Disorders - Post Traumatic Stress Disorder
Deblinger, Esther, Mannarino, Anthony P., Cohen, Judith A., Runyon, Melissa K., Steer, Robert A.
Background: Child sexual abuse (CSA) is associated with the development of a variety of
mental health disorders, and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an established treatment for children who have experienced CSA.
However, there are questions about how many TF-CBT sessions should be delivered to achieve clinical efficacy and whether a trauma narrative (TN)
component is essential. This study examined the differential effects of TF-CBT with or without the TN component in 8 versus 16 sessions. Methods: Two
hundred and ten children (aged 4-11 years) referred for CSA and posttraumatic stress disorder symptoms were randomly assigned to one of the four
treatment conditions: 8 sessions with no TN, 8 sessions with TN, 16 sessions with no TN, and 16 sessions with TN. Results: Mixed-model ANCOVAs
demonstrated that significant posttreatment improvements had occurred with respect to 14 outcome measures across all conditions. Significant main and
interactive effect differences were found across conditions with respect to specific outcomes. Conclusions: TF-CBT, regardless of the number of
sessions or the inclusion of a TN component, was effective in improving participant symptomatology as well as parenting skills and the children's
personal safety skills. The eight session condition that included the TN component seemed to be the most effective and efficient means of
ameliorating parents' abuse-specific distress as well as children's abuse-related fear and general anxiety. On the other hand, parents assigned to
the 16 session, no narrative condition reported greater increases in effective parenting practices and fewer externalizing child behavioral problems
at posttreatment. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Depression & Anxiety, 28(1) : 67-75
- Year: 2011
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Trauma-focused cognitive behavioural therapy (TF-
CBT)
Ertl, Verena, Pfeiffer, Anett, Schauer, Anett, Elbert, Thomas, Neuner, Frank
Context: The psychological rehabilitation of former child soldiers and their successful reintegration into
postconflict society present challenges. Despite high rates of impairment, there have been no randomized controlled trials examining the feasibility
and efficacy of mental health interventions for former child soldiers. Objective: To assess the efficacy of a community-based intervention targeting
symptoms of posttraumatic stress disorder (PTSD) in formerly abducted individuals. Design, Setting, and Participants: Randomized controlled trial
recruiting 85 former child soldiers with PTSD from a population-based survey of 1113 Northern Ugandans aged 12 to 25 years, conducted between
November 2007 and October 2009 in camps for internally displaced persons. Participants were randomized to 1 of 3 groups: narrative exposure therapy
(n = 29), an academic catch-up program with elements of supportive counseling (n = 28), or a waiting list (n = 28). Symptoms of PTSD and trauma-
related feelings of guilt were measured using the Clinician-Administered PTSD Scale. The respective sections of the Mini International
Neuropsychiatric Interview were used to assess depression and suicide risk, and a locally adapted scale was used to measure perceived stigmatization.
Symptoms of PTSD, depression, and related impairment were assessed before treatment and at 3 months, 6 months, and 12 months postintervention.
