Disorders - Post Traumatic Stress Disorder
Overbeek, Mathilde M., deSchipper, J. Clasien, Lamers-Winkelman, Francien, Schuengel, Carlo
A community-based intervention with specific factors for children and parents exposed to interparental violence (IPV) was compared with a control intervention based on non-specific factors. We hypothesized that participation in an intervention with specific factors, focused on IPV, parenting and coping, would be associated with better recovery. IPV exposed children and parents were group randomized over a specific factors- and control intervention. Baseline, posttest and follow-up measurements of 155 parents and children (aged 6 - 12 years, 55.5% boys) were fitted in a multilevel model. Outcomes were parent and teacher reported children's internalizing and externalizing problems (CBCL, TRF), child self-reported depressive symptoms (CDI) and parent and child reported children's post-traumatic stress symptoms (TSCYC, TSCC). Based on intention-to-treat and completer analyses, children in the specific factors intervention did not show better recovery than children in the control intervention. Children in both interventions decreased significantly in parent-reported children's internalizing and externalizing problems and post-traumatic stress symptoms. Children reported a decrease in their mean level of depressive and post-traumatic stress symptoms. Teachers reported a decrease in internalizing problems, but not in externalizing problems. No association between time since exposure and level and course of symptoms was found. Treatment differentiation was assessed and both programs were significantly different on hypothesized effective factors. Higher treatment adherence in both programs did not result in a larger difference in recovery. IPV exposed children improve over the course and after participating in a community-based child- and parent program, but specific factors in intervention may not carry additional benefits when implemented in community settings.
Child Abuse & Neglect, 37 : 1202-1214
- Year: 2013
- 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
Leenarts, L. E. W., Diehle, J., Doreleijers, T. A. H., Jansma, E. P., Lindauer, R. J. L.
This is a systematic review of evidence-based treatments for children exposed to childhood maltreatment. Because exposure to childhood maltreatment has been associated with a broad range of trauma-related psychopathology (e.g., PTSD, anxiety, suicidal ideation, substance abuse) and with aggressive and violent behavior, this review describes psychotherapeutic treatments which focus on former broad range of psychopathological outcomes. A total of 26 randomized controlled clinical trials and seven non-randomized controlled clinical trials published between 2000 and 2012 satisfied the inclusionary criteria and were included. These studies dealt with various kinds of samples, from sexually abused and maltreated children in child psychiatric outpatient clinics or in foster care to traumatized incarcerated boys. A total of 27 studies evaluated psychotherapeutic treatments which used trauma-focused cognitive, behavioral or cognitive-behavioral techniques; only two studies evaluated trauma-specific treatments for children and adolescents with comorbid aggressive or violent behavior; and four studies evaluated psychotherapeutic treatments that predominantly focused on other mental health problems than PTSD and used non-trauma focused cognitive, behavioral or cognitive-behavioral techniques. The results of this review suggest that trauma-focused cognitive-behavioral therapy (TF-CBT) is the best-supported treatment for children following childhood maltreatment. However, in line with increased interest in the diagnosis of complex PTSD and given the likely relationship between childhood maltreatment and aggressive and violent behavior, the authors suggest that clinical practice should address a phase-oriented approach. This review concludes with a discussion of future research directions and limitations.;
European Child & Adolescent Psychiatry, 22(5) : 269-283
- Year: 2013
- 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)
, Cognitive & behavioural therapies (CBT)
, Eye movement desensitisation and reprocessing (EMDR)
, Trauma-focused cognitive behavioural therapy (TF-CBT)
O'Callaghan, Paul, McMullen, John, Shannon, Ciaran, Rafferty, Harry, Black, Alastair
Objective: To assess the efficacy of trauma-focused cognitive behavioral therapy (TF-CBT) delivered by nonclinical facilitators in reducing posttraumatic stress, depression, and anxiety and conduct problems and increasing prosocial behavior in a group of war-affected, sexually exploited girls in a single-blind, parallel-design, randomized,+ controlled trial.; Method: Fifty-two 12- to 17-year-old, war-affected girls exposed to rape and inappropriate sexual touch in the Democratic Republic of Congo were screened for trauma, depression and anxiety, conduct problems, and prosocial behavior. They were then randomized to a 15 session, group-based, culturally modified TF-CBT (n = 24) group or a wait-list control group (n = 28). Primary analysis, by intention-to-treat, involving all randomly assigned participants occurred at pre- and postintervention and at 3-month follow-up (intervention group only).; Results: Compared to the wait list control, the TF-CBT group experienced significantly greater reductions in trauma symptoms (F(1,49) = 52.708, p<0·001, χ(p)2 = 0.518). In addition, the