Disorders - Post Traumatic Stress Disorder
Wolmer, Leo, Hamiel, Daniel, Laor, Nathaniel
Objective: The psychological
outcomes that the exposure to mass trauma has on children have been amply documented in the past decades. The objective of this study is to describe
the effects of a universal, teacher-based preventive intervention implemented with Israeli students before the rocket attacks that occurred during
Operation Cast Lead, compared with a nonintervention but exposed control group. Method: The study sample consisted of 1,488 students studying in
fourth and fifth grades in a city in southern Israel who were exposed to continuous rocket attacks during Operation Cast Lead. The intervention group
included about half (53.5%) of the children who studied in six schools where the teacher-led intervention was implemented 3 months before the
traumatic exposure. The control group (46.5% of the sample) included six schools matched by exposure in which the preventive intervention was not
implemented. Children filled out the UCLA-PTSD Reaction Index and the Stress/Mood Scale 3 months after the end of the rocket attacks. Results: The
intervention group displayed significantly lower symptoms of posttrauma and stress/mood than the control group (p < .001). Control children had 57%
more detected cases of postraumatic stress disorder (PTSD) than participant children. This difference was significantly more pronounced among boys
(10.2% versus 4.4%) and less among girls (12.5% versusl0.1%). Conclusions: The teacherbased, resilience-focused intervention is a universal, cost-
effective approach to enhance the preparedness of communities of children to mass trauma and to prevent the development of PTSD after exposure.
(PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Journal
of the American Academy of Child & Adolescent Psychiatry, 50(4) : 340-348
- Year: 2011
- Problem: Post Traumatic Stress Disorder
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Rolfsnes, Erika S.
This is a review and meta-analysis of school-based intervention programs
targeted at reducing symptoms of posttraumatic stress disorder (PTSD). Nineteen studies conducted in 9 different countries satisfied the inclusionary
criteria. The studies dealt with various kinds of type I and type II trauma exposure. Sixteen studies used cognitive–behavioral therapy methods;
the others used play/art, eye movement desensitization and reprocessing, and mind-body techniques. The overall effect size for the 19 studies was
d=0.68 (SD=0.41), indicating a medium-large effect in relation to reducing symptoms of PTSD. The authors’ findings suggest that intervention
provided within the school setting can be effective in helping children and adolescents following traumatic events. (PsycINFO Database Record (c)
2012 APA, all rights reserved) (journal abstract)
Journal of Traumatic Stress, 24(2) : 155-
165
- Year: 2011
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any)
Sloan, Denise M., Marx, Brian P., Greenberg, Eva M.
This study examined the efficacy of the written emotional disclosure (WED) procedure with a sample of young adults who met diagnostic
criteria for posttraumatic stress disorder (PTSD). Participants were randomly assigned to either WED or a control writing condition and were assessed
at baseline and one month following the writing sessions. During each writing session, participants’ heart rate was recorded; participants also
provided self-report ratings of emotional responding. Findings indicated no significant group differences for PTSD and depression symptom severity at
follow-up assessment. Relative to control participants, WED participants displayed significantly greater heart rate activity and reported greater
emotional responding during the first writing session; however, no reduction in emotional responding occurred for either condition from the first to
the last writing session. Taken together, these findings indicate that WED may not be an efficacious intervention for PTSD. Suggestions are made for
future work in this area. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Behaviour Research &
Therapy, 49(4) : 299-304
- Year: 2011
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Creative expression: music, dance, drama, art
Robjant, Katy, Fazel, Mina
Individuals who have
experienced multiple traumatic events over long periods as a result of war, conflict and organised violence, may represent a unique group amongst
PTSD patients in terms of psychological and neurobiological sequelae. Narrative Exposure Therapy (NET) is a short-term therapy for individuals who
have PTSD symptoms as a result of these types of traumatic experiences. Originally developed for use in low-income countries, it has since been used
to treat asylum seekers and refugees in high-income settings. The treatment involves emotional exposure to the memories of traumatic events and the
reorganisation of these memories into a coherent chronological narrative. This review of all the currently available literature investigates the
effectiveness of NET in treatment trials of adults and also of KIDNET, an adapted version for children. Results from treatment trials in adults have
demonstrated the superiority of NET in reducing PTSD symptoms compared with other therapeutic approaches. Most trials demonstrated that further
improvements had been made at follow-up suggesting sustained change. Treatment trials of KIDNET have shown its effectiveness in reducing PTSD amongst
children. Emerging evidence suggests that NET is an effective treatment for PTSD in individuals who have been traumatised by conflict and organised
violence, even in settings that remain volatile and insecure.\rCopyright © 2010 Elsevier Ltd. All rights reserved.