Intervention: Treatments were carried out in 8 sessions by trained local lay therapists, directly in the communities. Main Outcome Measures: Change
in PTSD severity, assessed over a 1-year period after treatment. Secondary outcome measures were depression symptoms, severity of suicidal ideation,
feelings of guilt, and perceived stigmatization. Results: PTSD symptom severity (range, 0-148) was significantly more improved in the narrative
exposure therapy group than in the academic catch-up (mean change difference, ‚àí14.06 [95% confidence interval, ‚àí27.19 to ‚àí0.92]) and waiting-
list (mean change difference, ‚àí13.04 [95% confidence interval, ‚àí26.79 to 0.72]) groups. Contrast analyses of the time vó treatment interaction of
the mixed-effects model on PTSD symptom change over time revealed a superiority of narrative exposure therapy compared with academic catch-up (F
[sub]1,234.1[/sub] = 5.21, P = .02) and wait-listing (F[sub]1,228.3[/sub] = 5.28, P = .02). Narrative exposure therapy produced a larger within-
treatment effect size (Cohen d = 1.80) than academic catch-up (d = 0.83) and wait-listing (d = 0.81). Conclusion: Among former Ugandan child
soldiers, short-term trauma-focused treatment compared either with an academic catch-up program including supportive counseling or with wait-listing
resulted in greater reduction of PTSD symptoms. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
JAMA, 306(5) : 503-
512
- Year: 2011
- Problem: Post Traumatic Stress Disorder, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Supportive
therapy, Other Psychological Interventions, Narrative exposure therapy (NET)
Cohen, Judith A., Mannarino, Anthony P., Iyengar, Satish
Objective: Design:
Setting: Participants: Interventions: Main Outcome Measures: Results: Conclusions: Trial Registration: To evaluate community-provided trauma-focused
cognitive behavior therapy (TF-CBT) compared with usual community treatment for children with intimate partner violence (IPV)-related posttraumatic
stress disorder (PTSD) symptoms.Randomized controlled trial conducted using blinded evaluators.Recruitment, screening, and treatment were conducted
at a community IPV center between September 1, 2004, and June 30, 2009.Of 140 consecutively referred 7- to 14-year-old children, 124
participated.Children and mothers were randomly assigned to receive 8 sessions of TF-CBT or usual care (child-centered therapy).Total child PTSD
symptoms assessed using child and parent structured interview (Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime
Version [K-SADS-PL]) and self-report (University of California at Los Angeles PTSD Reaction Index [RI]). Secondary child outcomes were scores on the
K-SADS-PL (PTSD symptom clusters), Screen for Child Anxiety Related Emotional Disorders (SCARED) (anxiety), Children's Depression Inventory
(depression), Kaufman Brief Intelligence Test (cognitive functioning), and Child Behavior Checklist (total behavior problems).Intent-to-treat
analysis using last observation carried forward showed superior outcomes for TF-CBT on the total K-SADS-PL (mean difference, 1.63; 95% confidence
interval [CI], 0.44-2.82), RI (mean difference, 5.5; 95% CI, 1.37-9.63), K-SADS-PL hyperarousal (mean difference, 0.71; 95% CI, 0.22-1.20), K-SADS-PL
avoidance (0.55; 0.07-1.03), and SCARED (mean difference, 5.13; 95% CI, 1.31-8.96). Multiple imputation analyses confirmed most of these findings.
The TF-CBT completers experienced significantly greater PTSD diagnostic remission (χ(2) = 4.67, P = .03) and had significantly fewer serious adverse
events.Community TF-CBT effectively improves children's IPV-related PTSD and anxiety.clinicaltrials.gov Identifier: NCT00183326.
Archives of Pediatrics & Adolescent Medicine, 165(1) : 16-
21
- Year: 2011
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Kramer, D. N., Landolt, M. A.
Background: Single traumatising events are associated with an elevated
rate of psychological disorders in children and adolescents. To date, it remains unclear whether early psychological interventions can reduce longer
term psychological maladjustment. Objective: To systematically review the literature to determine the characteristics and efficacy of early
psychological interventions in children and adolescents after a single, potentially-traumatising event. Design: Systematic searches were conducted of
all relevant bibliographic databases. Studies on early psychological interventions were included if the first session was conducted within 1 month of
the event. Two independent observers assessed each study for eligibility, using pre-determined inclusion and exclusion criteria, and rated the
study's methodological quality. A meta-analysis was conducted on the group effects between individuals allocated to intervention versus control
groups. Hence, effect sizes (ES) and confidence intervals were computed as well as heterogeneity and analogue-to-the ANOVA analyses. Results: Seven
studies (including four randomised controlled trials) met the inclusion criteria. Depending on the specific outcome variable (e.g., dissociation,
anxiety and arousal), small to large beneficial ES were noted. Although the meta-analysis revealed unexplained heterogeneity between the ES of the
included studies, and although studies varied greatly with regards to their methodological quality and the interventions tested, findings suggest
that early interventions should involve psycho-education, provide individual coping-skills and probably involve some kind of trauma exposure. Also, a
stepped procedure that includes an initial risk screen and the provision of multiple sessions to those children at risk may be a promising strategy.
Conclusions: To date, research on the effectiveness of early interventions in children after a potentially traumatising event remains scarce.