TF-CBT group showed a highly significant improvement in symptoms of depression and anxiety, conduct problems, and prosocial behavior. At 3-months follow-up the effect size (Cohen's d) for the TF-CBT group was 2.04 (trauma symptoms), 2.45 (depression and anxiety), 0.95 (conduct problems), and-1.57 (prosocial behavior).; Conclusions: A group-based, culturally modified, TF-CBT intervention delivered by nonclinically trained Congolese facilitators resulted in a large, statistically significant reduction in posttraumatic stress symptoms and psychosocial difficulties among war-affected girls exposed to rape or sexual violence. Clinical trial registration information-An RCT of TF-CBT with sexually-exploited, war-affected girls in the DRC; http://clinicaltrials.gov/; NCT01483261.; Copyright © 2013 American Academy of Child & Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
Journal of the American Academy of Child & Adolescent Psychiatry, 52(4) : 359-369
- Year: 2013
- Problem: Anxiety Disorders (any), Post Traumatic Stress Disorder, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Trauma-focused cognitive behavioural therapy (TF-CBT)
McMullen, John., O'Callaghan, Paul., Shannon, Ciaran., Black, Alastair., Eakin, John.
Background: The Democratic Republic of Congo (DRC) has been home to the world's deadliest conflict since World War II and is reported to have the largest number of child soldiers in the world. Despite evidence of the debilitating impact of war, no group-based mental health or psychosocial intervention has been evaluated in a randomised controlled trial for psychologically distressed former child soldiers.; Method: A randomised controlled trial involving 50 boys, aged 13-17, including former child soldiers (n = 39) and other war-affected boys (n = 11). They were randomly assigned to an intervention group, or wait-list control group. The intervention group received a 15-session, group-based, culturally adapted Trauma-Focused Cognitive-Behavioural Therapy (TF-CBT) intervention. Assessment interviews were completed at baseline, postintervention and 3-month follow-up (intervention group).; Results: Analysis of Covariance (ANCOVA) demonstrated that, in comparison to the wait-list control group, the TF-CBT intervention group had highly significant reductions in posttraumatic stress symptoms, overall psychosocial distress, depression or anxiety-like symptoms, conduct problems and a significant increase in prosocial behaviour (p < .001 for all). Effect sizes were higher when former child soldier scores were separated for sub-analysis. Three-month follow-up of the intervention group found that treatment gains were maintained.; Conclusions: A culturally modified, group-based TF-CBT intervention was effective in reducing posttraumatic stress and psychosocial distress in former child soldiers and other war-affected boys.; © 2013 The Authors. Journal of Child Psychology and Psychiatry © 2013 Association for Child and Adolescent Mental Health.
Journal of Child Psychology & Psychiatry & Allied Disciplines, 54(11) : 1231-1241
- Year: 2013
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Trauma-focused cognitive behavioural therapy (TF-CBT)
Stankovic, M., Grbesa, G., Kostic, J., Simonovic, M., Milenkovic, T., Visnjic, A.
Background/Aim. Traumatic stress refers to physical and emotional reactions caused by events which represent a life threat or a disturbance of physical and phychological integrity of a child, as well as their parents or gaerdians. Car accidents are the main cause of posttraumatic stress disorder (PTSD) in children. The aim of this study was to preview clinical efficiency of systemic family therapy (SFT) as therapy intervention in treatment of children with posttraumatic stress disorder (PTSD) traumatized in car accident under identical circumstances of exposure. We pointed out the importance of specific family factors (family cohesion and adaptability, emotional reaction of the parents) on PTSD clinical outcome. Methods. The sample of this clinical observational study included 7-sixth grade pupiles - 5 boys and 2 girls, aged 13. All of the pupils were involved in car accident with one death. Two groups were formed - one group included three children who were involved in 8 SFT sessions together with their families. The second group included 4 children who received an antidepressant sertraline in the period of three months. Results. Two months after the car accident, before the beginning of the therapy, all of the children were the members of rigidly enmeshed family systems, considering the high average cohesion scores and the low average adaptability scores on the FACES III. Three months after the received therapy, having evaluated the results of the therapeutic approaches, we established that the adaptability scores of the families included in the SFT were higher than the scores of the families of the children who received pharmacotherapy with one boy still meeting the criteria for PTSD. Conclusion. Systemic family therapy was efficient in the treatment of children with PTSD, traumatized in car accident. Therapy efficiency was higher when both parents and children were included in SFT than in the case when they were not included in the family therapy. The change in the functioning of the family systems was not accidental or simply time-dependant, but it depended on the therapy which was applied and the increased level of family adaptability as the main risk factor of retraumatization.
