefing and control group, significant lower scores
of PTSD and positive efficacy in improving symptoms of re-experiencing, avoidance and hyperarousal were found in the \"512 PIM\" group. \"512 PIM\"
was an effective psychological intervention for military rescuers in reducing symptoms of PTSD, anxiety and depression after a crisis.
Social
Psychiatry & Psychiatric Epidemiology, 47(7) : 1111-1119
- Year: 2012
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Psychological debriefing, Other Psychological Interventions
Vandervord-Nixon, Reginald David, Sterk, Jisca, Pearce, Amanda
The present study compared the efficacy of trauma-focused cognitive behavior therapy (CBT) with trauma-focused
cognitive therapy (without exposure; CT) for children and youth with posttraumatic stress disorder (PTSD). Children and youth who had experienced
single-incident trauma (N = 33; 7 - 17 years old) were randomly assigned to receive 9 weeks of either CBT or CT which was administered individually
to children and their parents. Intent-to-treat analyses demonstrated that both interventions significantly reduced severity of PTSD, depression, and
general anxiety. At posttreatment 65% of CBT and 56% of the CT group no longer met criteria for PTSD. Treatment completers showed a better response
(CBT: 91%; CT: 90%), and gains were maintained at 6-month follow-up. Maternal depressive symptoms and unhelpful trauma beliefs moderated children's
outcome. It is concluded that PTSD secondary to single-incident trauma can be successfully treated with trauma-focused cognitive behavioural methods
and the use of exposure is not a prerequisite for good outcome. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract)
Journal of Abnormal Child Psychology, 40(3) : 327-
337
- Year: 2012
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Trauma-focused cognitive behavioural therapy (TF-
CBT)
Tol, W. A., Komproe, I. H., Jordans, M. J. D., Vallipuram, A., Sivayokan, S., MacY, R. D., De ong, J. T.,
We aimed to examine outcomes, moderators and mediators of a preventive school-based mental health
intervention implemented by paraprofessionals in a war-affected setting in northern Sri Lanka. A cluster randomized trial was employed. Subsequent to
screening 1,370 children in randomly selected schools, 399 children were assigned to an intervention (n=199) or waitlist control condition (n=200).
The intervention consisted of 15 manualized sessions over 5 weeks of cognitive behavioral techniques and creative expressive elements. Assessments
took place before, 1 week after, and 3 months after the intervention. Primary outcomes included post-traumatic stress disorder (PTSD), depressive,
and anxiety symptoms. No main effects on primary outcomes were identified. A main effect in favor of intervention for conduct problems was observed.
This effect was stronger for younger children. Furthermore, we found intervention benefits for specific subgroups. Stronger effects were found for
boys with regard to PTSD and anxiety symptoms, and for younger children on pro-social behavior. Moreover, we found stronger intervention effects on
PTSD, anxiety, and function impairment for children experiencing lower levels of current war-related stressors. Girls in the intervention condition
showed smaller reductions on PTSD symptoms than waitlisted girls. We conclude that preventive school-based psychosocial interventions in volatile
areas characterized by ongoing war-related stressors may effectively improve indicators of psychological wellbeing and posttraumatic stress-related
symptoms in some children. However, they may undermine natural recovery for others. Further research is necessary to examine how gender, age and
current war-related experiences contribute to differential intervention effects.
World
Psychiatry, 11(2) : 114-122
- Year: 2012
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Other Psychological Interventions, Creative expression: music, dance, drama, art
Schottelkorb, April A., Doumas, Diana M., Garcia, Rhyan
The authors investigated the effectiveness of child-centered play therapy (CCPT) in comparison with an evidence-based intervention,
trauma-focused cognitive - behavioral therapy (TF-CBT) with traumatized refugee children aged 6 to 13. Thirty-one traumatized refugee children were
randomly assigned to participate in CCPT or TF-CBT in the elementary school setting in the northwest United States. Results indicated that both CCPT
and TF-CBT were effective in reducing trauma symptoms according to child and parent report. Findings support the use of CCPT in treating traumatized
refugee children. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
International Journal of Play Therapy, 21(2) : 57-73
- Year: 2012
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Salloum, A., Overstreet, S.
This study evaluated the differential
effects of the Grief and Trauma Intervention (GTI) with coping skills and trauma narrative processing (CN) and coping skills only (C). Seventy
African American children (6-12 years old) were randomly assigned to GTI-CN or GTI-C. Both treatments consisted of a manualized 11-session
intervention and a parent meeting. Measures of trauma exposure, posttraumatic stress symptoms, depression, traumatic grief, global distress, social
support, and parent reported behavioral problems were administered at pre, post, 3 and 12 months post intervention. In general, children in both
treatment groups demonstrated significant improvements in distress related symptoms and social support, which, with the exception of externalizing
symptoms for GTI-C, were maintained up to 12 months post intervention. Results suggest that building coping skills without the structured trauma
narrative may be a viable intervention to achieve symptom relief in children experiencing trauma-related distress. However, it may be that highly
distressed children experience more symptom relief with coping skills plus narrative processing than with coping skills alone. More research on the
differential effects of coping skills and trauma narration on child distress and adaptive functioning outcomes is needed. (copyright) 2012 Elsevier
Ltd.
