Turrini, G., Purgato, M., Acarturk, C., Anttila, M., Au, T., Ballette, F., Bird, M., Carswell, K., Churchill, R., Cuijpers, P., Hall, J., Hansen, L. J., Kosters, M., Lantta, T., Nose, M., Ostuzzi, G., Sijbrandij, M., Tedeschi, F., Valimaki, M., Wancata, J., White, R., Van Ommeren, M., Barbui, C.

Efficacy and acceptability of psychosocial interventions in asylum seekers and refugees: Systematic review and meta- analysis

AimsIn the past few years, there has been an unprecedented increase in the number of forcibly displaced migrants worldwide, of which a substantial proportion is refugees and asylum seekers. Refugees and asylum seekers may experience high levels of psychological distress, and show high rates of mental health conditions. It is therefore timely and particularly relevant to assess whether current evidence supports the provision of psychosocial interventions for this population. We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the efficacy and acceptability of psychosocial interventions compared with control conditions (treatment as usual/no treatment, waiting list, psychological placebo) aimed at reducing mental health problems in distressed refugees and asylum seekers.MethodsWe used Cochrane procedures for conducting a systematic review and meta- analysis of RCTs. We searched for published and unpublished RCTs assessing the efficacy and acceptability of psychosocial interventions in adults and children asylum seekers and refugees with psychological distress. Post-traumatic stress disorder (PTSD), depressive and anxiety symptoms at post- intervention were the primary outcomes. Secondary outcomes include: PTSD, depressive and anxiety symptoms at follow-up, functioning, quality of life and dropouts due to any reason.ResultsWe included 26 studies with 1959 participants. Meta-analysis of RCTs revealed that psychosocial interventions have a clinically significant beneficial effect on PTSD (standardised mean difference [SMD] = ?irc;'0.71; 95% confidence interval [CI] ?irc;'1.01 to ?irc;'0.41; I² = 83%; 95% CI 78-88; 20 studies, 1370 participants; moderate quality evidence), depression (SMD = ?irc;'1.02; 95% CI ?irc;'1.52 to ?irc;'0.51; I² = 89%; 95% CI 82-93; 12 studies, 844 participants; moderate quality evidence) and anxiety outcomes (SMD = ?irc;'1.05; 95% CI ?irc;'1.55 to ?irc;'0.56; I² = 87%; 95% CI 79-92; 11 studies, 815 participants; moderate quality evidence). This beneficial effect was maintained at 1 month or longer follow-up, which is extremely important for populations exposed to ongoing post-migration stressors. For the other secondary outcomes, we identified a non-significant trend in favour of psychosocial interventions. Most evidence supported interventions based on cognitive behavioural therapies with a trauma-focused component. Limitations of this review include the limited number of studies collected, with a relatively low total number of participants, and the limited available data for positive outcomes like functioning and quality of life.ConclusionsConsidering the epidemiological relevance of psychological distress and mental health conditions in refugees and asylum seekers, and in view of the existing data on the effectiveness of psychosocial interventions, these interventions should be routinely made available as part of the health care of distressed refugees and asylum seekers. Evidence-based guidelines and implementation packages should be developed accordingly. Copyright © Cambridge University Press 2019 This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Epidemiology and Psychiatric Sciences., :

Matthijssen, S.J., vanBeerschoten, L.M., deJongh, A., Klugkist, I.G., vandenHout, M.A.

Effects of \"Visual Schema Displacement Therapy\" (VSDT), an abbreviated EMDR protocol and a control condition on emotionality and vividness of aversive memories: Two critical analogue studies

Background and objectives: Visual Schema Displacement Therapy (VSDT) is a novel therapy which has been described as a treatment for stress and dysfunction caused by a traumatic event. Although its developers claim this therapy is quicker and more beneficial than other forms of trauma therapy, its effectiveness has not been tested. Methods: We compared the efficacy of VSDT to an abbreviated EMDR protocol and a non-active control condition (CC) in two studies. In Study 1 participants (N = 30) were asked to recall three negative emotional memories under three conditions: VSDT, EMDR, and a CC, each lasting 8 min. Emotional disturbance and vividness of the memories were rated before and after the (within group) conditions. The experiment was replicated using a between group study. In Study 2 participants (N = 75) were assigned to one of the three conditions, and a follow-up after 6-8 days was added. Results: In both studies VSDT and EMDR were superior to the CC in reducing emotional disturbance, and VSDT was superior to EMDR. VSDT and EMDR outperformed the CC in terms of reducing vividness. Limitation: Results need to be replicated in clinical samples. Conclusions: It is unclear how VSDT yields positive effects, but irrespective of its causal mechanisms, VSDT warrants clinical exploration. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

Journal of Behavior Therapy and Experimental Psychiatry, 63 : 48-56

Jaberghaderi, N., Rezaei, M., Kolivand, M., Shokoohi, A.

