Disorders - Post Traumatic Stress Disorder
Baldwin, D.S., Anderson, I. M., Nutt, D. J., Allgulander, C., Bandelow, B., den-Boer, J. A., Christmas, D. M., Davies, S., Fineberg, N., Lidbetter, N., Malizia, A., McCrone, P., Nabarro, D., O'Neill, C, Scott, J., van-der-Wee, N., Wittchen, H-U.,
This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.;
Journal of Psychopharmacology, 28(5) : 403-439
- Year: 2014
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Post Traumatic Stress Disorder
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
Dorsey, S., Pullmann, M. D., Berliner, L., Koschmann, E., McKay, M., Deblinger, E.
The goal of this study was to examine the impact of supplementing Trauma-focused Cognitive Behavioral Therapy (TF-CBT; Cohen et al., 2006) with evidence-based engagement strategies on foster parent and foster youth engagement in treatment, given challenges engaging foster parents in treatment. A randomized controlled trial of TF-CBT standard delivery compared to TF-CBT plus evidence-based engagement strategies was conducted with 47 children and adolescents in foster care and one of their foster parents. Attendance, engagement, and clinical outcomes were assessed 1 month into treatment, end of treatment, and 3 months post-treatment. Youth and foster parents who received TF-CBT plus evidence-based engagement strategies were more likely to be retained in treatment through four sessions and were less likely to drop out of treatment prematurely. The engagement strategies did not appear to have an effect on the number of canceled or no-show sessions or on treatment satisfaction. Clinical outcomes did not differ by study condition, but exploratory analyses suggest that youth had significant improvements with treatment. Strategies that specifically target engagement may hold promise for increasing access to evidence-based treatments and for increasing likelihood of treatment completion.; Copyright © 2014 Elsevier Ltd. All rights reserved.
Child Abuse & Neglect, 38(9) : 1508-1520
- Year: 2014
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Trauma-focused cognitive behavioural therapy (TF-CBT)
, Other service delivery and improvement interventions
De-Arellano, M. A. R., Lyman, R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Huang, L., Delphin-Rittmon, M. E.
Objective: Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a conjoint parent-child treatment developed by Cohen, Mannarino, and Deblinger that uses cognitive-behavioral principles and exposure techniques to prevent and treat posttraumatic stress, depression, and behavioral problems. This review defined TF-CBT, differentiated it from other models, and assessed the evidence base. Methods: Authors reviewed meta-analyses, reviews, and individual studies (1995 to 2013). Databases surveyed were PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, PILOTS, the ERIC, and the CINAHL. They chose from three levels of research evidence (high, moderate, and low) on the basis of benchmarks for number of studies and quality of their methodology. They also described the evidence of effectiveness. Results: The level of evidence for TF-CBT was rated as high on the basis of ten RCTs, three of which were conducted independently (not by TF-CBT developers). TF-CBT has demonstrated positive outcomes in reducing symptoms of posttraumatic stress disorder, although it is less clear whether TF-CBT is effective in reducing behavior problems or symptoms of depression. Limitations of the studies include concerns about investigator bias and exclusion of vulnerable populations. Conclusions: TF-CBT is a viable treatment for reducing trauma-related symptoms among some children who have experienced trauma and their nonoffending caregivers. Based on this evidence, TF-CBT should be available as a covered service in health plans. Ongoing research is needed to further identify best practices for TF-CBT in various settings and with individuals from various racial and ethnic backgrounds and with varied trauma histories, symptoms, and stages of intellectual, social, and emotional development.