Behaviour
Research & Therapy, 50(3) : 169-179
- Year: 2012
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Skills training, Other Psychological Interventions
Saxe, G., Ellis, B., Fogler, J., Navalta, C. P.
Background: This study aimed to obtain preliminary evidence for the extent to which a novel intervention embedded within a
systems-oriented treatment model [trauma systems therapy (TST)] engages and retains traumatized children and their families in treatment. Method:
Twenty youth who had prominent symptoms of posttraumatic stress were randomly assigned to receive TST or care as usual (CAU). Results: At the 3-month
assessment, 90% of TST participants were still in treatment, whereas only 10% of CAU participants remained. Within-group analyses of TST participants
demonstrated significant reductions in posttraumatic stress and aggression as well as a slight improvement in home safety. Conclusions: These
preliminary findings point to the need to utilize effective engagement approaches to retain traumatized children and their families in treatment.
(copyright) 2011 The Authors. Child and Adolescent Mental Health (copyright) 2011 Association for Child and Adolescent Mental Health.
Child & Adolescent Mental Health, 17(1) : 58-
61
- Year: 2012
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Wilkinson, J. M., Carrion, V. G.
After the experience of a traumatic event, children and adolescents are especially vulnerable to
developing debilitating symptoms of Posttraumatic Stress Disorder (PTSD). Criteria for diagnosing this disorder in the pediatric population have
proven insufficiently sensitive for children, especially those who are very young. Age-related PTSD symptom expression suggests PTSD assessment and
treatment requires developmental consideration. Preschool age children, school age children, adolescents, and adults also possess potentially
distinct differences from one another in pharmacokinetics, psychosocial influences, and neurobiology. Pharmacotherapy is often indicated for use in
the treatment of pediatric PTSD. Extrapolation of evidence in adult literature for safety, tolerability, and efficacy is nonlinear and should not
substitute for dedicated drug trials in pediatric PTSD. This paper reviews all identified randomized controlled trials (RCTs), uncontrolled and open
label trials, and case reports/series regarding pharmacotherapy in this population. Emphasis is placed on methodologic rigor and developmental
consideration. These trials are discussed in sufficient detail to inform readers of their relative strengths and weaknesses, and of the
generalizability of the studies' conclusions. This review summarizes reports by drug class and developmental cohorts (preschool age, school age, and
adolescents). The review will help clinicians a) decide when medications are needed, b) understand current evidence-based alternatives and c) utilize
a developmental approach in the selection of medication. (copyright) 2012 Bentham Science Publishers.
Current Psychopharmacology, 1(3) : 252-270
- Year: 2012
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants
Mannarino, A. P., Cohen, J. A., Deblinger, E., Runyon,
M. K., Steer, R. A.
This study presents the findings from 6- and 12-month follow-up assessments of 158 children ages 4-11
years who had experienced sexual abuse and who had been treated with Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) with or without the
inclusion of the trauma narrative (TN) treatment module and in 8 or 16 treatment sessions. Follow-up results indicated that the overall significant
improvements across 14 outcome measures that had been reported at posttreatment were sustained 6 and 12 months after treatment and on two of these
measures (child self-reported anxiety and parental emotional distress) there were additional improvements at the 12-month follow-up. Higher levels of
child internalizing and depressive symptoms at pretreatment were predictive of the small minority of children who continued to meet full criteria for
posttraumatic stress disorder at the 12-month follow-up. These results are discussed in the context of the extant TF-CBT treatment literature.
(copyright) The Author(s) 2012.
Child Maltreatment, 17(3) : 231-241
- Year: 2012
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Narrative exposure therapy (NET), Trauma-focused cognitive behavioural therapy (TF-
CBT)
Macdonald, G., Higgins, J. P., Ramchandani, P., Valentine, J. C., Bronger, L. P., Klein, P., O'Daniel, R., Pickering, M., Rademaker, B., Richardson,
G., Taylor, M.
Despite
differences in how it is defined, there is a general consensus amongst clinicians and researchers that the sexual abuse of children and adolescents
('child sexual abuse') is a substantial social problem worldwide. The effects of sexual abuse manifest in a wide range of symptoms, including fear,
anxiety, post-traumatic stress disorder and various externalising and internalising behaviour problems, such as inappropriate sexual behaviours.