However, our review suggests that early interventions may be helpful. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
European Journal of
Psychotraumatology, 2(7858) :
- Year: 2011
- Problem: Anxiety Disorders (any), Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Psychological debriefing, Psychoeducation
De-Roos, C., Greenwald, R., Den-Hollander-Gijsman, M., Noorthoorn, E., Van-Buuren,
S., De-Jongh, A.
Background: Building on previous research with disaster-exposed children and adolescents, a randomised clinical trial was performed
in the treatment of trauma-related symptoms. In the current study two active treatments were compared among children in a broad age range and from a
wide diversity of ethnic populations. Objective: The primary aim was to compare the effectiveness and efficiency of Cognitive Behavioural Therapy
(CBT) and Eye Movement Desensitisation and Reprocessing (EMDR). Design: Children (n = 52, aged 4-18) were randomly allocated to either CBT (n = 26)
or EMDR (n = 26) in a disaster mental health after-care setting after an explosion of a fireworks factory. All children received up to four
individual treatment sessions over a 4 8 week period along with up to four sessions of parent guidance. Blind assessment took place pre- and post-
treatment and at 3 months follow-up on a variety of parent-rated and self-report measures of post-traumatic stress disorder symptomatology,
depression, anxiety, and behaviour problems. Analyses of variance (general linear model repeated measures) were conducted on the intention-to-treat
sample and the completers. Results: Both treatment approaches produced significant reductions on all measures and results were maintained at follow-
up. Treatment gains of EMDR were reached in fewer sessions. Conclusion: Standardised CBT and EMDR interventions can significantly improve functioning
of disaster-exposed children. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
European Journal of Psychotraumatology Vol 2 2011, ArtID
5694, 2 :
- Year: 2011
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Eye movement desensitisation and reprocessing (EMDR)
Hourani, L. L., Kizakevich, P. N., Hubal, R., Spira, J., Strange, L. B., Holiday, D. B., Bryant, S., McLean, A.
N.
Predeployment stress inoculation training (PRESIT) is designed to help
personnel cope with combatrelated stressors and trauma exposure. PRESIT comprises education on combat and operational stress control, attentional
retraining and relaxation training, and practice and assessment via a multimedia stressor environment (MSE). Heart rate variability (HRV) and a
reaction time task assessed learned skills and inoculation to MSE arousal. Participants with deployment experience and who were in the experimental
group demonstrated improvement, measured as greater relaxation demonstrated during the MSE of a follow-up session relative to that of a baseline
session. There was also a training effect for this group, such that those participants who showed greater relaxation from a baseline HRV state during
the training (i.e., on relaxation breathing and focusing) showed more improvement between sessions. In contrast, there were no significant predictive
variables for the participants in training who had never deployed. Participants with more Posttraumatic Stress Disorder (PTSD) symptoms at baseline
showed more capability for improvement, as was true for participants who were more anxious about their next deployment. (copyright) Virtual Reality
Medical Institute.
Journal of Cyber Therapy & Rehabilitation, 4(1) : 101-119
- Year: 2011
- Problem: Post Traumatic Stress Disorder
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Ghosh Ippen, Chandra
Objective: Methods: Results: Conclusions: Practice Implications: This study involves a reanalysis
of data from a randomized controlled trial to examine whether child-parent psychotherapy (CPP), an empirically based treatment focusing on the
parent-child relationship as the vehicle for child improvement, is efficacious for children who experienced multiple traumatic and stressful life
events (TSEs).Participants comprised 75 preschool-aged children and their mothers referred to treatment following the child's exposure to domestic
violence. Dyads were randomly assigned to CPP or to a comparison group that received monthly case management plus referrals to community services and
were assessed at intake, posttest, and 6-month follow-up. Treatment effectiveness was examined by level of child TSE risk exposure (<4 risks versus
4+ TSEs).For children in the 4+ risk group, those who received CPP showed significantly greater improvements in PTSD and depression symptoms, PTSD
diagnosis, number of co-occurring diagnoses, and behavior problems compared to those in the comparison group. CPP children with <4 risks showed
greater improvements in symptoms of PTSD than those in the comparison group. Mothers of children with 4+ TSEs in the CPP group showed greater
reductions in symptoms of PTSD and depression than those randomized to the comparison condition. Analyses of 6-month follow-up data suggest
improvements were maintained for the high risk group.The data provide evidence that CPP is effective in improving outcomes for children who
experienced four or more TSEs and had positive effects for their mothers as well.Numerous studies show that exposure to childhood trauma and
adversity has negative consequences for later physical and mental health, but few interventions have been specifically evaluated to determine their
effectiveness for children who experienced multiple TSEs. The findings suggest that including the parent as an integral participant in the child's
treatment may be particularly effective in the treatment of young children exposed to multiple risks.\rCopyright © 2011 Elsevier Ltd. All rights
reserved.