Psychiatric Services, 65(5) : 591-602
- Year: 2014
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- Type: Systematic reviews
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Trauma-focused cognitive behavioural therapy (TF-CBT)
Foa, Edna B., McLean, Carmen P., Capaldi, Sandra, Rosenfield, David
Importance:E Evidence-based treatments for posttraumatic stress disorder (PTSD) have not been established for adolescents despite high prevalence of PTSD in this population. Objective: To examine the effects of counselor-delivered prolonged exposure therapy compared with supportive counseling for adolescents with PTSD. Design, Setting and Participants: A single-blind, randomized clinical trial of 61 adolescent girls with PTSD using a permuted block design. Counselors previously naive to prolonged exposure therapy provided the treatments in a community mental health clinic. Data collection lasted from February 2006 through March 2012. Interventions: Participants received fourteen 60- to 90-minute sessions of prolonged exposure therapy (n = 31) or supportive counseling (n = 30). Main Outcomes and Measures: All outcomes were assessed before treatment, at mid-treatment, and after treatment and at 3-, 6-, and 12-month follow-up. The primary outcome, PTSD symptom severity, was assessed by the Child PTSD Symptom Scale - Interview (range, 0-51; higher scores indicate greater severity). Secondary outcomes were presence or absence of PTSD diagnosis assessed by the DSM-IV Schedule for Affective Disorders and Schizophrenia for School-Age Children and functioning assessed by the Children's Global Assessment Scale (range, 1-100; higher scores indicate better functioning). Additional secondary measures, PTSD severity assessed by the Child PTSD Symptom Scale - Self-Report (range, 0-51; higher scores indicate greater severity) and depression severity assessed by the Children's Depression Inventory (range, 0-54; higher scores indicate greater severity), were also assessed weekly during treatment. RESULTS Data were analyzed as intent to treat. During treatment, participants receiving prolonged exposure demonstrated greater improvement on the PTSD symptom severity scale (difference between treatments in improvement, 7.5; 95% CI, 2.5-12.5; P < .001) and on all secondary outcomes (loss of PTSD diagnosis: difference, 29.3%, 95% CI, 20.2%-41.2%; P = .01; self-reported PTSD severity: difference, 6.2; 95% CI, 1.2-11.2; P = .02; depression: difference, 4.9; 95% CI, 1.6-8.2; P = .008; global functioning: difference, 10.1; 95% CI, 3.4-16.8; P = .008). These treatment differences were maintained through the 12-month follow-up: for interviewer-assessed PTSD (difference, 6.0; 95% CI, 1.6-10.4; P = .02), loss of PTSD diagnosis (difference, 31.1; 95% CI, 14.7-34.8; P = .01), self-reported PTSD (difference, 9.3; 95% CI, 1.2-16.5; P = .02), depression (difference, 7.2; 95% CI, 1.4-13.0; P = .02), and global functioning (difference, 11.2; 95% CI, 4.5-17.9; P = .01). Conclusion and Relevance: Adolescents girls with sexual abuse - related PTSD experienced greater benefit from prolonged exposure therapy than from supportive counseling even when delivered by counselors who typically provide supportive counseling. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)
JAMA, 310(24) : 2650-2657
- Year: 2013
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Supportive therapy
Brillantes-Evangelista, G.
The study investigates the effectiveness of visual arts and poetry as interventions in alleviating symptoms of depression and post-traumatic stress disorder (PTSD) among adolescents with history of abuse. Participants were selected from five shelters within Metro Manila based on the depression and PTSD measures. They were divided into three groups: visual arts, poetry, and control groups. Each of the intervention groups went through eight sessions of art works or poetry with specific themes and modality. Results show that participants in the intervention groups had a general decrease of scores from pretest to posttest on the depression and PTSD scales. On the other hand, many participants in the control group obtained higher posttest scores. Results also indicate that the visual arts intervention was significantly effective in alleviating symptoms of PTSD but not of depression; while poetry intervention was significantly effective in alleviating symptoms of depression it was less so in treating PTSD. Nonetheless, analysis on the activities held suggests that the visual arts and poetry interventions helped the adolescents address their issues, make sense of their lives, and create positive alternative stories for themselves. (copyright) 2012 Elsevier Inc.
Arts in Psychotherapy, 40(1) : 71-84
- Year: 2013
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- Type: Controlled clinical trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Creative expression: music, dance, drama, art
Parker, B., Turner, W.
Background: The sexual abuse of children and adolescents is a significant worldwide problem. It is associated with a wide variety of negative psychological, social and physical consequences for the victims. These effects can often be seen immediately following sexual abuse, but they may manifest later on and sometimes only in adult life. There are a number of different interventions aimed at helping children and adolescents who have been sexually abused, and psychoanalytic/psychodynamic psychotherapy has a long-established tradition of being used for such victims. In this review, we set out to find the evidence for its effectiveness specifically in children and adolescents who have been sexually abused. Objectives: To assess the effectiveness of psychoanalytic/psychodynamic psychotherapy for children and adolescents who have been sexually abused. Search methods: We searched the following databases in May 2013: CENTRAL, Ovid MEDLINE, Embase, PsycINFO, CINAHL, Sociological Abstracts, Social Science Citation Index, Conference Proceedings Citation Index - Social Science and Humanities, LILACS and WorldCat. We also searched three trials registers, checked the reference lists of relevant studies and contacted known experts. Selection criteria: Randomised and quasi-randomised trials comparing psychoanalytic/psychodynamic psychotherapy with treatment as usual or no treatment/waiting list control for children and adolescents up to age of 18 who had experienced sexual abuse at any time prior to the intervention. Data collection and analysis: The review authors (BP and WT) independently screened search results to identify studies that met eligibility criteria. Main results: No studies were identified that met the inclusion criteria for this review. Authors' conclusions: There are no randomised and quasi-randomised trials that compare psychoanalytic/psychodynamic therapy with treatment as usual, no treatment or waiting list control for children and adolescents who have been sexually abused. As a result, we cannot draw any conclusions as to the effectiveness of psychoanalytic/psychodynamic psychotherapy for this population. This important gap emphasises the need for further research into the effectiveness of psychoanalytic/psychodynamic psychotherapy in this population. Such research should ideally be in the form of methodologically high-quality, large-scale randomised controlled trials. If these are not conducted, future systematic reviews on this subject may need to consider including other lower quality evidence in order to avoid overlooking important research. Copyright © 2013 The Cochrane Collaboration.
Cochrane Database of Systematic Reviews, 2013 (7) (no pagination)(CD008162) :
- Year: 2013
- Problem: Anxiety Disorders (any), Post Traumatic Stress Disorder, Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Psychodynamic/Psychoanalysis
Hermenau, K., Hecker, T., Schaal, S., Maedl, A., Elbert, T.
Former child soldiers and ex-combatants are at high risk of developing trauma-related disorders and appetitive aggression, which reduce successful integration into peaceful societies. In a randomized controlled clinical trial, we offered Narrative Exposure Therapy for Forensic Offender Rehabilitation (FORNET) to 15 ex-combatants with the goal of reducing traumatic stress and appetitive aggression compared to "treatment as usual." Measures included the PTSD Symptom Scale-Interview and the Appetitive Aggression Scale assessed prior to treatment and 2 weeks and 6 months after the treatment. We also assessed closeness to combatants as an index of reintegration. The treatment group reported reduced PTSD symptoms and less contact with combatants. Appetitive aggression decreased substantially in both groups. The results indicate that it is feasible to add psychological treatment to facilitate the reintegration process. We wish to thank the former combatants and former child soldiers who participated in this study and the Congolese translators. We also want to thank the very motivated and reliable staff of the reintegration center, especially Pascal Badibanga Zagabe, Leonce Kyakimwa, Lydie Mirimo Ajua, David Ngufu, and Matata Banyene. Furthermore, we want to thank Charlotte Salmen for conducting the follow-up interviews and James Moran for conducting the follow-up interviews as well as proofreading the manuscript. Sources of support: Deutsche Forschungsgemeinschaft (DFG), vivo international. Trial registration clinicaltrials.gov Identifier: NCT01625117 (copyright) 2013 Copyright Taylor and Francis Group, LLC.
Journal of Aggression, Maltreatment & Trauma, 22(8) : 916-934
- Year: 2013
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Narrative exposure therapy (NET)
Forman-Hoffman, Valerie L., Zolotor, Adam J., McKeeman, Joni L., Blanco, Roberto, Knauer, Stefanie R., Lloyd, Stacey W., Fraser, Jenifer Goldman, Viswanathan, Meera
Objectives: To assess the effectiveness of interventions targeting traumatic stress among children exposed to nonrelational traumatic events (eg, accidents, natural disasters, war).; Methods: We assessed research on psychological and pharmacological therapy as part of an Agency for Healthcare Research and Quality-commissioned comparative effectiveness review. We conducted focused searches of Medline, Cochrane Library, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, and Web of Science. Two trained reviewers independently selected, extracted data from, and rated the risk of bias of relevant trials and systematic reviews. We used qualitative rather than quantitative analysis methods because of statistical heterogeneity, insufficient numbers of similar studies, and variation in outcome reporting.; Results: We found a total of 21 trials and 1 cohort study of medium or low risk of bias from our review of 6647 unduplicated abstracts. We generally did not find studies that attempted to replicate findings of effective interventions. In the short term, no pharmacotherapy intervention demonstrated efficacy, and only a few psychological treatments (each with elements of cognitive behavioral therapy) showed benefit. The body of evidence provides little insight into how interventions to treat children exposed to trauma might influence healthy long-term development.; Conclusions: Our findings serve as a call to action: Psychotherapeutic intervention may be beneficial relative to no treatment in children exposed to traumatic events. Definitive guidance, however, requires far more research on the comparative effectiveness of interventions targeting children exposed to nonrelational traumatic events.;
Pediatrics, 131(3) : 526-539
- Year: 2013
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
Fraser, J. G., Lloyd, S., Murphy, R., Crowson, M., Zolotor, A. J., Coker-Schwimmer, E., Viswanathan, M.
Objective: To systematically review the comparative effectiveness evidence for interventions to ameliorate the negative sequelae of maltreatment exposure in children ages birth to 14 years.; Methods: We assessed the research on pharmacological and psychosocial interventions (parent-mediated approaches or trauma-focused treatments) reporting mental and behavioral health, caregiver-child relationship, and developmental and/or school functioning outcomes. We conducted focused searches of MEDLINE (through PubMed), Social Sciences Citation Index, PsycINFO, and the Cochrane Library (1990-2012). Reviewer pairs independently evaluated the studies for eligibility using predetermined inclusion/exclusion criteria, evaluated studies for risk of bias, extracted data, and graded the strength of evidence (SOE) for each comparison and each outcome based on predetermined criteria.; Results: Based on our review of 6282 unduplicated citations, we found 17 trials eligible for inclusion. Although several interventions show promising comparative benefit for child well-being outcomes, the SOE for all but one of these interventions was low. The results highlight numerous substantive and methodological gaps to address in the future research.; Conclusions: It is too early to make strong treatment recommendations, as comparative research remains relatively nascent in the child maltreatment arena. These gaps reflect, in large part, the Herculean demands on researchers involved in conducting high-quality clinical studies with this highly vulnerable population. The National Child Traumatic Stress Network and the Developmental-Behavioral Pediatrics Research Network (DBPNet) are two potentially powerful platforms to conduct large rigorous trials needed to move the field forward. More broadly, a paradigm shift among researchers and funders alike is needed to galvanize the commitment and resources necessary for conducting collaborative clinical trials with this highly vulnerable population.;
Journal of Developmental & Behavioral Pediatrics, 34(5) : 353-368
- Year: 2013
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
Habigzang, L. F., Damasio, B. F., Koller, S. H.
This study evaluated the impact of a cognitive behavioral group therapy model in Brazilian girls who had experienced sexual abuse. The effect of the waiting period before treatment and the enduring effectiveness of the treatment after six and 12 months were also evaluated. Forty-nine female sexual abuse victims between the ages of 9 and 16 completed instruments measuring depression, anxiety, stress, and post-traumatic stress disorder before, during, and after the group therapy. The group therapy had a positive impact on their psychological functioning, significantly reducing symptoms of anxiety, stress, and post-traumatic stress disorder. The therapeutic effects lasted six to 12 months after the treatment ended. The model proved effective for treating young female victims of sexual abuse.
Journal of child sexual abuse, 22(2) : 173-190
- Year: 2013
- Problem: Post Traumatic Stress Disorder
- Type: Controlled clinical trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Leor, A., Dolberg, O. T., Eshel, S. P., Yagil, Y., Schreiber, S.
To describe and evaluate the impact of an early intervention (Trauma-Focused Early Intensive Cognitive Behavioral Intervention, TF-EICBI) in children and adolescents who were victims of suicide bombing attacks (SBAs) in Israel. Description of an intervention and preliminary experience in its use. An acute trauma center of a Child and Adolescent Psychiatric Unit in a Department of Psychiatry of a university-affiliated medical center. Ten children and adolescents who were victims of SBAs and underwent early interventions (EIG) were compared to 11 adolescent victims who received no intervention (NEIG). The EIG included all the children and adolescent survivors of various SBAs that had occurred during 1 year who presented to our hospital after the TF-EICBI was implemented (June 2001). The NEIG comprised all adolescents girls <18 years of age at follow-up who survived one SBA (at the "Dolphinarium" Discotheque) before the TF-EICBI was available. At the time of the 1-year post-SBA follow-up, all 21 subjects were assessed by the Structured Clinical Interview for Axis 1 DSMIII R Disorders (SCID), and the Child Behavior Checklist (CBCL). One (10 percent) EI subject and four (36.4 percent) NEI subjects had post-traumatic stress disorder. The mean CBCL total score and most of the mean CBCL behavior problem scores were significantly higher (p < 0.021) among the NEI group members. Intervention was effective in preventing and lowering mental morbidity of children and adolescents after SBAs.
American Journal of Disaster Medicine, 8(4) : 227-234
- Year: 2013
- Problem: Post Traumatic Stress Disorder
- Type: Controlled clinical trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Trauma-focused cognitive behavioural therapy (TF-CBT)
Gwozdziewycz, Nicolas, Mehl-Madrona, Lewis
Background: Narrative therapies, especially narrative exposure therapy, are used to treat the effects of trauma in refugees and to prevent psychiatric illness. These methods involve helping the person to tell the story of what happened to them until it no longer elicits anxiety.; Methods: We reviewed all quantitative studies related to narrative exposure methods for treating trauma or posttraumatic stress disorder in refugees. We focused on studies with sufficient information to calculate effect sizes and statistical power.; Results: We found 7 quantitative studies for which effect size and power could be calculated. The total average effect size for all interventions was 0.63 (medium). The average effect size for studies in which interventions were administered by physicians, adequately trained graduate students, or both was 0.53. The effect size for studies in which the counselors were themselves refugees was 1.02. The 95% confidence intervals for the effect sizes of narrative exposure therapy did not reach below 0.; Conclusion: Studies demonstrating the effectiveness of narrative methods have adequate effect sizes and statistical power. Empowering lay counselors to treat their fellow refugees in future studies is warranted.;
The Permanente Journal, 17(1) : 70-76
- Year: 2013
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
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Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Narrative exposure therapy (NET)