Effectiveness of cognitive behavioral therapy and eye movement desensitization and reprocessing in child victims of domestic violence

Objective: This study was conducted to examine and compare the effectiveness of cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) in child victims of domestic violence (child physical abuse and/or witnessing parents' conflicts). Method (s): A total of 139 girls and boys, aged 8-12 years, were randomly assigned into CBT (n = 40), EMDR (n = 40), or control groups (n=59). All children received up to 12 individual treatment sessions over 4-12 weeks. Blind assessment was done before and 2 weeks after the treatment and on a variety of teacher-parent-rated and self-report measures of posttraumatic symptomatology, depression, anxiety, and behavior problems. Result(s): CBT and EMDR were effective in ameliorating psychological sequelae of victims of domestic violence on the measured variables (p =.001). Comparison of the treatment and control groups suggested moderate to high practical significance in treatment groups vs controls. Conclusion(s): Both CBT and EMDR can help children to greatly recover from the outcomes of domestic violence in comparison with control group. Moreover, structured trauma treatments are strongly recommended and can be used for children. Copyright © 2019 Tehran University of Medical Sciences. All rights reserved.

Iranian Journal of Psychiatry, 14(1) : 67-75

Rosner, R., Rimane, E., Frick, U., Gutermann, J., Hagl, M., Renneberg, B., Schreiber, F., Vogel, A., Steil, R.

Effect of Developmentally Adapted Cognitive Processing Therapy for Youth with Symptoms of Posttraumatic Stress Disorder after Childhood Sexual and Physical Abuse: A Randomized Clinical Trial

Importance: Despite the high prevalence, evidence-based treatments for abuse-related posttraumatic stress disorder (PTSD) in adolescents have rarely been studied. Objective(s): To examine whether developmentally adapted cognitive processing therapy (D- CPT) is more effective than a wait-list condition with treatment advice (WL/TA) among adolescents with PTSD related to childhood abuse. Design, Setting, and Participant(s): This rater-blinded, multicenter, randomized clinical trial (stratified by center) enrolled treatment-seeking adolescents and young adults (aged 14-21 years) with childhood abuse-related PTSD at 3 university outpatient clinics in Germany from July 2013 to June 2015, with the last follow-up interview conducted by May 2016. Of 194 patients, 88 were eligible for randomization. Intervention(s): Participants received D-CPT or WL/TA. Cognitive processing therapy was enhanced by a motivational and alliance-building phase, by including emotion regulation and consideration of typical developmental tasks, and by higher session frequency in the trauma-focused core CPT phase. In WL/TA, participants received treatment advice with respective recommendations of clinicians and were offered D-CPT after 7 months. Main Outcomes and Measures: All outcomes were assessed before treatment (baseline), approximately 8 weeks after the start of treatment, after the end of treatment (posttreatment), and at the 3-month follow-up. The primary outcome, PTSD symptom severity, was assessed in clinical interview (Clinician-Administered PTSD Scale for Children and Adolescents for DSM-IV [CAPS-CA]). Secondary outcomes were self-reported PTSD severity, depression, borderline symptoms, behavior problems, and dissociation. Result(s): The 88 participants (75 [85%] female) had a mean age of 18.1 years (95% CI, 17.6-18.6 years). In the intention-to-treat analysis, the 44 participants receiving D-CPT (39 [89%] female) demonstrated greater improvement than the 44 WL/TA participants (36 [82%] female) in terms of PTSD severity (mean CAPS-CA scores, 24.7 [95% CI, 16.6-32.7] vs 47.5 [95% CI, 37.9-57.1]; Hedges g = 0.90). This difference was maintained through the follow-up (mean CAPS-CA scores, 25.9 [95% CI, 16.2-35.6] vs 47.3 [95% CI, 37.8-56.8]; Hedges g = 0.80). Treatment success was greatest during the trauma-focused core phase. The D-CPT participants also showed greater and stable improvement in all secondary outcomes, with between- groups effect sizes ranging from 0.65 to 1.08 at the posttreatment assessment (eg, for borderline symptoms, 14.1 [95% CI, 8.0-20.2] vs 32.0 [95% CI, 23.8-40.2]; Hedges g = 0.91). Conclusions and Relevance: Adolescents and young adults with abuse-related PTSD benefited more from D-CPT than from WL/TA. Treatment success was stable at the follow-up and generalized to borderline symptoms and other comorbidities. Trial Registration: German Clinical Trials Register identifier: DRKS00004787. Copyright © 2019 American Medical Association. All rights reserved.