Clinical Psychology
Review, 30(8) : 1030-1039
- Year: 2010
- 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), Narrative exposure therapy (NET)
Shechtman, Z., Mor, M.
The study was conducted in Israel following the
2006 Lebanon war. The purpose was to examine the impact of counseling groups employing an expressivesupportive modality on children and adolescents
with war-related or divorce/ loss-related trauma symptoms. The 164 children were placed into 18 small groups for 10 weekly sessions. The children
were screened for traumatic stress symptoms and then randomly divided into experimental and control (wait-list) conditions. All participants
completed the measures of the dependent variables (trauma symptoms, anxiety), a social support measure, and group-process measures (group
relationships, group cohesion, and catharsis). Results indicated a significantly sharper reduction in trauma symptoms and anxiety in the experimental
group than in the control group, regardless of type of trauma. A reduction in anxiety was predicted by gains in social support and group
cohesiveness.
International Journal of Group Psychotherapy, 60(2) : 221-
244
- Year: 2010
- 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
Ruf, M., Schauer, M., Neuner, F., Catani, C., Schauer, E., Elbert, T.
The authors examined the effectiveness of narrative exposure therapy for children (KIDNET) in treating posttraumatic stress
disorder (PTSD) in refugee children living in exile. Twenty-six children traumatized by organized violence were randomly assigned to KIDNET or to a
waiting list. Significant treatment by time interactions on all PTSD-relevant variables indicated that the KIDNET group, but not the controls, showed
a clinically significant improvement in symptoms and functioning. Success of the KIDNET group remained stable at 12-month follow-up. This study
confirms previous findings that, if left untreated, PTSD in children may persist for an extended period. However, it also shows that it is possible
to effectively treat chronic PTSD and restore functioning in traumatized refugee children in only 8 treatment sessions.
Journal of Traumatic Stress, 23(4) : 437-
445
- Year: 2010
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Narrative exposure therapy (NET)
Strawn, J. R., Keeshin, B. R., DelBello, M. P., Geracioti
Jr, T. D., Putnam, F. W.
Objective: Despite the high prevalence and
significant morbidity associated with posttraumatic stress disorder (PTSD) in children and adolescents, there are limited and conflicting data to
guide psychopharmacologic interventions. With these considerations in mind, we sought to summarize the current evidence for psychopharmacologic
interventions in youth with PTSD. Data Sources/Study Selection: We conducted a literature review of the National Library of Medicine to identify
publications of pharmacologic treatments for youth with PTSD or posttraumatic stress symptoms. The search was limited to articles written in English
and published between 1966 and 2009. In addition, we manually searched each citation for additional references and the following journals: Journal of
the American Academy of Child and Adolescent Psychiatry and the Journal of Child and Adolescent Psychopharmacology. Data Extraction: All articles
were manually reviewed and evaluated. Thereafter, each agent or class of medication was categorized by level of evidence. Data Synthesis: Three
double-blind, randomized controlled trials of selective serotonin reuptake inhibitors (SSRIs) and 1 double-blind randomized controlled trial of
imipramine in children and adolescents with PTSD or acute stress disorder were identified. Additionally, several open-label studies and case series
involving other classes of medications (eg, antiadrenergics, other antidepressants, and second-generation antipsychotics) were reviewed. Conclusions:
The extant data do not support the use of SSRIs as first-line treatments for PTSD in children and adolescents. There is limited evidence that the
brief use of antiadrenergic agents, second-generation antipsychotics, and several mood stabilizers may attenuate some PTSD symptoms in youth.
However, controlled trials of these agents in children and adolescents with PTSD are needed. (copyright) Copyright 2010 Physicians Postgraduate
Press, Inc.
Journal of Clinical Psychiatry, 71(7) : 932-
941
- Year: 2010
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any)
Robb, A. S., Cueva, J. E., Sporn, J., Yang, R., Vanderburg, D. G.
Objective: The aim of this study was to evaluate the safety and efficacy of sertraline in children and adolescents
who met Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for posttraumatic stress disorder (PTSD). Method:
Children and adolescents (6-17 years old) meeting DSM-IV criteria for PTSD were randomized to 10 weeks of double-blind treatment with sertraline (50
-200mg/day) or placebo. The primary efficacy measure was the University of California, Los Angeles Post-Traumatic Stress Disorder Index for DSM-IV
(UCLA PTSD-I). Results: A total of 131 patients met entry criteria and were randomized to sertraline (n=67; female, 59.7%; mean age, 10.8; mean UCLA
PTSD-I score, 43.8(plus or minus)8.5) or placebo (n=62; female, 61.3%; mean age, 11.2; mean UCLA PTSD-I score, 42.1(plus or minus)8.8). There was no
difference between sertraline and placebo in least squares (LS) mean change in the UCLA PTSD-I score, either on a completer analysis (-20.4(plus or
minus)2.1 vs.-22.8(plus or minus)2.1; p=0.373) or on an last observation carried forward (LOCF) end point analysis (-17.7(plus or minus)1.9 vs.-20.8
(plus or minus)2.1; p=0.201). Attrition was higher on sertraline (29.9%) compared to placebo (17.7%). Discontinuation due to adverse events occurred
in a 7.5% treated with sertraline and 3.2% treated with placebo. Conclusions: Sertraline was a generally safe treatment in children and adolescents
with PTSD, but did not demonstrate efficacy when compared to placebo during 10 weeks of treatment. (copyright) Copyright 2010, Mary Ann Liebert,
Inc.
Journal of Child & Adolescent Psychopharmacology, 20(6) : 463-
471
- Year: 2010
- 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)
Nugent, N. R., Christopher, N. C., Crow, J. P., Browne, L., Ostrowski, S., Delahanty, D. L.
Initial research supports the use of propranolol to prevent posttraumatic stress disorder (PTSD); research
has not examined pharmacological prevention for children. Twenty-nine injury patients (ages 10-18 years old) at risk for PTSD were randomized to a
double-blind 10-day trial of propranolol or placebo initiated within 12 hours postadmission. Six-week PTSD symptoms and heart rate were assessed.
Although intent-to-treat analyses revealed no group differences, findings supported a significant interaction between gender and treatment in
medication-adherent participants, Delta R(2) = .21. Whereas girls receiving propranolol reported more PTSD symptoms relative to girls receiving
placebo, Delta R(2) = .44, boys receiving propranolol showed a nonsignificant trend toward fewer PTSD symptoms than boys receiving placebo, Delta R
(2) = .32. Findings inform gender differences regarding pharmacological PTSD prevention in youth.
Journal of Traumatic Stress, 23(2) : 282-287
- Year: 2010
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Peltonen, K., Punamaki, R. L.
Increasing research is available on the preconditions for
child mental health and optimal development in traumatic conditions, whereas less is known how to translate the findings into effective interventions
to help traumatized children. This literature review analyses the effectiveness of psychosocial preventive interventions and treatments and their
theoretical bases among children traumatized in the context of armed conflicts (war, military violence, terrorism and refugee). The first aim is to
evaluate the effectiveness of preventive interventions in preventing emotional distress and impairment and promoting optimal emotionalcognitive and
social development. The second task is to analyze the nature of the underlying mechanisms for the success of preventive interventions, and the
theoretical premises of the choice of intervention techniques, procedures and tools. We found 16 relevant published studies, but an examination of
them revealed that only four of them had experimental designs strong enough that they could be included in the meta-analysis. While the subjective
reports of the researchers suggested that systematic preventive interventions were effective in decreasing PTSD and depressive symptoms among
children traumatized due to armed conflict, the more objective results of the meta-analysis and the weaknesses in designs uncovered during the meta-
analysis undermine such a conclusion. Additionally, a majority of the reported preventive interventions focused only on children's biased cognitive
processes and negative emotions, while only a few aimed at influencing multiple domains of child development and improving developmental functioning
on emotional, social and psychophysiological levels. It is concluded that substantial additional work needs to be done in developing effective
preventive interventions and treatments for children traumatized by exposure to war and violence. Aggr. Behav. 36:95-116, 2010. (copyright) 2009
Wiley-Liss, Inc.
Aggressive Behavior, 36(2) : 95-116
- Year: 2010
- 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)
Stamatakos, M., Campo, J. V.
Purpose of Review: To review and summarize existing literature regarding
pharmacological interventions for post-traumatic stress disorder (PTSD) in children and adolescents. A literature search limited to articles focused
on the pharmacological treatment of children aged 0-18 years with a history of trauma and/or PTSD was conducted through the National Library of
Medicine and PsychInfo, 1967-present, and each citation manually reviewed. Recent Finddings: Pharmacologic trials for pediatric PTSD are limited in
scope and number, with one small double-blind, randomized controlled trial of the selective serotonin reuptake inhibitor (SSRI) sertraline. Two
brief, small, double-blind, randomized controlled trials of imipramine for children and adolescents with acute stress disorder have been conducted,
with mixed results. Only case reports or open-labeled trials have been conducted with alpha-adrenergic agents, other antidepressants, atypical
antipsychotics, and antiepileptic agents. Summary: Data supporting the use of medications in the treatment of PTSD in children and adolescents are
limited. SSRIs show promise and deserve additional study, but conclusive support for their use is not available as it is in adults. Additional
research is needed, with other drugs of interest including other antidepressants, alpha-adrenergic agents, and possibly the antiepileptic agent
carbamazepine. (copyright) 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Current Opinion in
Pediatrics, 22(5) : 599-604
- Year: 2010
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any)
Hetrick, SE., Purcell, R., Garner, B., Parslow, R.
Background: PTSD is an anxiety disorder related to exposure to a severe
psychological trauma. Symptoms include re-experiencing the event, avoidance and arousal as well as distress and impairment resulting from these
symptoms.Guidelines suggest a combination of both psychological therapy and pharmacotherapy may enhance treatment response, especially in those with
more severe PTSD or in those who have not responded to either intervention alone.Objectives: To assess whether the combination of psychological
therapy and pharmacotherapy provides a more efficacious treatment for PTSD than either of these interventions delivered separately.Search methods:
Searches were conducted on the trial registers kept by the CCDAN group (CCDANCTR-Studies and CCDANCTR-References) to June 2010. The reference
sections of included studies and several conference abstracts were also scanned.Selection criteria: Patients of any age or gender, with chronic or
recent onset PTSD arising from any type of event relevant to the diagnostic criteria were included. A combination of any psychological therapy and
pharmacotherapy was included and compared to wait list, placebo, standard treatment or either intervention alone. The primary outcome was change in
total PTSD symptom severity. Other outcomes included changes in functioning, depression and anxiety symptoms, suicide attempts, substance use,
withdrawal and cost.Data collection and analysis: Two or three review authors independently selected trials, assessed their 'risk of bias' and
extracted trial and outcome data. We used a fixed-effect model for meta-analysis. The relative risk was used to summarise dichotomous outcomes and
the mean difference and standardised mean difference were used to summarise continuous measures.Main results: Four trials were eligible for
inclusion, one of these trials (n =24) was on children and adolescents. All used an SSRI and prolonged exposure or a cognitive behavioural
intervention. Two trials compared combination treatment with pharmacological treatment and two compared combination treatment with psychological
treatment. Only two trials reported a total PTSD symptom score and these data could not be combined. There was no strong evidence to show if there
were differences between the group receiving combined interventions compared to the group receiving psychological therapy (mean difference 2.44, 95%
CI -2.87, 7.35 one study, n=65) or pharmacotherapy (mean difference -4.70, 95% CI -10.84 to 1.44; one study, n = 25). Trialists reported no
significant differences between combination and single intervention groups in the other two studies. There were very little data reported for other
outcomes, and in no case were significant differences reported.Authors' conclusions: There is not enough evidence available to support or refute the
effectiveness of combined psychological therapy and pharmacotherapy compared to either of these interventions alone. Further large randomised
controlled trials are urgently required.
Cochrane Database of Systematic
Reviews, (7) : CD7316
- Year: 2010
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Trauma-focused cognitive behavioural therapy (TF-
CBT)