Child Abuse & Neglect, 35(7) : 504-
513
- Year: 2011
- 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), Psychodynamic/Psychoanalysis, Case management, Other service delivery and improvement
interventions
Kar, N.
Background: Post-traumatic stress disorder
(PTSD) is a psychiatric sequel to a stressful event or situation of an exceptionally threatening or catastrophic nature. Cognitive behavioral therapy
(CBT) has been used in the management of PTSD for many years. This paper reviews the effectiveness of CBT for the treatment of PTSD following various
types of trauma, its potential to prevent PTSD, methods used in CBT, and reflects on the mechanisms of action of CBT in PTSD. Methods: Electronic
databases, including PubMed, were searched for articles on CBT and PTSD. Manual searches were conducted for cross-references in the relevant journal
sites. Results: The current literature reveals robust evidence that CBT is a safe and effective intervention for both acute and chronic PTSD
following a range of traumatic experiences in adults, children, and adolescents. However, nonresponse to CBT by PTSD can be as high as 50%,
contributed to by various factors, including comorbidity and the nature of the study population. CBT has been validated and used across many
cultures, and has been used successfully by community therapists following brief training in individual and group settings. There has been effective
use of Internet-based CBT in PTSD. CBT has been found to have a preventive role in some studies, but evidence for definitive recommendations is
inadequate. The effect of CBT has been mediated mostly by the change in maladaptive cognitive distortions associated with PTSD. Many studies also
report physiological, functional neuroimaging, and electroencephalographic changes correlating with response to CBT. Conclusion: There is scope for
further research on implementation of CBT following major disasters, its preventive potential following various traumas, and the neuropsychological
mechanisms of action. (copyright) 2011 Feng et al.
Neuropsychiatric Disease & Treatment, 7(1) : 167-
181
- Year: 2011
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Kowalik, Joanna, Weller, Jennifer, Venter, Jacob, Drachman, David
Background and Objectives: Method: Results: Limitations: Conclusions: There is no clear gold
standard treatment for childhood posttraumatic stress disorder (PTSD). An annotated bibliography and meta-analysis were used to examine the efficacy
of cognitive behavioral therapy (CBT) in the treatment of pediatric PTSD as measured by outcome data from the Child Behavior Checklist (CBCL).A
literature search produced 21 studies; of these, 10 utilized the CBCL but only eight were both 1) randomized; and 2) reported pre- and post-
intervention scores.The annotated bibliography revealed efficacy in general of CBT for pediatric PTSD. Using four indices of the CBCL, the meta-
analysis identified statistically significant effect sizes for three of the four scales: Total Problems (TP; -.327; p = .003), Internalizing (INT;
-.314; p = .001), and Externalizing (EXT; -.192; p = .040). The results for TP and INT were reliable as indicated by the fail-safe N and rank
correlation tests. The effect size for the Total Competence (TCOMP; -.054; p = .620) index did not reach statistical significance.Limitations
included methodological inconsistencies across studies and lack of a randomized control group design, yielding few studies for meta-analysis.The
efficacy of CBT in the treatment of pediatric PTSD was supported by the annotated bibliography and meta-analysis, contributing to best practices
data. CBT addressed internalizing signs and symptoms (as measured by the CBCL) such as anxiety and depression more robustly than it did externalizing
symptoms such as aggression and rule-breaking behavior, consistent with its purpose as a therapeutic intervention.\rCopyright © 2011 Elsevier Ltd.
All rights reserved.
