Disorders - Post Traumatic Stress Disorder
Fu, C., Underwood, C.
Background: Children and adolescents are among the most vulnerable groups affected by natural and man-made disaster. To better understand research and practice concerning mental health and psychosocial support efforts in humanitarian settings, the authors conducted a comprehensive review of all intervention programmes within the past decade that universally targeted children and adolescents who were exposed to a natural and/or man-made disaster. Methods: We searched PubMed, PsychINFO, Cochrane Library and CINAHL for mental health and psychosocial interventions (MHPSS) involving children and adolescents. A total of 11 studies, 4 from natural disasters and 7 from conflict-affected areas met the inclusion criteria. Effect sizes were calculated using a random effects model for studies in post-natural disaster and war/terrorist-affected settings separately. Results: The weighted mean effect sizes for interventions in both settings were statistically significant: -0.308, 95% CI=-0.54- -0.07, z=-2.58, p=0.010 after a natural disaster, and -0.514, 95% CI=-0.80 to -0.23, z=-3.57, p<0.001 in conflict areas. This indicates that MHPSS interventions in both disaster settings resulted in a reduction in PTSD symptoms compared to the control. Conclusions: This review suggests that school-based, universal programmes that are conducted by teachers or local paraprofessionals are effective in reducing PTSD symptoms in children and adolescents. The few studies meeting the inclusion criteria of this study demonstrate the need for further expansion of statistical methods and study designs to test for the effects of interventions in challenging humanitarian settings. Copyright © 2015 NISC Pty Ltd.
Journal of Child and Adolescent Mental Health, 27(3) : 161-171
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
Murray, L. K., Skavenski, S., Kane, J. C., Mayeya, J., Dorsey, S., Cohen, J. A., Michalopoulos, L. T. M., Imasiku, M., Bolton, P. A.,
IMPORTANCE: Orphans and vulnerable children (OVC) are at high risk for experiencing trauma and related psychosocial problems. Despite this, no randomized clinical trials have studied evidence-based treatments for OVC in low-resource settings. OBJECTIVE: To evaluate the effectiveness of lay counselor-provided trauma-focused cognitive behavioral therapy (TF-CBT) to address trauma and stress-related symptoms among OVC in Lusaka, Zambia. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial compared TF-CBT and treatment as usual (TAU) (varying by site) for children recruited from August 1, 2012, through July 31, 2013, and treated until December 31, 2013, for trauma-related symptoms from 5 community sites within Lusaka, Zambia. Children were aged 5 through 18 years and had experienced at least one traumatic event and reported significant trauma-related symptoms. Analysis was with intent to treat. INTERVENTIONS: The intervention group received 10 to 16 sessions of TF-CBT (n = 131). The TAU group (n = 126) received usual community services offered to OVC. MAIN OUTCOMES AND MEASURES: The primary outcome was mean item change in trauma and stress-related symptoms using a locally validated version of the UCLA Posttraumatic Stress Disorder Reaction Index (range, 0-4) and functional impairment using a locally developed measure (range, 0-4). Outcomes were measured at baseline and within 1 month after treatment completion or after a waiting period of approximately 4.5 months after baseline for TAU. RESULTS: At follow-up, the mean item change in trauma symptom score was -1.54 (95% CI, -1.81 to -1.27), a reduction of 81.9%, for the TF-CBT group and -0.37 (95% CI, -0.57 to -0.17), a reduction of 21.1%, for the TAU group. The mean item change for functioning was -0.76 (95% CI, -0.98 to -0.54), a reduction of 89.4%, and -0.54 (95% CI, -0.80 to -0.29), a reduction of 68.3%, for the TF-CBT and TAU groups, respectively. The difference in change between groups was statistically significant for both outcomes (P < .001). The effect size (Cohen d) was 2.39 for trauma symptoms and 0.34 for functioning. Lay counselors participated in supervision and assessed whether the intervention was provided with fidelity in all 5 community settings. CONCLUSIONS AND RELEVANCE: The TF-CBT adapted for Zambia substantially decreased trauma and stress-related symptoms and produced a smaller improvement in functional impairment among OVC having experienced high levels of trauma. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01624298.
JAMA Pediatrics, 169(8) : 761-769
- Year: 2015
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Trauma-focused cognitive behavioural therapy (TF-CBT)
, Other service delivery and improvement interventions
Lenz, A., Hollenbaugh, K.
We evaluated the effectiveness of trauma-focused cognitive behavioral therapy (TF-CBT) for treating posttraumatic stress disorder and co-occurring depression symptoms across 21 between-group studies representing the data of 1,860 children and adolescents (1,106 girls and 754 boys). Separate meta-analytic procedures were conducted for studies that implemented wait-list/no treatment and alternative treatment comparisons to estimate aggregated treatment effect of TF-CBT and moderators of effect size magnitude. Limitations of our findings and implications for counselors are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Counseling Outcome Research & Evaluation, 6(1) : 18-32
- Year: 2015
- 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)
, Trauma-focused cognitive behavioural therapy (TF-CBT)
Ruggiero, K. J., Price, M., Adams, Z., Stauffacher, K., McCauley, J., Danielson, C. K., Knapp, R., Hanson, R. F., Davidson, T. M., Amstadter, A. B., Carpenter, M. J., Saunders, B. E., Kilpatrick, D. G., Resnick, H. S.
Objective: To assess the efficacy of Bounce Back Now (BBN), a modular, Web-based intervention for disaster-affected adolescents and their parents. Method: A population-based randomized controlled trial used address-based sampling to enroll 2,000 adolescents and parents from communities affected by tornadoes in Joplin, MO, and several areas in Alabama. Data collection via baseline and follow-up semi-structured telephone interviews was completed between September 2011 and August 2013. All families were invited to access the BBN study Web portal irrespective of mental health status at baseline. Families who accessed the Web portal were assigned randomly to 1 of 3 groups: BBN, which featured modules for adolescents and parents targeting adolescents' mental health symptoms; BBN plus additional modules targeting parents' mental health symptoms; or assessment only. The primary outcomes were adolescent symptoms of posttraumatic stress disorder (PTSD) and depression. Results: Nearly 50% of families accessed the Web portal. Intent-to-treat analyses revealed time × condition interactions for PTSD symptoms (B = -0.24, SE = 0.08, p <.01) and depressive symptoms (B = -0.23, SE = 0.09, p <.01). Post hoc comparisons revealed fewer PTSD and depressive symptoms for adolescents in the experimental versus control conditions at 12-month follow-up (PTSD: B = -0.36, SE = 0.19, p =.06; depressive symptoms: B = -0.42, SE = 0.19, p = 0.03). A time × condition interaction also was found that favored the BBN versus BBN + parent self-help condition for PTSD symptoms (B = 0.30, SE = 0.12, p =.02) but not depressive symptoms (B = 0.12, SE = 0.12, p =.33). Conclusion: Results supported the feasibility and initial efficacy of BBN as a scalable disaster mental health intervention for adolescents. Technology-based solutions have tremendous potential value if found to reduce the mental health burden of disasters. Clinical trial registration information: Web-based Intervention for Disaster-Affected Youth and Families; http://clinicaltrials.gov; NCT01606514.
Journal of the American Academy of Child & Adolescent Psychiatry, 54(9) : 709-717
- 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: Service Delivery & Improvement, Psychological Interventions (any)
, Psychoeducation, Self-help
, Technology, interventions delivered using technology (e.g. online, SMS)
Ventevogel, P., Spiegel, P.
JAMA, 314(5) : 511-512
- 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)
Tang, T. C., Yang, P., Yen, C. F., Liu, T. L.
In this case-control study, we aimed to assess the intervention effects of foursession eye movement desensitization and reprocessing (EMDR) on reducing the severity of disaster-related anxiety, general anxiety, and depressive symptoms in Taiwanese adolescents who experienced Typhoon Morakot. A total of 83 adolescents with posttraumatic stress disorder related to Typhoon Morakot, major depressive disorder, or current moderate or high suicide risk after experiencing Typhoon Morakot were allocated to a four-session course of EMDR (N=41) or to treatment as usual (TAU; N = 42). A multivariate analysis of covariance was performed to examine the effects of EMDR in reducing the severity of disaster-related anxiety, general anxiety, and depressive symptoms in adolescents by using preintervention severity values as covariates. The multivariate analysis of covariance results indicated that the EMDR group exhibited significantly lower preintervention severity values of general anxiety and depression than did the TAU group. In addition, the preintervention severity value of disaster-related anxiety in the EMDR group was lower than that in the TAU group (p=0.05). The results of this study support that EMDR could alleviate general anxiety and depressive symptoms and reduce disaster-related anxiety in adolescents experiencing major traumatic disasters.
Kaohsiung Journal of Medical Sciences, 31(7) : 363-369
- Year: 2015
- Problem: Anxiety Disorders (any), Post Traumatic Stress Disorder, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Eye movement desensitisation and reprocessing (EMDR)
O’Callaghan, P., Branham, L., Shannon, C., Betancourt, T. S., Dempster, M., McMullen, J.
Rural communities in the Haut-Uele Province of northern Democratic Republic of Congo live in constant danger of attack and/or abduction by units of the Lord's Resistance Army operating in the region. This pilot study sought to develop and evaluate a community-participative psychosocial intervention involving life skills and relaxation training and Mobile Cinema screenings with this war-affected population living under current threat. 159 war-affected children and young people (aged 7 - 18) from the villages of Kiliwa and Li-May in north-eastern DR Congo took part in this study. In total, 22% of participants had been abduction previously while 73% had a family member abducted. Symptoms of post-traumatic stress reactions, internalising problems, conduct problems and pro-social behaviour were assessed by blinded interviewers at pre- and post-intervention and at 3-month follow-up. Participants were randomised (with an accompanying caregiver) to 8 sessions of a group-based, community-participative, psychosocial intervention (n =79) carried out by supervised local, lay facilitators or a wait-list control group (n =80). Average seminar attendance rates were high: 88% for participants and 84% for caregivers. Drop-out was low: 97% of participants were assessed at post-intervention and 88% at 3 month follow-up. At post-test, participants reported significantly fewer symptoms of post-traumatic stress reactions compared to controls (Cohen's d =0.40). At 3 month follow up, large improvements in internalising symptoms and moderate improvements in pro-social scores were reported, with caregivers noting a moderate to large decline in conduct problems among the young people. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)
Child Abuse & Neglect, 38(7) : 1197-1207
- Year: 2014
- 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)
, Skills training, Other Psychological Interventions, Relaxation
Pedersen, E. R., Kaysen, D. L., Lindgren, K. P., Blayney, J., Simpson, T. L.
As more advanced methodologies are developed for symptom assessment in traumatic stress studies, it is important to examine how these methodologies can exacerbate distress or contribute to symptoms among study participants. Using a sample of 202 female college students, we examined the changes in posttraumatic stress disorder (PTSD) symptoms and general psychological symptomatology among groups of trauma-exposed and non-trauma-exposed women randomly assigned to complete 30 days of daily monitoring of traumatic symptoms and substance use behaviors using personal digital assistants (PDAs). These two groups were compared with a trauma-exposed sample of women who did not complete daily monitoring assessments and only completed pre- and post-monitoring online assessments. While trauma-exposed participants in the monitoring group reported more distress from the daily assessments than those in the monitoring group with no history of trauma, this distress level was relatively low. Online surveys delivered pre- and post-monitoring showed a similar pattern. Trauma-exposed participants in monitoring and no-monitoring groups reported a decrease in general psychological symptoms over the 30 days; however, monitoring participants reported increased levels of PTSD severity over time. Closer examination revealed the observed changes were relatively moderate. Participants expressed benefits and risks regarding study participation supporting the findings that repeated assessments of traumatic symptoms using personal handheld devices may lead to small increases in distress and PTSD symptoms, but that these approaches may be generally well tolerated. (copyright) The Author(s) 2013.
Journal of Interpersonal Violence, 29(5) : 824-845
- Year: 2014
- 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
Tol, W. A., Komproe, I. H., Jordans, M. J. D., Ndayisaba, A., Ntamutumba, P., Sipsma, H., Smallegange, E. S., Macy, R. D., de-Jong, J. T. V. M.
Background: Armed conflicts are associated with a wide range of impacts on the mental health of children and adolescents. We evaluated the effectiveness of a school-based intervention aimed at reducing symptoms of posttraumatic stress disorder, depression, and anxiety (treatment aim); and improving a sense of hope and functioning (preventive aim). Methods: We conducted a cluster randomized trial with 329 children in war-affected Burundi (aged 8 to 17 (mean 12.29 years, standard deviation 1.61); 48% girls). One group of children (n = 153) participated in a 15-session school-based intervention implemented by para-professionals, and the remaining 176 children formed a waitlist control condition. Outcomes were measured before, one week after, and three months after the intervention. Results: No main effects of the intervention were identified. However, longitudinal growth curve analyses showed six favorable and two unfavorable differences in trajectories between study conditions in interaction with several moderators. Children in the intervention condition living in larger households showed decreases on depressive symptoms and function impairment, and those living with both parents showed decreases on posttraumatic stress disorder and depressive symptoms. The groups of children in the waitlist condition showed increases in depressive symptoms. In addition, younger children and those with low levels of exposure to traumatic events in the intervention condition showed improvements on hope. Children in the waitlist condition who lived on their original or newly bought land showed improvements in hope and function impairment, whereas children in the intervention condition showed deterioration on these outcomes. Conclusions: Given inconsistent effects across studies, findings do not support this school-based intervention as a treatment for posttraumatic stress disorder and depressive symptoms in conflict-affected children. The intervention appears to have more consistent preventive benefits, but these effects are contingent upon individual (for example, age, gender) and contextual (for example, family functioning, state of conflict, displacement) variables. Results suggest the potential benefit of school-based preventive interventions particularly in post-conflict settings. Trial registration: The study was registered as ISRCTN42284825. (copyright) 2014 Tol et al.; licensee BioMed Central Ltd.
BMC Medicine, 12(1) :
- Year: 2014
- 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
Weiss, N.H., Tull, M. T., Gratz, K. L.
Posttraumatic stress disorder (PTSD) is associated with a wide range of risky behaviors (e.g., substance use and risky sexual behaviors); however, few studies have examined mechanisms that may underlie risky behaviors in this population. The present study utilized a prospective experimental design to examine the effects of emotion dysregulation and impulsivity on risky behaviors across time. Thirty women with sexual assault - related PTSD were randomly assigned to receive emotion modulation (EM), impulsivity reduction (IR), or healthy living (HL; comparison condition) skills trainings. Participants completed measures of emotion dysregulation, impulsivity, and risky behaviors pre-manipulation and 1-month post-manipulation. Participants in the EM and IR conditions reported a significant reduction in risky behaviors from pre- to post-manipulation relative to the HL condition. Changes in emotion dysregulation from pre- to post-manipulation fully accounted for reductions in risky behaviors over time. Results provide preliminary experimental support for the role of emotion dysregulation in risky behaviors. (PsycINFO Database Record (c) 2015 APA, all rights reserved). (journal abstract)
Behavior Modification, 38(6) : 914-939
- Year: 2014
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Scheeringa, M. S., Weems, C. F.
Objective: Research on D-cycloserine (DCS), a partial N-methyl-d-aspartic acid (NMDA) agonist, has suggested that it may enhance exposure-based therapies for anxiety disorders. Results with DCS in adult posttraumatic stress disorder (PTSD) have been conflicting; however, no data have been reported on children with PTSD. Although many individuals with PTSD respond to exposure-based cognitive behavioral therapy (CBT), there are subgroups of individuals who are nonresponders, and many responders still have substantial residual symptoms. This randomized, triple-blind, placebo-controlled study tested DCS as an adjunct to CBT to improve and speed treatment response for PTSD in youth. Methods: Seven to 18 year-old youth with exposure to trauma and PTSD were offered a 12 session, manualized CBT treatment. Those who remained in treatment at the fifth session were randomly allocated (n=57) to either CBT and DCS or CBT and placebo. Results: Youth in the CBT and DCS group had significant reductions in symptoms, but these reductions were not greater than those in the CBT and placebo group. There was a trend toward DCS speeding PTSD symptom recovery during the exposure-based sessions, and evidence that the CBT and DCS group better maintained stability of gains on inattention ratings from posttreatment to the 3 month follow-up. Conclusions: This initial study of CBT and DCS to treat pediatric PTSD provided suggestive and preliminary evidence for more rapid symptom recovery and beneficial effects on attention, but did not show an overall greater effect for reducing PTSD symptoms. It appears that augmentation with DCS represents unique challenges in PTSD. Because PTSD involves complex, life-threatening trauma memories, as opposed to the imagined dreadful outcomes of other anxiety disorders, the use of DCS may require greater attention to how its use is coupled with exposure-based techniques. DCS may have inadvertently enhanced reconsolidation of trauma memories rather than more positive and adaptive memories. In addition, the results suggest that future research could focus on the longer-term benefits of DCS on attention and ways to capitalize on attention-enhancing therapies. ClinicalTrials.gov registry: Effect of D-cycloserine on Treatment of Posttraumatic Stress Disorder (PTSD) in Youth, #NCT01157416, http://clinicaltrials.gov/ct2/results?term=NCT01157416&Search= Search, and D-cycloserine Adjunctive Treatment for Posttraumatic Stress Disorder (PTSD) in Adolescents, #NCT01157429, http://clinicaltrials.gov/ct2/results? term=NCT01157429&Search=Search. (copyright) 2014 Mary Ann Liebert, Inc.
Journal of Child & Adolescent Psychopharmacology, 24(2) : 69-77
- Year: 2014
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, D-cycloserine (DCS)
Newby, J. M., Lang, T., Werner-Seidler, A., Holmes, E., Moulds, M. L.
Negative appraisals maintain intrusive memories and intrusion-distress in depression, but treatment is underdeveloped. This study compared the efficacy of computerised bias modification positive appraisal training (CBM) versus a therapist-delivered cognitive behavioural therapy session (CB-Education) that both aimed to target and alter negative appraisals of a negative intrusive autobiographical memory.Dysphoric participants (Mean BDI-II=27.85; N=60) completed baseline ratings of a negative intrusive memory, negative appraisals and the Impact of Event Scale, and were randomly allocated either one session of CBM, CB-Education, or a no intervention monitoring control condition (Control). Mood and intrusion symptoms were assessed at one week follow-up.For all groups, there were significant reductions over one week in mood (depression and anxiety), memory intrusiveness and negative appraisals. Groups differed in terms of intrusion-related distress, with the CB-Education group showing greatest reduction, followed by the CBM group.The study provides evidence for the link between maladaptive appraisals of intrusive memories and distress in depressed mood. Further, both a single session of CB-Education and (to a lesser degree) CBM are useful in reducing intrusion-related distress. This study may have been underpowered to detect differences and replication is needed with larger samples. (copyright) 2014 The Authors.
Behaviour Research & Therapy, 56(1) : 60-67
- Year: 2014
- 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: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Attention/cognitive bias modification
, Technology, interventions delivered using technology (e.g. online, SMS)