JAMA Psychiatry, 76(5) : 484-491

Abdollahpour, S., Khosravi, A., Motaghi, Z., Keramat, A., Mousavi, S. A.

Effect of Brief Cognitive Behavioral Counseling and Debriefing on the Prevention of Post-traumatic Stress Disorder in Traumatic Birth: A Randomized Clinical Trial

OBJECTIVE: Planning to promote the health of mothers in postpartum is important in all countries. This study aimed to determine the effectiveness of two counseling method on prevention of post-traumatic stress after childbirth. METHOD(S): In this clinical trial, 193 of mothers who had experienced a traumatic birth were randomly assigned to three groups. Participants were assessed using IES_R questionnaire at 4-6 weeks and 3 months after delivery. RESULT(S): Debriefing and brief cognitive behavioral counseling (CBC) significantly improved the symptoms of postpartum traumatic stress disorder. After 3 months, CBC had a significant effect on the symptoms. CONCLUSION(S): Screening of traumatic childbirth, implementation of supportive care, and early counseling prior to the initiation of post-traumatic stress are recommended. TRIAL REGISTRATION NUMBER: IRCT2015072522396N2. http://en.search.irct.ir/view/24735 .

Community Mental Health Journal., 55(7) : 1173- 1178

Rith-Najarian, L. R., Mesri, B., Park, A. L., Sun, M., Chavira, D. A., Chorpita, B. F.

Durability of cognitive behavioral therapy effects for youth and adolescents with anxiety, depression, or traumatic stress: A meta-analysis on long-term follow-ups

Cognitive behavioral therapies (CBT) for youth with anxiety, traumatic stress, and depression have demonstrated strong effects in individual studies and meta-analyses. Relatively more attention has been given to posttreatment effects, though, and assessment of follow-up effects has been limited at the meta-analytic level. The current meta-analysis aimed to (a) examine the effects of youth CBT at posttreatment, 1-month, 3-month, 6-month, 1-year, and long-term (2+ years) follow-up as well as (b) identify research-related variables (e.g., measure respondent type) that relate to effects. Using a random effects model across 110 child and adolescent CBT groups, within-group effect sizes were large at posttreatment (g = 1.24) and from 1-month through long-term follow-up (g = 1.23-1.82), and effect sizes did not significantly differ by treatment target (i.e., anxiety, traumatic stress, depression). However, availability of outcome data for effect sizes diminished across later follow-up assessments. Moreover, effect sizes were significantly associated with outcome respondent type across assessment timing, with outcome measures from caregiver and youth respondents associated with smaller effect sizes (B = -0.97, p < 0.001) relative to outcome measures that were evaluator-reported. Results provide initial support for the durability of treatment effects for youth CBTs and highlight the importance of some confounding variables. Implications for improving treatment research standards and prioritizing assessment of long-term follow-up assessment are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

Behavior Therapy, 50(1) : 225- 240

Hylton, E., Ironson, G.

Creative arts therapy for traumatized adolescents exposed to a school shooting: A pilot study [conference abstract]

Background: On February 14th, 2018, a gunman open-fired a semi-automatic weapon at Marjory Stoneman Douglas Highschool in Parkland, FL, killing seventeen students and staff members. Mass shootings have increased in the United States in recent decades and are associated with adverse psychological outcomes. This pilot study evaluates the effectiveness of a two-week creative arts therapy camp at improving the mental health status of adolescents exposed to the Parkland shooting. Method(s): This study used a pre-post design to evaluate a creative arts therapy intervention. Participants (n=44) were rising high school students enrolled in a two-week summer arts therapy camp, where they had the option of participating in visual art, drama, or music therapy. A questionnaire including the Patient Health Questionnaire 8-Item Scale, Generalized Anxiety Disorder 7-Item Scale, and Child's Reaction to Traumatic Events Scale were administered on the first and final days of the intervention. Result(s): At baseline, a third of participants indicated clinically significant depression (31.8%), a third indicated clinically significant anxiety (31.8%), and nearly two thirds indicated high levels of posttraumatic stress (60.5%). There were statistically significant reductions in PTSD [mean difference=6.8, t (33)=3.08, p=.004], depression [mean difference=1.79, t(33)=2.25, p=.031], and anxiety symptoms [mean difference=2.4 , t(33)=3.26, p=.003] between pre- and post-intervention time points, with effect sizes between .38-.56. Drama therapy appeared to be the most effective of the three arts therapy approaches. Within the drama group, there was a significant decrease in PTSD symptoms [mean difference=8.67, t(8)=2.80, p=.023], anxiety symptoms [mean difference=5.33 t(9)=3.44, p=.007], and depressive symptoms [mean difference=5.03, t(9)=2.49, p=.034]. Symptom reductions within the music and visual art groups were not statistically significant. Conclusion(s): Creative arts therapy appears to be a well-tolerated and age-appropriate intervention to improve the mental health status of traumatized adolescents. Students have the choice to engage with the trauma to the extent that they are ready. Of the three arts therapy types, drama therapy may be the most effective treatment to reduce anxiety, PTSD, and depressive symptoms in adolescents exposed to gun violence.

Psychosomatic Medicine, 81 (4) : A104

VanWestrhenen, N., Fritz, E., Vermeer, A., Boelen, P., Kleber, R.

Creative arts in psychotherapy for traumatized children in South Africa: An evaluation study

Aim To evaluate the feasibility and effect of a 10 -session creative arts in psychotherapy group programme on posttraumatic stress symptoms, behavioural problems, and posttraumatic growth, in children who experienced a traumatic event. Design A multicentre non-randomized controlled trial with a treatment and a control condition conducted in South Africa (4 sites). Methods 125 children aged 7 to 13 years were assigned either to the treatment condition receiving creative arts in psychotherapy or a control condition with a low-level supportive programme without treatment. Attrition rates were 63.4% and in total 47 children completed the programme and questionnaires assessing posttraumatic stress, posttraumatic growth and behaviour problems both at baseline and follow-up; 23 in the treatment group and 24 in the control group. Adjusted mean differences were analysed using ANCOVA with bootstrapping. Results Results showed that both hyperarousal symptoms (d = 0.61) and avoidance symptoms (d = 0.41) decreased more in the treatment group compared to the control group. There was no significant effect of the intervention found for reported levels of behavioural problems and posttraumatic growth. Conclusion In spite of severe challenges implementing and executing this pioneering study in underprivileged areas of South Africa, support was found for creative arts in psychotherapy reducing hyperarousal and avoidance symptoms, but not for other symptoms. Valuable lessons were learned on feasibility of implementing this intervention in a developing context. Copyright © 2019 van Westrhenen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PLoS ONE, 14 (2)(e0210857) :

Sun, M., Rith-Najarian, L. R., Williamson, T. J., Chorpita, B. F.

Treatment Features Associated with Youth Cognitive Behavioral Therapy Follow-Up Effects for Internalizing Disorders: A Meta-Analysis

Our aim was to investigate whether four treatment features (i.e., the inclusion of parental involvement, goal-setting strategies, maintenance/relapse prevention sessions, the addition of booster sessions) were associated with posttreatment and follow-up effect size of youth cognitive behavioral therapies (yCBTs) for anxiety, depression, posttraumatic stress disorder, and obsessive-compulsive disorder in age groups spanning young children to adolescents. We conducted a random-effects meta-analysis of 106 yCBTs tested in 76 randomized clinical trials from the PracticeWise Database to examine average effects of yCBTs posttreatment and at a later follow-up assessment. We coded the use of parental involvement, goal setting, booster sessions, and maintenance/relapse prevention in each yCBT and conducted random-effects meta-regression analyses to investigate whether these treatment features were associated with yCBT effects at posttreatment as well as at follow-up. Overall, yCBTs produced large pre- to posttreatment effects (d = 1.05), 95% confidence interval [0.94, 1.15], and larger pre- to follow-up effects (d = 1.29), 95% confidence interval [1.18, 1.40]. Metaregression results indicated that parental involvement was significantly associated with larger pre- to posttreatment effect sizes as well as pre- to follow-up effect sizes. Booster sessions, goal setting, and maintenance/relapse prevention were not significantly related to effect sizes at posttreatment or follow-up. Parental involvement may be helpful for maximizing long-term effectiveness of yCBT. Future studies should investigate for whom and under what conditions inclusion of yCBT treatment features is related to the durability of treatment gains.

Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 48(Supplement1) : S269-S283

Unterhitzenberger, J., Wintersohl, S., Lang, M., Konig, J., Rosner, R.

Providing manualized individual trauma-focused CBT to unaccompanied refugee minors with uncertain residence status: A pilot study

Background: Unaccompanied refugee minors (URMs) seeking asylum show high rates of posttraumatic stress disorder (PTSD), depression and anxiety. In addition, they experience post-migration stressors like an uncertain residence status. Therefore, psychotherapeutic interventions for URMs are urgently needed but have scarcely been investigated up to now. This study aimed to examine manualized individual trauma-focused cognitive behavioural therapy (TF-CBT) for URMs with PTSD involving their professional caregivers (i.e. social workers in child and adolescent welfare facilities). Method(s): We conducted an uncontrolled pilot study with three follow-up assessments (post-intervention, 6 weeks, and 6 months). Participants who met the PTSD diagnostic criteria were treated in a university psychotherapeutic outpatient clinic in Germany with a mean of 15 sessions of TF-CBT. All participants (n = 26) were male UM (Mage = 17.1, SD = 1.0), predominately from Afghanistan (n = 19, 73.1%) and did not have a residence permit. The sample was severely traumatized according to the number of traumatic event types reported (M = 11.3, SD = 2.8). The primary outcome was PTSD measured with the Child and Adolescent Trauma Screen (CATS) and the Diagnostic Interview for Mental Disorders in Childhood and Adolescence (Kinder-DIPS). Secondary outcomes were depression, behavioural and somatic symptoms. All but the somatic symptoms were assessed in both self-report and proxy report. Result(s): At post-intervention the completer sample (n = 19) showed significantly decreased PTSD symptoms, F(1, 18) = 11.41, p =.003, with a large effect size (d = 1.08). Improvements remained stable after 6 weeks and 6 months. In addition to PTSD symptoms, their caregivers reported significantly decreased depressive and behavioural symptoms in participants. According to the clinical interview, 84% of PTSD cases recovered after TF-CBT treatment. After 6 months, youths whose asylum request had been rejected showed increased PTSD symptoms according to individual trajectories in the Kinder-DIPS. The effect was, however, non-significant. Conclusion(s): Intervention studies are feasible with URMs. This pilot study presents preliminary evidence for the efficacy of an evidence-based intervention like TF-CBT in reducing PTSD symptoms in URMs. Stressors related to asylum proceedings after the end of therapy have the potential to negatively influence psychotherapy outcomes. Copyright © 2019 The Author(s).

Child and Adolescent Psychiatry and Mental Health, 13 (1) (no pagination)(22) :

Morina, N., Sterr, T. N.

Lack of evidence for the efficacy of psychotherapies for PTSD and depression in child and adolescent refugees

World Psychiatry, 18(1) : 107- 108

Levinson, J., Kohl, K., Baltag, V., Ross, D. A.

Investigating the effectiveness of school health services delivered by a health provider: A systematic review of systematic reviews

Schools are the only institution regularly reaching the majority of school-age children and adolescents across the globe. Although at least 102 countries have school health services, there is no rigorous, evidence-based guidance on which school health services are effective and should be implemented in schools. To investigate the effectiveness of school health services for improving the health of school-age children and adolescents, a systematic review of systematic reviews (overview) was conducted. Five databases were searched through June 2018. Systematic reviews of intervention studies that evaluated school-based or school-linked health services delivered by a health provider were included. Review quality was assessed using a modified Ballard and Montgomery four-item checklist. 1654 references were screened and 20 systematic reviews containing 270 primary studies were assessed narratively. Interventions with evidence for effectiveness addressed autism, depression, anxiety, obesity, dental caries, visual acuity, asthma, and sleep. No review evaluated the effectiveness of a multi-component school health services intervention addressing multiple health areas. From the limited amount of information available in existing systematic reviews, the strongest evidence supports implementation of anxiety prevention programs, indicated asthma education, and vision screening with provision of free spectacles. Additional systematic reviews are needed that analyze the effectiveness of comprehensive school health services, and specific services for under-researched health areas relevant for this population. Copyright © 2019 Levinson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PLoS ONE, 14 (6) (no pagination)(e0212603) :