Vojnosanitetski Pregled, 70(2) : 149-154
- Year: 2013
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Family therapy
Wu, S., Zhu, X., Zhang, Y., Liang, J., Liu, X., Yang, Y., Yang, H., Miao, D.
We sought to compare the efficacy of the "512 Psychological Intervention Model" (that is, "512 PIM", a new psychological intervention) with debriefing on symptoms of post-traumatic stress disorder (PTSD), anxiety and depression of Chinese military rescuers in relation to a control group that had no intervention. We conducted a randomized controlled trial with 2,368 military rescuers 1 month after this event and then at follow-up 1, 2 and 4 months later to evaluate changes in symptoms of PTSD, anxiety and depression based on DSM-IV criteria, respectively. Baseline analysis suggested no significant differences between the study groups. Severity of PTSD, anxiety and depression decreased over time in all three groups, with significant differences between the groups in symptoms of PTSD (P < 0.01). Compared with the debriefing and control group, significant lower scores of PTSD and positive efficacy in improving symptoms of re-experiencing, avoidance and hyperarousal were found in the "512 PIM" group. "512 PIM" was an effective psychological intervention for military rescuers in reducing symptoms of PTSD, anxiety and depression after a crisis.
Social Psychiatry & Psychiatric Epidemiology, 47(7) : 1111-1119
- Year: 2012
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Psychological debriefing, Other Psychological Interventions
Vandervord-Nixon, Reginald David, Sterk, Jisca, Pearce, Amanda
The present study compared the efficacy of trauma-focused cognitive behavior therapy (CBT) with trauma-focused cognitive therapy (without exposure; CT) for children and youth with posttraumatic stress disorder (PTSD). Children and youth who had experienced single-incident trauma (N = 33; 7 - 17 years old) were randomly assigned to receive 9 weeks of either CBT or CT which was administered individually to children and their parents. Intent-to-treat analyses demonstrated that both interventions significantly reduced severity of PTSD, depression, and general anxiety. At posttreatment 65% of CBT and 56% of the CT group no longer met criteria for PTSD. Treatment completers showed a better response (CBT: 91%; CT: 90%), and gains were maintained at 6-month follow-up. Maternal depressive symptoms and unhelpful trauma beliefs moderated children's outcome. It is concluded that PTSD secondary to single-incident trauma can be successfully treated with trauma-focused cognitive behavioural methods and the use of exposure is not a prerequisite for good outcome. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract)
Journal of Abnormal Child Psychology, 40(3) : 327-337
- Year: 2012
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Trauma-focused cognitive behavioural therapy (TF-CBT)
Tol, W. A., Komproe, I. H., Jordans, M. J. D., Vallipuram, A., Sivayokan, S., MacY, R. D., De ong, J. T.,
We aimed to examine outcomes, moderators and mediators of a preventive school-based mental health intervention implemented by paraprofessionals in a war-affected setting in northern Sri Lanka. A cluster randomized trial was employed. Subsequent to screening 1,370 children in randomly selected schools, 399 children were assigned to an intervention (n=199) or waitlist control condition (n=200). The intervention consisted of 15 manualized sessions over 5 weeks of cognitive behavioral techniques and creative expressive elements. Assessments took place before, 1 week after, and 3 months after the intervention. Primary outcomes included post-traumatic stress disorder (PTSD), depressive, and anxiety symptoms. No main effects on primary outcomes were identified. A main effect in favor of intervention for conduct problems was observed. This effect was stronger for younger children. Furthermore, we found intervention benefits for specific subgroups. Stronger effects were found for boys with regard to PTSD and anxiety symptoms, and for younger children on pro-social behavior. Moreover, we found stronger intervention effects on PTSD, anxiety, and function impairment for children experiencing lower levels of current war-related stressors. Girls in the intervention condition showed smaller reductions on PTSD symptoms than waitlisted girls. We conclude that preventive school-based psychosocial interventions in volatile areas characterized by ongoing war-related stressors may effectively improve indicators of psychological wellbeing and posttraumatic stress-related symptoms in some children. However, they may undermine natural recovery for others. Further research is necessary to examine how gender, age and current war-related experiences contribute to differential intervention effects.