Journal of Behavior Therapy & Experimental Psychiatry, 42(3) : 405-
413
- Year: 2011
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Trask, E. V.
The present meta-
analysis examined the effects of psychosocial treatments at reducing deleterious outcomes of sexual abuse. The meta-analysis included a total of 35
published and unpublished studies written in English, focusing on youth under the age of 18, and evaluating the effectiveness of treatments for the
most common negative outcomes of sexual abuse: PTSD symptoms, externalizing problems, and internalizing problems. Results revealed medium effect
sizes for PTSD symptoms, externalizing problems, and internalizing problems following treatment for sexual abuse. This study also examined the
potential moderating effects of treatment (e.g., modality, duration, and inclusion of caregiver) and participant (e.g., age, gender, and ethnicity)
characteristics. Results indicated that longer interventions were associated with greater treatment gains while group and individual treatments were
equally effective. These findings shed new light on treatment effectiveness and provide useful information regarding the conditions under which
treatment may be most effective. Future directions for research in this area are discussed. (copyright) 2010 Elsevier Ltd.
Aggression & Violent Behavior, 16(1) : 6-19
- Year: 2011
- 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)
Stoddard, Frederick J., Jr., Luthra, Rohini, Sorrentino, Erica A., Saxe, Glenn N., Drake, Jennifer, Chang, Yuchiao, Levine, John B., Chedekel, David
S., Sheridan, Robert L.
Background: This study evaluated the
potential benefits of a centrally acting selective serotonin reuptake inhibitor, sertraline, versus placebo for prevention of symptoms of
posttraumatic stress disorder (PTSD) and depression in burned children. This is the first controlled investigation based on our review of the early
use of a medication to prevent PTSD in children. Methods: Twenty-six children aged 6–20 were assessed in a 24-week double-blind placebo-controlled
design. Each child received either flexibly dosed sertraline between 25–150 mg/day or placebo. At each reassessment, information was collected in
compliance with the study medication, parental assessment of the child’s symptomatology and functioning, and the child’s self-report of
symptomatology. The protocol was approved by the Human Studies Committees of Massachusetts General Hospital and Shriners Hospitals for Children.
Results: The final sample was 17 subjects who received sertraline versus 9 placebo control subjects matched for age, severity of injury, and type of
hospitalization. There was no significant difference in change from baseline with child-reported symptoms; however, the sertraline group demonstrated
a greater decrease in parent-reported symptoms over 8 weeks (‚àí4.1 vs. ‚àí0.5, p = 0.005), over 12 weeks (‚àí4.4 vs. ‚àí1.2, p = .008), and over 24
weeks (‚àí4.0 vs. ‚àí0.2, p = 0.017). Conclusions: Sertraline was a safe drug, and it was somewhat more effective in preventing PTSD symptoms than
placebo according to parent report but not child report. Based on this study, sertraline may prevent the emergence of PTSD symptoms in children.
(PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Journal of Child & Adolescent Psychopharmacology, 21(5) : 469-477
- Year: 2011
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Taylor, Marcus K., Stanfill, Katherine E., Padilla, Genieleah A., Markham, Amanda E., Ward, Michael D., Koehler,
Matthew M., Anglero, Antonio, Adams, Barry D.
In this randomized, controlled field study, we examined the effects of a brief psychological skills training (PST) intervention on stress
responses during military survival school. A second purpose was to build upon prior research in this unique environment by extending the follow-up
window to 3 months. Baseline subjective distress (dissociative) symptoms were measured in 65 male military subjects, who were then randomized either
to PST or a control group that received no training beyond the normal survival school curriculum. PST received training in arousal control, mental
imagery, goal setting, and positive self-talk in two separate 40-minute sessions before stressful field exercises. Stress symptoms were then assessed
during a mock-captivity phase of training, as well as 24 hours, 1 month, and 3 months after completion of training. Repeated-measures analyses of
variance with follow-up paired t tests examined differences between groups and across time. Survival training precipitated remarkable increases in
subjective distress, but few substantive group differences emerged. This study extends prior work quantifying the human stress response to intense
military training.
Military
Medicine, 176(12) : 1362-1368
- Year: 2011
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Skills training