Child sexual abuse is associated with increased risk of psychological problems in adulthood. Cognitive-behavioural approaches are used to help
children and their non-offending or 'safe' parent to manage the sequelae of childhood sexual abuse. This review updates the first Cochrane review
of cognitive-behavioural approaches interventions for children who have been sexually abused, which was first published in 2006. To assess the
efficacy of cognitive-behavioural approaches (CBT) in addressing the immediate and longer-term sequelae of sexual abuse on children and young people
up to 18 years of age. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2011 Issue 4); MEDLINE (1950 to November Week 3
2011); EMBASE (1980 to Week 47 2011); CINAHL (1937 to 2 December 2011); PsycINFO (1887 to November Week 5 2011); LILACS (1982 to 2 December 2011) and
OpenGrey, previously OpenSIGLE (1980 to 2 December 2011). For this update we also searched ClinicalTrials.gov and the International Clinical Trials
Registry Platform (ICTRP). We included randomised or quasi-randomised controlled trials of CBT used with children and adolescents up to age 18 years
who had experienced being sexually abused, compared with treatment as usual, with or without placebo control. At least two review authors
independently assessed the eligibility of titles and abstracts identified in the search. Two review authors independently extracted data from
included studies and entered these into Review Manager 5 software. We synthesised and presented data in both written and graphical form (forest
plots). We included 10 trials, involving 847 participants. All studies examined CBT programmes provided to children or children and a non-offending
parent. Control groups included wait list controls (n = 1) or treatment as usual (n = 9). Treatment as usual was, for the most part, supportive,
unstructured psychotherapy. Generally the reporting of studies was poor. Only four studies were judged 'low risk of bias' with regards to sequence
generation and only one study was judged 'low risk of bias' in relation to allocation concealment. All studies were judged 'high risk of bias' in
relation to the blinding of outcome assessors or personnel; most studies did not report on these, or other issues of bias. Most studies reported
results for study completers rather than for those recruited.Depression, post-traumatic stress disorder (PTSD), anxiety and child behaviour problems
were the primary outcomes. Data suggest that CBT may have a positive impact on the sequelae of child sexual abuse, but most results were not
statistically significant. Strongest evidence for positive effects of CBT appears to be in reducing PTSD and anxiety symptoms, but even in these
areas effects tend to be 'moderate' at best. Meta-analysis of data from five studies suggested an average decrease of 1.9 points on the Child
Depression Inventory immediately after intervention (95% confidence interval (CI) decrease of 4.0 to increase of 0.4; I(2) = 53%; P value for
heterogeneity = 0.08), representing a small to moderate effect size. Data from six studies yielded an average decrease of 0.44 standard deviations on
a variety of child post-traumatic stress disorder scales (95% CI 0.16 to 0.73; I(2) = 46%; P value for heterogeneity = 0.10). Combined data from five
studies yielded an average decrease of 0.23 standard deviations on various child anxiety scales (95% CI 0.3 to 0.4; I(2) = 0%; P value for
heterogeneity = 0.84). No study reported adverse effects. The conclusions of this updated review remain the same as those when it was first
published. The eview confirms the potential of CBT to address the adverse consequences of child sexual abuse, but highlights the limitations of the
evidence base and the need for more carefully conducted and better reported trials.
Cochrane Database of Systematic
Reviews, 5 : CD001930
- Year: 2012
- Problem: Anxiety Disorders (any), 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)
Qouta, Samir R., Palosaari, Esa, Diab, Marwan
We examined the
effectiveness of a psychosocial intervention in reducing mental health symptoms among war-affected children, and the role of peritraumatic
dissociation in moderating the intervention impact on posttraumatic stress symptoms (PTSS). School classes were randomized into intervention (n =
242) and waitlist control (n = 240) conditions in Gaza, Palestine. The intervention group participated in 16 extracurriculum sessions of teaching
recovery techniques (TRT) and the controls received normal school-provided support. Participants were 10- to 13-year-old Palestinian girls (49.4%)
and boys (50.6%). Data on PTSS, depressive symptoms, and psychological distress were collected at baseline (T1), postintervention (T2), and 6-month
follow-up (T3). Peritraumatic dissociation was assessed only at baseline. Regression analyses that took regression to the mean and cluster sampling
into account were applied. The results on intervention effectiveness were specific to gender and peritraumatic dissociation. At T2, the intervention
significantly reduced the proportion of clinical PTSS among boys, and both the symptom level (R² = .24), and proportion of clinical PTSS among girls
who had a low level of peritraumatic dissociation. The results have implications for risk-specific tailoring of psychosocial interventions in war
conditions. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Journal of Traumatic
Stress, 25(3) : 288-298
- Year: 2012
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions