Disorders - Post Traumatic Stress Disorder
Smith, P., Yule, W., Perrin, S., Tranah,
T., Dalgleish, T., Clark, D. M.
OBJECTIVE: To
evaluate the efficacy of individual trauma-focused cognitive-behavioral therapy (CBT) for treating posttraumatic stress disorder (PTSD) in children
and young people. METHOD: Following a 4-week symptom-monitoring baseline period, 24 children and young people (8-18 years old) who met full DSM-IV
PTSD diagnostic criteria after experiencing single-incident traumatic events (motor vehicle accidents, interpersonal violence, or witnessing
violence) were randomly allocated to a 10-week course of individual CBT or to placement on a waitlist (WL) for 10 weeks. RESULTS: Compared to the WL
group, participants who received CBT showed significantly greater improvement in symptoms of PTSD, depression, and anxiety, with significantly better
functioning. After CBT, 92% of participants no longer met criteria for PTSD; after WL, 42% of participants no longer met criteria. CBT gains were
maintained at 6-month follow-up. Effects of CBT were partially mediated by changes in maladaptive cognitions, as predicted by cognitive models of
PTSD. CONCLUSIONS: Individual trauma-focused CBT is an effective treatment for PTSD in children and young people. Copyright 2007 copyright American
Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent
Psychiatry., 46(8) : 1051-1061
- Year: 2007
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Stallard, P., Velleman, R., Salter, E., Howse, I., Yule, W., Taylor, G.
Objective: To
determine whether an early intervention using a psychological debriefing format is effective in preventing psychological distress in child road
traffic accident survivors. Design: Randomised controlled trial. Setting: Accident and Emergency Department, Royal United Hospital, Bath. Subjects:
158 children aged 7-18. Follow-up assessment completed eight months post accident with 132 (70/82 of the experimental group and 62/76 in the control
group). Main outcome measures: Self-completed measures of psychological distress; fulfilment of diagnostic criteria for post-traumatic stress
disorder. Results: Children in both groups demonstrated considerable improvements at follow-up. The early intervention did not result in any
additional significant gains. Conclusions: Although children in this study made significant improvements it is unclear whether these are better or
worse than natural recovery rates. The specific intervention did not result in additional gains although the structured assessment provided for both
groups may have been helpful in reducing subsequent pathology. copyright 2005 Association for Child Psychology and Psychiatry.
Journal of Child
Psychology & Psychiatry & Allied Disciplines., 47(2) : 127-134
- Year: 2006
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Psychological debriefing
Stallard, P.
Children exposed to a wide range of traumatic events suffer significant
post-traumatic reactions. Randomised controlled trials assessing the effectiveness of interventions with traumatised children are described, the
limitations of the current literature base identified and issues regarding the applicability of these findings and interventions to everyday clinical
practice discussed. Methodological issues, variations in interventions, parental involvement, theoretical underpinning and outcomes will be discussed
and implications for future studies highlighted. copyright 2006 Elsevier Ltd. All rights reserved.
Clinical Psychology Review., 26(7) : 895-911
- Year: 2006
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
Deblinger, E., Mannarino, A. P., Cohen, J. A., Steer, R. A.
OBJECTIVE: To ascertain whether the differential responses that previously have been found between trauma-focused, cognitive-behavioral therapy
(TF-CBT), and child-centered therapy (CCT) for treating posttraumatic stress disorder (PTSD) and related problems in children who had been sexually
abused would persist following treatment and to examine potential predictors of treatment outcome. METHOD: A total of 183 children 8 to 14 years old
and their primary caregivers were assessed 6 and 12 months after their posttreatment evaluations. RESULTS: Mixed-model repeated analyses of
covariance found that children treated with TF-CBT had significantly fewer symptoms of PTSD and described less shame than the children who had been
treated with CCT at both 6 and 12 months. The caregivers who had been treated with TF-CBT also continued to report less severe abuse-specific
distress during the follow-up period than those who had been treated with CCT. Multiple traumas and higher levels of depression at pretreatment were
positively related to the total number of PTSD symptoms at posttreatment for children assigned to the CCT condition only. CONCLUSIONS: Children and
caregivers assigned to TF-CBT continued to have fewer symptoms of PTSD, feelings of shame, and abuse-specific parental distress at 6- and 12-month
assessments as compared to participants assigned to CCT. Copyright 2006 copyright American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry., 45(12) : 1474
-1484
- Year: 2006
- 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, Trauma-focused cognitive behavioural therapy (TF-
CBT)
Cohen, Judith A., Mannarino, Anthony P., Knudsen, Kraig
OBJECTIVE: To measure the durability
of improvement in response to two alternative treatments for sexually abused children. METHOD: Eighty-two sexually abused children ages 8-15 years
old and their primary caretakers were randomly assigned to trauma-focused cognitive-behavioral therapy (TF-CBT) or non-directive supportive therapy
(NST) delivered over 12 sessions; this study examines symptomatology during 12 months posttreatment. DATA ANALYSIS: Intent-to-treat and treatment
completer repeated measures analyses were conducted. RESULTS: Intent-to-treat indicated significant group x time effects in favor of TF-CBT on
measures of depression, anxiety, and sexual problems. Among treatment completers, the TF-CBT group evidenced significantly greater improvement in
anxiety, depression, sexual problems and dissociation at the 6-month follow-up and in PTSD and dissociation at the 12-month follow-up. CONCLUSION:
This study provides additional support for the durability of TF-CBT effectiveness.
Child Abuse & Neglect, 29(2) : 135-
45
- Year: 2005
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Supportive
therapy, Trauma-focused cognitive behavioural therapy (TF-
CBT)
Cohen, Judith A., Deblinger, Esther, Mannarino, Anthony P., Steer, Robert A.
OBJECTIVE: To examine the differential efficacy of trauma-focused cognitive-behavioral therapy
(TF-CBT) and child-centered therapy for treating posttraumatic stress disorder (PTSD) and related emotional and behavioral problems in children who
have suffered sexual abuse. METHOD: Two hundred twenty-nine 8- to 14-year-old children and their primary caretakers were randomly assigned to the
above alternative treatments. These children had significant symptoms of PTSD, with 89% meeting full DSM-IV PTSD diagnostic criteria. More than 90%
of these children had experienced traumatic events in addition to sexual abuse. RESULTS: A series analyses of covariance indicated that children
assigned to TF-CBT, compared to those assigned to child-centered therapy, demonstrated significantly more improvement with regard to PTSD,
depression, behavior problems, shame, and abuse-related attributions. Similarly, parents assigned to TF-CBT showed greater improvement with respect
to their own self-reported levels of depression, abuse-specific distress, support of the child, and effective parenting practices. CONCLUSIONS: This
study adds to the growing evidence supporting the efficacy of TF-CBT with children suffering PTSD as a result of sexual abuse and suggests the
efficacy of this treatment for children who have experienced multiple traumas.
Journal of the American Academy of Child & Adolescent Psychiatry, 43(4) : 393-
402
- Year: 2004
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions, Trauma-focused cognitive behavioural therapy (TF-
CBT)
Jaberghaderi, N., Greenwald,
R., Rubin, A., Zand, S. O., Dolatabadi, S.
Fourteen randomly assigned Iranian girls ages 12 - 13 years who
had been sexually abused received up to 12 sessions of CBT or EMDR treatment. Assessment of post-traumatic stress symptoms and problem behaviours was
completed at pre-treatment and 2 weeks post-treatment. Both treatments showed large effect sizes on the post-traumatic symptom outcomes, and a medium
effect size on the behaviour outcome, all statistically significant. A non-significant trend on self-reported post-traumatic stress symptoms favoured
EMDR over CBT. Treatment efficiency was calculated by dividing change scores by number of sessions; EMDR was significantly more efficient, with large
effect sizes on each outcome. Limitations include small N, single therapist for each treatment condition, no independent verification of treatment
fidelity, and no long-term follow-up. These findings suggest that both CBT and EMDR can help girls to recover from the effects of sexual abuse, and
that structured trauma treatments can be applied to children in Iran.
Clinical Psychology & Psychotherapy, 11(5) : 358-
368
- Year: 2004
- Problem: Anxiety Disorders (any), 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)
Lytle, R. A., Hazlett-Stevens, H., Borkovec, T. D.
Much of the Eye Movement Desensitization and Reprocessing (EMDR) efficacy research has been widely criticized, limiting scientific
understanding of its therapeutic components. The present investigation of Eye Movement Desensitization (EMD) effectiveness included undergraduate
students reporting current intrusive cognitions conceming a traumatic event. Forty-five participants received a single treatment session of either:
(a) EMD, as described by Shapiro [J. Behav. Ther. Exp. Psychiatry 20 (1989b) 211], (b) an identical procedure which employed eye fixation on a
stationary target, or (c) non-directive counseling. Standardized self-report, subjective rating, Daily Diary, and intrusive thought sampling measures
were collected before and after treatment. Results indicated that participants in the eye fixation group reported marginally (p < .052) fewer
cognitive intrusions than the non-directive group 1 week following treatment. No significant differences between the EMD and non-directive conditions
or between the EMD and eye fixation conditions on this measure were found. During the treatment session, both desensitization groups were superior to
the non-directive group in reducing reported vividness of the mental image of the original event. However, the non-directive group improved to the
level of the two other groups by the following week. Rapid saccadic eye movements were therefore unrelated to immediate treatment effects for this
sub-clinical sample, and non-directive treatment largely yielded eventual outcomes equivalent to the two desensitization conditions.
Journal of Anxiety Disorders, 16(3) : 273-288
- Year: 2002
- Problem: Anxiety Disorders (any), Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Eye movement desensitisation and reprocessing (EMDR), Other Psychological Interventions
Chemtob, Claude M., Nakashima, Joanne P., Hamada, Roger S.
CONTEXT: Natural disasters negatively affect children's emotional and behavioral adjustment. Although
treatments to reduce psychological morbidity following disasters are needed, it has been difficult to conduct treatment research in postdisaster
environments because of the sensitivity of victims to perceived intrusiveness and exploitation. OBJECTIVE: To evaluate the efficacy of a public
health--inspired intervention combining school-based screening and psychosocial treatment to identify and treat children with persistent disaster-
related trauma symptoms. DESIGN: To identify children with continued high levels of trauma-related symptoms 2 years after a major disaster, we
conducted a community-wide school-based screening of disaster-exposed public elementary school children. Children with the highest levels of trauma-
related symptoms were randomly assigned to 1 of 3 consecutively treated cohorts. Children in the cohorts awaiting treatment served as wait-list
controls. Within each cohort, children were randomly assigned to either individual or group treatment to allow comparison of the efficacy of the 2
treatment modalities. SETTING: All 10 public elementary schools on the island of Kauai (one of the Hawaiian Islands) 2 years after Hurricane Iniki.
PARTICIPANTS: All 4258 children in second through sixth grade were screened. The 248 children with the highest levels of psychological trauma
symptoms were selected for treatment. INTERVENTION: Children were randomly assigned to either individual or group treatment provided by specially
trained school-based counselors. Treatment comprised 4 sessions. MAIN OUTCOME MEASURES: The Kauai Reaction Inventory, a self-report measure of trauma
symptoms, and the Child Reaction Inventory, a semistructured clinical interview for posttraumatic stress disorder symptoms. RESULTS: After treatment,
children reported significant reductions in self-reported trauma-related symptoms. This symptom reduction was maintained at the 1-year follow-up.
Clinical interviews also indicated that treated children had fewer trauma symptoms compared with untreated children. CONCLUSIONS: School-based
community-wide screening followed by psychosocial intervention seems to effectively identify and reduce children's disaster-related trauma symptoms
and may facilitate psychological recovery. While group and individual treatments did not differ in efficacy, fewer children dropped out of the group
treatment. This approach may be applicable to screening and treating children exposed to a variety of large-scale disasters.
Archives of Pediatrics & Adolescent Medicine, 156(3) : 211-6
- Year: 2002
- 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, Creative expression: music, dance, drama, art
Deblinger, E., Steer, R. A., Lippmann, J.
Objective: The present study
sought to determine whether the 12-session pre- to posttest therapeutic gains that had been found by Deblinger, Lippmann, and Steer (1996a) for an
initial sample of 100 sexually abused children suffering posttraumatic stress disorder (PTSD) symptoms would be sustained 2 years after
treatment.Method: These sexually abused children, along with their nonoffending mothers, had been randomly assigned to one of three cognitive-
behavioral treatment conditions, child only, mother only, or mother and child, or a community comparison condition, and were followed for 3 months, 6
months, 1 year, and 2 years after treatment.Results: A series of repeated MANCOVAs, controlling for the pre-test scores, indicated that for the three
measures of psychopathology that had significantly decreased in the original study (i.e., externalizing behavior problems, depression, and PTSD
symptoms), these measures at 3 months, 6 months, 1 year, and 2 years were comparable to the posttest scores.Conclusions: These findings suggest that
the pre- to post-treatment improvements held across the 2-year follow-up period. The clinical and research implications of these findings are
discussed. Copyright (C) 1999 Elsevier Science Inc.
Child Abuse & Neglect, 23(12) : 1371-
1378
- Year: 1999
- 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)
Scheck, M. M., Schaeffer, J.
A., Gillette, C.
To study the efficacy of eye movement
desensitization and reprocessing (EMDR) with traumatized young women, 60 women between the ages of 16 and 25 were randomly assigned to two sessions
of either EMDR or an active listening (AL) control. Factorial ANOVA interaction effects and simple main effects for outcome measures (Beck Depression
Inventory, State-Trait Anxiety Inventory, Penn Inventory for Posttraumatic Stress Disorder, Impact of Event Scale, Tennessee Self-Concept Scale)
indicated significant improvement for both groups and significantly greater pre-post change for EMDR-treated participants. Pre-post effect sizes for
the EMDR group averaged 1.56 compared to 0.65 for the AL group. Despite treatment brevity, the posttreatment outcome variable means of EMDR-treated
participants compared favorably with nonpatient or successfully treated norm groups on all measures.
Journal of Traumatic Stress, 11(1) : 25-44
- Year: 1998
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Eye movement desensitisation and reprocessing (EMDR)
Echeburua, E., DeCorral, P., Zubizarreta, I., Sarasua, B.
The aim of this research was to test the comparative effectiveness of two therapeutic
modalities in the treatment of chronic posttraumatic stress disorder in victims of sexual aggression: (a) self-exposure and cognitive restructuring
and (b) progressive relaxation training. The sample consisted o f 20 patients (victims of rape in adulthood or adult victims of childhood sexual
abuse) selected according to DSM-III-R criteria. A multigroup experimental design with repeated measures (pretreatment, posttreatment, and 1-, 3-, 6
-, and 12-month follow-up) was used. Most treated patients improved, but the success rate was higher in all measures in the exposure and cognitive
restructuring group immediately on posttreatment arid at follow-up. Implications of this study for clinical practice and future research in this
field are commented on.
Behavior Modification, 21(4) : 433-
456
- Year: 1997
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Exposure therapy, Exposure
and response prevention, Other Psychological Interventions, Relaxation