World Psychiatry, 11(2) : 114-122
- Year: 2012
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Other Psychological Interventions, Creative expression: music, dance, drama, art
Schottelkorb, April A., Doumas, Diana M., Garcia, Rhyan
The authors investigated the effectiveness of child-centered play therapy (CCPT) in comparison with an evidence-based intervention, trauma-focused cognitive - behavioral therapy (TF-CBT) with traumatized refugee children aged 6 to 13. Thirty-one traumatized refugee children were randomly assigned to participate in CCPT or TF-CBT in the elementary school setting in the northwest United States. Results indicated that both CCPT and TF-CBT were effective in reducing trauma symptoms according to child and parent report. Findings support the use of CCPT in treating traumatized refugee children. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
International Journal of Play Therapy, 21(2) : 57-73
- Year: 2012
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions
Salloum, A., Overstreet, S.
This study evaluated the differential effects of the Grief and Trauma Intervention (GTI) with coping skills and trauma narrative processing (CN) and coping skills only (C). Seventy African American children (6-12 years old) were randomly assigned to GTI-CN or GTI-C. Both treatments consisted of a manualized 11-session intervention and a parent meeting. Measures of trauma exposure, posttraumatic stress symptoms, depression, traumatic grief, global distress, social support, and parent reported behavioral problems were administered at pre, post, 3 and 12 months post intervention. In general, children in both treatment groups demonstrated significant improvements in distress related symptoms and social support, which, with the exception of externalizing symptoms for GTI-C, were maintained up to 12 months post intervention. Results suggest that building coping skills without the structured trauma narrative may be a viable intervention to achieve symptom relief in children experiencing trauma-related distress. However, it may be that highly distressed children experience more symptom relief with coping skills plus narrative processing than with coping skills alone. More research on the differential effects of coping skills and trauma narration on child distress and adaptive functioning outcomes is needed. (copyright) 2012 Elsevier Ltd.
Behaviour Research & Therapy, 50(3) : 169-179
- Year: 2012
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Skills training, Other Psychological Interventions
Saxe, G., Ellis, B., Fogler, J., Navalta, C. P.
Background: This study aimed to obtain preliminary evidence for the extent to which a novel intervention embedded within a systems-oriented treatment model [trauma systems therapy (TST)] engages and retains traumatized children and their families in treatment. Method: Twenty youth who had prominent symptoms of posttraumatic stress were randomly assigned to receive TST or care as usual (CAU). Results: At the 3-month assessment, 90% of TST participants were still in treatment, whereas only 10% of CAU participants remained. Within-group analyses of TST participants demonstrated significant reductions in posttraumatic stress and aggression as well as a slight improvement in home safety. Conclusions: These preliminary findings point to the need to utilize effective engagement approaches to retain traumatized children and their families in treatment. (copyright) 2011 The Authors. Child and Adolescent Mental Health (copyright) 2011 Association for Child and Adolescent Mental Health.
Child & Adolescent Mental Health, 17(1) : 58-61
- Year: 2012
- 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
Wilkinson, J. M., Carrion, V. G.
After the experience of a traumatic event, children and adolescents are especially vulnerable to developing debilitating symptoms of Posttraumatic Stress Disorder (PTSD). Criteria for diagnosing this disorder in the pediatric population have proven insufficiently sensitive for children, especially those who are very young. Age-related PTSD symptom expression suggests PTSD assessment and treatment requires developmental consideration. Preschool age children, school age children, adolescents, and adults also possess potentially distinct differences from one another in pharmacokinetics, psychosocial influences, and neurobiology. Pharmacotherapy is often indicated for use in the treatment of pediatric PTSD. Extrapolation of evidence in adult literature for safety, tolerability, and efficacy is nonlinear and should not substitute for dedicated drug trials in pediatric PTSD. This paper reviews all identified randomized controlled trials (RCTs), uncontrolled and open label trials, and case reports/series regarding pharmacotherapy in this population. Emphasis is placed on methodologic rigor and developmental consideration. These trials are discussed in sufficient detail to inform readers of their relative strengths and weaknesses, and of the generalizability of the studies' conclusions. This review summarizes reports by drug class and developmental cohorts (preschool age, school age, and adolescents). The review will help clinicians a) decide when medications are needed, b) understand current evidence-based alternatives and c) utilize a developmental approach in the selection of medication. (copyright) 2012 Bentham Science Publishers.
Current Psychopharmacology, 1(3) : 252-270
- Year: 2012
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants