Disorders - Post Traumatic Stress Disorder
Diab, M., Peltonen, K., Qouta, S. R., Palosaari, E., Punamaki, R-L.
The study examines, first, the effectiveness of a psychosocial intervention based on Teaching Recovery Techniques (TRT) to increase resiliency among Palestinian children, exposed to a major trauma of war. Second, it analyses the role of family factors (maternal attachment and family atmosphere) as moderating the intervention impacts on resilience. School classes in Gaza were randomized into intervention (N = 242) and control (N = 240) groups. The percentage of girls (49.4%) and boys (50.6%) were equal, and the child age was 10-13 years in both groups. Children reported positive indicators of their mental health (prosocial behaviour and psychosocial well-being) at baseline (T1), post-intervention (T2) and at a six-month follow-up (T3). At T1 they accounted their exposure to war trauma. Mothers reported about their willingness to serve as an attachment figure, and the child reported about the family atmosphere. Resilience was conceptualized as a presence of positive indications of mental health despite trauma exposure. Against our hypothesis, the intervention did not increase the level of resilience statistically significantly, nor was the effect of the intervention moderated by maternal attachment responses or family atmosphere. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Child Abuse & Neglect, 40 : 24-35
- Year: 2015
- 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
Diehle, J., Opmeer, B.C., Boer, F., Mannarino, A. P., Lindauer, R. J.
To prevent adverse long-term effects, children who suffer from posttraumatic stress symptoms (PTSS) need treatment. Trauma-focused cognitive behavioral therapy (TF-CBT) is an established treatment for children with PTSS. However, alternatives are important for non-responders or if TF-CBT trained therapists are unavailable. Eye movement desensitization and reprocessing (EMDR) is a promising treatment for which sound comparative evidence is lacking. The current randomized controlled trial investigates the effectiveness and efficiency of both treatments. Forty-eight children (8-18 years) were randomly assigned to eight sessions of TF-CBT or EMDR. The primary outcome was PTSS as measured with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). Secondary outcomes included parental report of child PTSD diagnosis status and questionnaires on comorbid problems. The Children's Revised Impact of Event Scale was administered during the course of treatment. TF-CBT and EMDR showed large reductions from pre- to post-treatment on the CAPS-CA (-20.2; 95 % CI -12.2 to -28.1 and -20.9; 95 % CI -32.7 to -9.1). The difference in reduction was small and not statistically significant (mean difference of 0.69, 95 % CI -13.4 to 14.8). Treatment duration was not significantly shorter for EMDR (p = 0.09). Mixed model analysis of monitored PTSS during treatment showed a significant effect for time (p < 0.001) but not for treatment (p = 0.44) or the interaction of time by treatment (p = 0.74). Parents of children treated with TF-CBT reported a significant reduction of comorbid depressive and hyperactive symptoms. TF-CBT and EMDR are effective and efficient in reducing PTSS in children. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
European Child & Adolescent Psychiatry, 24(2) : 227-236
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Eye movement desensitisation and reprocessing (EMDR)
, Trauma-focused cognitive behavioural therapy (TF-CBT)
Allan, N. P., Short, N. A., Albanese, B. J., Keough, M. E., Schmidt, N. B.
Anxiety sensitivity (AS), or fear of anxious arousal, is a higher-order cognitive risk-factor for posttraumatic stress disorder (PTSD) composed of lower-order physical, cognitive, and social concerns regarding anxiety symptoms. Brief and effective interventions have been developed targeting AS and its constituent components. However, there is limited evidence as to whether an intervention aimed at targeting AS would result in reductions in PTS symptoms and whether the effects on PTS symptoms would be mediated by reductions in AS. Furthermore, there is no evidence whether these mediation effects would be because of the global or more specific components of AS. The direct and indirect effects of an AS intervention on PTS symptoms were examined in a sample of 82 trauma-exposed individuals (M age = 18.84 years, SD = 1.50) selected based on elevated AS levels (i.e., 1 SD above the mean) and assigned to either a treatment (n = 40) or an active control (n = 42) condition. Results indicated that the intervention led to reductions in Month 1 PTS symptoms, controlling for baseline PTS symptoms. Furthermore, this effect was mediated by changes in global AS and AS social concerns, occurring from intervention to Week 1. These findings provide an initial support for an AS intervention in amelioration of PTS symptoms and demonstrate that it is primarily reductions in the higher-order component of AS contributing to PTS symptom reduction.
Cognitive Behaviour Therapy, 44(6) : 512-524
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Psychoeducation
Boals, A., Murrell, A. R., Berntsen, D., Southard-Dobbs, S., Agtarap, S.
Event centrality, the extent to which one perceives a stressful or traumatic event as central to one's identity, has been shown to be one of the predictors of PTSD symptoms. Boals and Murrell (in press) found that an Acceptance and Commitment Therapy (ACT)-based, therapist-led treatment resulted in significant decreases in event centrality, which in turn led to decreases in PTSD symptoms. In the current study, a version of this treatment was administered using a modified expressive writing intervention. Participants were randomly assigned to learn core components about either ACT, cognitive-behavioral therapy (CBT), or baseball (control) via audio analogs. The ACT and CBT groups then attempted to apply what they learned in two subsequent expressive writing sessions, while the baseball group wrote about a neutral topic. The results revealed that participants in the ACT and CBT conditions evidenced significant decreases in event centrality, if they followed the writing instructions correctly, in comparison to the control group. However, there were no group differences in changes in PTSD symptoms. These results suggest that principles of ACT and traditional CBT expressed using a modified expressive writing intervention hold great promise to help individuals recover from stressful experiences. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Journal of Contextual Behavioral Science, 4(4) : 269-276
- Year: 2015
- Problem: Anxiety Disorders (any), 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
Callinan, S., Johnson, D., Wells, A.
Attention Training (ATT) is a technique used in metacognitive therapy but it has also been shown to produce stand-alone effects. The present study replicates and extends an earlier study of the effects of ATT on traumatic-stress symptoms. A sample of 60 university students who reported a traumatic life event were randomly assigned to either an ATT group (n = 29) or a control group (n = 31). They were exposed to a recorded narrative of their stressful experience before and after the intervention and the primary outcomes were frequency of intrusions and negative affect reported. Secondary outcomes included self-report and performance-based measures of attention flexibility. ATT significantly reduced intrusions and improved negative affect in individuals who had experienced a stressful life event. The technique also appeared to reduce self-focused attention, increase attention flexibility and modified performance on an emotional attention set shifting task. The results suggest that ATT can be beneficial in reducing specific traumatic stress symptoms. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Cognitive Therapy & Research, 39(1) : 4-13
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Attention/cognitive bias modification
Konanur, S., Muller, R. T., Cinamon, J. S., Thornback, K., Zorzella, K. P. M.
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a widely used treatment model for trauma-exposed children and adolescents ( Cohen, Mannarino, & Deblinger, 2006). The Healthy Coping Program (HCP) was a multi-site community based intervention carried out in a diverse Canadian city. A randomized, waitlist-control design was used to evaluate the effectiveness of TF-CBT with trauma-exposed school-aged children ( Muller & DiPaolo, 2008). A total of 113 children referred for clinical services and their caregivers completed the Trauma Symptom Checklist for Children ( Briere, 1996) and the Trauma Symptom Checklist for Young Children ( Briere, 2005). Data were collected pre-waitlist, pre-assessment, pre-therapy, post-therapy, and six months after the completion of TF-CBT. The passage of time alone in the absence of clinical services was ineffective in reducing children's posttraumatic symptoms. In contrast, children and caregivers reported significant reductions in children's posttraumatic stress (PTS) following assessment and treatment. The reduction in PTS was maintained at six month follow-up. Findings of the current study support the use of the TF-CBT model in community-based settings in a diverse metropolis. Clinical implications are discussed. Copyright © 2015 Elsevier Ltd.
Child Abuse and Neglect, 50 : 159-170
- Year: 2015
- 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)
Langley, A. K., Gonzalez, A., Sugar, C. A., Solis, D., Jaycox, L.
Objective: To evaluate the feasibility and acceptability of a school-based intervention for diverse children exposed to a range of traumatic events, and to examine its effectiveness in improving symptoms of posttraumatic stress, depression, and anxiety. Method: Participants were 74 schoolchildren (Grades 1-5) and their primary caregivers. All participating students endorsed clinically significant posttraumatic stress symptoms. School clinicians were trained to deliver Bounce Back, a 10-session cognitive-behavioral group intervention. Children were randomized to immediate or delayed (3-month waitlist) intervention. Parent-and child-report of posttraumatic stress and depression, and child report of anxiety symptoms, were assessed at baseline, 3 months, and 6 months. Results: Bounce Back was implemented with excellent clinician fidelity. Compared with children in the delayed condition, children who received Bounce Back immediately demonstrated significantly greater improvements in parent-and child-reported posttraumatic stress and child-reported anxiety symptoms over the 3-month intervention. Upon receipt of the intervention, the delayed intervention group demonstrated significant improvements in parent-and child-reported posttraumatic stress, depression, and anxiety symptoms. The immediate treatment group maintained or showed continued gains in all symptom domains over the 3-month follow-up period (6-month assessment). Conclusions: Findings support the feasibility, acceptability, and effectiveness of the Bounce Back intervention as delivered by school-based clinicians for children with traumatic stress. Implications are discussed.
Journal of Consulting & Clinical Psychology, 83(5) : 853-865
- Year: 2015
- 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)
, Cognitive & behavioural therapies (CBT)
Pfefferbaum, B., Jacobs, A. K., Nitiema, P., Everly, G. S.
INTRODUCTION: Debriefing, a controversial crisis intervention delivered in the early aftermath of a disaster, has not been well evaluated for use with children and adolescents. This report constitutes a review of the child debriefing evidence base.
METHODS: A systematic search of selected bibliographic databases (EBM Reviews, EMBASE, ERIC, Medline, Ovid, PILOTS, PubMed, and PsycINFO) was conducted in the spring of 2014 using search terms related to psychological debriefing. The search was limited to English language sources and studies of youth, aged 0 to 18 years. No time limit was placed on date of publication. The search yielded 713 references. Titles and abstracts were reviewed to select publications describing scientific studies and clinical reports. Reference sections of these publications, and of other literature known to the authors that was not generated by the search, were used to locate additional materials. Review of these materials generated 187 publications for more thorough examination; this assessment yielded a total of 91 references on debriefing in children and adolescents. Only 15 publications on debriefing in children and adolescents described empirical studies. Due to a lack of statistical analysis of effectiveness data with youth, and some articles describing the same study, only seven empirical studies described in nine papers were identified for analysis for this review. These studies were evaluated using criteria for assessment of methodological rigor in debriefing studies.
RESULTS: Children and adolescents included in the seven empirical debriefing studies were survivors of motor-vehicle accidents, a maritime disaster, hostage taking, war, or peer suicides. The nine papers describing the seven studies were characterized by inconsistency in describing the interventions and populations and by a lack of information on intervention fidelity. Few of the studies used randomized design or blinded assessment. The results described in the reviewed studies were mixed in regard to debriefing's effect on posttraumatic stress, depression, anxiety, and other outcomes. Even in studies in which debriefing appeared promising, the research was compromised by potentially confounding interventions.
CONCLUSION: The results highlight the small empirical evidence base for drawing conclusions about the use of debriefing with children and adolescents, and they call for further dialogue regarding challenges in evaluating debriefing and other crisis interventions in children.
Prehospital & Disaster Medicine, 30(3) : 306-315
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Psychological debriefing
Pityaratstian, N., Piyasil, V., Ketumarn, P., Sitdhiraksa, N., Ularntinon, S., Pariwatcharakul, P.
Background: Post-traumatic stress disorder (PTSD) is a common and debilitating consequence of natural disaster in children and adolescents. Accumulating data show that cognitive behavioural therapy (CBT) is an effective treatment for PTSD. However, application of CBT in a large-scale disaster in a setting with limited resources, such as when the tsunami hit several Asian countries in 2004, poses a major problem. Aims: This randomized controlled trial aimed to test for the efficacy of the modified version of CBT for children and adolescents with PSTD. Method: Thirty-six children (aged 10-15 years) who had been diagnosed with PSTD 4 years after the tsunami were randomly allocated to either CBT or wait list. CBT was delivered in 3-day, 2-hour-daily, group format followed by 1-month posttreatment self-monitoring and daily homework. Results: Compared to the wait list, participants who received CBT demonstrated significantly greater improvement in symptoms of PTSD at 1-month follow-up, although no significant improvement was observed when the measures were done immediately posttreatment. Conclusions: Brief, group CBT is an effective treatment for PTSD in children and adolescents when delivered in conjunction with posttreatment self-monitoring and daily homework. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Behavioural & Cognitive Psychotherapy, 43(5) : 549-561
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Martsenkovsky, I., Martsenkovska, I., Martsenkovsky, D.
Introduction: Military action in Ukraine led to increasing in the number of patients with PTSD among children. Open-label studies demonstrated the efficacy of SSRI's for the treatment of PTSD, primarily paroxetine. Feasibility of using of these drugs in children and adolescents is controversial [1-2]. Objective: To evaluate a short and long-term efficacy and tolerability of fluoxetine in the treatment of PTSD in children. Methods: double-blind, placebo-controlled 12-week study with a fixed dose of fluoxetine (20-40 mg). The trial design consisted of 1-week, single-blind, placebo run-in period, followed by a 12-week treatment period and a 2-week taper phase. Were randomized 110 children aged from 12 to 18 years (MD = 14,2), that have been moved from the combat zone in the east of Ukraine and met the DSM-5criterias for PTSD. Drug efficacy was assessed weekly using the CAPS-2; CGI-I / CGI-S. Safety assessed: Adverse event (AE) recording, suicidality assessment. Result: The reduction in CAPS-2 scales was statistically significant among children randomized to fluoxetine treatment compared with placebo in a week 12 endpoint (treatment difference -11.10; 95% Cl- 13.4, -7,38; p <0.001). Significant greater proportion of fluoxetine-treated patient (52%) than placebo-treated (43%) were defined as treatment responders based on CGI scale (adjusted odds ratio = 2.28; 95% Cl 1.75, 2.93; p <0.001). The most common adverse effects in fluoxetine group were somnolence, headache and irritability, each occurring in <20% patients. Conclusion: Fluoxetine at a dose of 20-40 mg / day is more effective than placebo, well-tolerated and can be recommended in pediatric practice.
European Psychiatry, 30 : 1537
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Antidepressants (any)
Martsenkovskyi, D.
Introduction: Military action in Ukraine has led to more than a million displaced persons, many of them children and adolescents. In these children and adolescents there is an increased diagnosis of PTSD. In addition to PTSD, these children and adolescents often fulfill the diagnostic criteria for Attention Deficit Hyperactivity Disorder, Depressive and Anxiety disorders, and Disruptive, Impulse-Control and Conduct Disorders. Open-label studies have demonstrated the efficacy of SSRIs for the treatment of PTSD, primarily paroxetine. The feasibility of using these drugs in children and adolescents is controversial [1-2]. Objective: To evaluate the short- and long-term efficacy and tolerability of fluoxetine in the treatment of PTSD in children. Methods: A double-blind, placebo-controlled 12-week study with a fixed dose of fluoxetine (20-40 mg) was conducted. The trial design consisted of a 1-week, single-blind, placebo run-in period, followed by a 12-week treatment period and a 2-week taper phase.We randomized 110 children aged from 12 to 18 years (median 14.2 years), who were evacuated from the combat zone in eastern Ukraine and who met the DSM-5 criteria for PTSD. Drug efficacy was assessed weekly using the Clinician-Administered PTSD Scale Part 2 (CAPS-2) in clusters (re-experiencing, avoidance/ numbing and hyperarousal), and the Clinical Global Impression Improvement/Severity (CGI-I/CGI-S) scales. Presence of baseline depression was determined using the M.I.N.I. Safety measures: Adverse event (AE) recording, clinical laboratory measures, vital signs parameters, electrocardiograms (ECGs), suicidality assessment, and physical examination. Result: The reduction in CAPS-2 score was significantly different between children randomized to fluoxetine treatment and children receiving placebo in a week-12 endpoint (treatment difference -11.10; 95% CI -13.4, -7.38; p<0.001). A significantly greater proportion of fluoxetine-treated patients (52%) than placebo-treated patients (43%) were treatment responders according to the CGI scale (adjusted odds ratio = 2.28; 95% CI 1.75, 2.93; p<0.001). The most common adverse effects in the fluoxetine group were somnolence, headache and irritability, each occurring in <20% of patients. The effect of fluoxetine in the treatment of PTSD is not solely due to its effect on comorbid depressive symptoms. Fluoxetine is statistically significantly effective in treating PTSD in children and adolescents with and without comorbid depression or depressive symptoms (p <0.001). Fluoxetine is effective in treating all three symptom clusters of PTSD, including the re-experiencing cluster which can be considered to be the most specific for PTSD. Fluoxetine is also effective in patients with PTSD alone and in patients with PTSD and a comorbid condition. There were no significant differences in therapeutic response in these patients. Conclusion: Fluoxetine at a dose of 20-40 mg/day is more effective than placebo, well-tolerated and can be recommended in pediatric practice. More research is needed on the efficacy of combination therapies of fluoxetine and psychological methods of treatment, primarily Trauma Focused CBT and EMDR - desensitization and processing of eye movement and psychoeducational work with primary support group of child.
European Neuropsychopharmacology, 25 : S643-S644
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Antidepressants (any)
Lewis, G. F., Hourani, L., Tueller, S., Kizakevich, P., Bryant, S., Weimer, B., Strange, L.
Decreased heart rate variability (HRV) is associated with posttraumatic stress disorder (PTSD) and depression symptoms, but PTSD's effects on the autonomic stress response and the potential influence of HRV biofeedback in stress relaxation training on improving PTSD symptoms are not well understood. The objective of this study was to examine the impact of a predeployment stress inoculation training (PRESTINT) protocol on physiologic measures of HRV in a large sample of the military population randomly assigned to experimental HRV biofeedback-assisted relaxation training versus a control condition. PRESTINT altered the parasympathetic regulation of cardiac activity, with experimental subjects exhibiting greater HRV, that is, less arousal, during a posttraining combat simulation designed to heighten arousal. Autonomic reactivity was also found to be related to PTSD and self-reported use of mental health services. Future PRESTINT training could be appropriate for efficiently teaching self-help skills to reduce the psychological harm following trauma exposure by increasing the capacity for parasympathetically modulated reactions to stress and providing a coping tool (i.e., relaxation method) for use following a stressful situation. Copyright © 2015 Society for Psychophysiological Research.
Psychophysiology, 52(9) : 1167-1174
- Year: 2015
- 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, Relaxation