Disorders - Post Traumatic Stress Disorder
Punamaki, R. L., Peltonen, K., Diab, M., Qouta, S. R.
Emotion regulation (ER) is crucial for children's mental health in general and traumatic stress in particular. Therefore, therapeutic interventions for posttraumatic stress symptoms (PTSS) address ER in various ways. We examined whether a psychosocial intervention (Teaching Recovery Techniques; TRT) could increase functional ER and decrease dysfunctional ER, and whether the positive ER change mediates the intervention effects on children's mental health in a war context. Participants were 482 Palestinian children (girls 49.4%; 10-13 years, M = 11.29, SD =.68) who were randomized either to the TRT or the waiting-list control groups. They reported emotion regulation (ERQ; Rydell, Thorell, & Bohlin, 2007), PTS (CRIES-R), depressive (Birleson, Hudson, Gray-Buchanan, & Wolff, 1987), and psychological distress (SDQ) symptoms and psychosocial well-being at baseline (T1), postintervention at 3 months (T2), and the 9-month follow-up (T3). Results show that the TRT intervention was not effective in changing ER, but there was a general decrease in ER intensity. ER did not mediate the intervention effects on children's mental health, but the decrease in the ER intensity was associated with better mental health, indicated by the decrease in posttraumatic, depressive, and distress symptoms and the increase in psychosocial well-being.
Acta Anaesthesiologica Belgica, 20(4) : 241-252
- Year: 2014
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- 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)
, Other Psychological Interventions
Ormhaug, S. M., Jensen, T. K., Wentzel-Larsen, T., Shirk, S. R.
Objective: We examined the contribution of alliance to the outcome of therapy with traumatized youths across two different treatment conditions (trauma-focused cognitive behavioral therapy [TF-CBT] and therapy as usual [TAU]). Method: Participants were 156 youths (M age = 15.1 years, range = 10-18; 79.5% girls), randomly assigned to TF-CBT or TAU. Symptoms were assessed pretreatment, midtreatment (Session 6), and posttreatment (Session 15). Alliance was assessed after Sessions 1 and 6, using the Therapeutic Alliance Scale for Children - Revised (TASC-R). Results: Alliance scores were comparable across treatment conditions, but TF-CBT participants had significantly lower posttraumatic stress symptoms (PTSS) posttreatment (d = 0.51). Hierarchical regression analyses showed that there were no significant alliance effects in models without an Alliance null Treatment Group interaction: Alliance ratings were significant predictors of reduction in PTSS (Est. = -0.53, p =.003, 95% confidence interval [CI] = -0.87 to -0.18) and additional outcomes measured in TF-CBT but not in TAU (PTSS posttreatment: Est. = 0.01, p =.647, 95% CI = -0.29 to 0.47). Conclusion: This study was the first to investigate the contribution of alliance to outcome among adolescents with posttraumatic symptoms, treated with TF-CBT or TAU. Our findings indicated that there was an important interaction between alliance and therapeutic approach, as alliance predicted outcome in TF-CBT, but not in the nonspecific treatment condition. A positive working relationship appeared to be especially important in the context of this evidence-based treatment, which requires youth involvement in specific therapy tasks. Further, findings showed that use of a manual did not compromise alliance formation. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (copyright) 2013 American Psychological Association.
Journal of Consulting & Clinical Psychology, 82(1) : 52-64
- Year: 2014
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Trauma-focused cognitive behavioural therapy (TF-CBT)
Pfefferbaum, B., Newman, E., Nelson, S. D.
Objective: The purpose of this review is to describe interventions used with children who are exposed to disasters and terrorism and to present information about the potential benefits of these interventions. Methods: A literature search conducted in January 2013 using relevant databases and literature known to the authors that was not generated by the search yielded a total of 85 studies appropriate for review. Results: Intervention approaches used with children exposed to disasters and terrorism included preparedness interventions, psychological first aid, psychological debriefing, psychoeducation, cognitive behavioral techniques, exposure and narrative techniques, eye movement desensitization and reprocessing, and traumatic grief interventions. The investigation of these interventions is complex, and studies varied in methodological rigor (e.g., sample size, the use of control groups, outcomes measured). Conclusions: Given the limitations in the currently available empirical information, this review integrates the literature, draws tentative conclusions about the current state of knowledge, and suggests future directions for study. (copyright) Mary Ann Liebert, Inc.
Journal of Child & Adolescent Psychopharmacology, 24(1) : 24-31
- Year: 2014
- 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: Psychological Interventions (any)
Newman, E., Pfefferbaum, B., Kirlic, N., Tett, R., Nelson, S., Liles, B.
Although many post-disaster interventions for children and adolescent survivors of disaster and terrorism have been created, little is known about the effectiveness of such interventions. Therefore, this meta-analysis assessed PTSD outcomes among children and adolescent survivors of natural and man-made disasters receiving psychological interventions. Aggregating results from 24 studies (total N = 2630) indicates that children and adolescents receiving psychological intervention fared significantly better than those in control or waitlist groups with respect to PTSD symptoms. Moderator effects were also observed for intervention package, treatment modality (group vs. individual), providersnull level of training, intervention setting, parental involvement, participant age, length of treatment, intervention delivery timing, and methodological rigor. Findings are discussed in detail with suggestions for practice and future research.
Current Psychiatry Reports, 16(9) :
- Year: 2014
- 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: Psychological Interventions (any)
Kuckertz, J. M., Amir, N., Boffa, J. W., Warren, C. K., Rindt, S. E. M., Norman, S., Ram, V., Ziajko, L., Webb-Murphy, J., McLay, R.
Attention bias modification (ABM) may be an effective treatment for anxiety disorders (Beard, Sawyer, & Hofmann, 2012). As individuals with PTSD possess an attentional bias towards threat-relevant information ABM may prove effective in reducing PTSD symptoms. We examined the efficacy of ABM as an adjunct treatment for PTSD in a real-world setting. We administered ABM in conjunction with prolonged exposure or cognitive-processing therapy and medication in a community inpatient treatment facility for military personnel diagnosed with PTSD. Participants were randomized to either ABM or an attention control condition (ACC). While all participants experienced reductions in PTSD symptoms, participants in the ABM group experienced significantly fewer PTSD and depressive symptoms at post-treatment when compared to the ACC group. Moreover, change in plasticity of attentional bias mediated this change in symptoms and initial attentional bias moderated the effects of the treatment. These results suggest that ABM may be an effective adjunct treatment for PTSD.
Behaviour Research & Therapy, 63 : 25-35
- Year: 2014
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Attention/cognitive bias modification
Jacob, N., Neuner, F., Maedl, A., Schaal, S., Elbert, T.
Background: Dissemination of psychotherapeutic modules to local counselors seems a key requirement for coping with mental health disasters in conflict regions. We tested a trainthe- trainer (TTT) dissemination model for the treatment of posttraumatic stress disorder (PTSD).
Methods: We randomly assigned widowed or orphaned survivors of the 1994 Rwandan genocide with a PTSD diagnosis to narrative exposure therapy (NET) treatment (NET-1, n = 38) or to a 6-month waiting list (WL) condition to be followed by treatment (WL/ NET-2, n = 38). Expert therapists trained a first dissemination generation of local Rwandan psychologists in NET complemented by 2 sessions of interpersonal psychotherapy modules. Under the supervision of the experts, these Rwandan psychologists (a) provided NET to the NET-1 participants and (b) subsequently trained and supervised a second generation of local psychologists. This second dissemination generation provided treatment to the WL/NET-2 group. The primary outcome measure was the Clinician-Administered PTSD Scale total score before therapy and at 3- and 12-month follow-ups.
Results: At the 3-month follow-up, the NET-1 participants suffered significantly and substantially less from PTSD symptoms than the participants in the WL group. The treatment gains of NET-1 were maintained and increased at follow-up, with a within-group effect size of Cohen's d = 1.47 at the 12-month follow-up. After treatment by the second dissemination generation of therapists, the WL/NET-2 participants improved to an extent similar to that of the NET-1 group at follow-ups, with an effect size of Cohen's d = 1.37 at the 12-month follow-up.
Conclusions: A TTT model of PTSD treatment dissemination can be effective in resourcepoor postconflict societies.
Psychotherapy & Psychosomatics, 83(6) : 354-363
- Year: 2014
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Narrative exposure therapy (NET)
Jensen, T. K., Holt, T., Ormhaug, S. M., Egeland, K., Granly, L., Hoaas, L. C., Hukkelberg, S. S., Indregard, T., Stormyren, S. D., Wentzel-Larsen, T.
The efficacy of trauma-focused cognitive behavioral therapy (TF-CBT) has been shown in several randomized controlled trials. However, few trials have been conducted in community clinics, few have used therapy as usual (TAU) as a comparison group, and none have been conducted outside of the United States. The objective of this study was to evaluate the effectiveness of TF-CBT in regular community settings compared with TAU. One hundred fifty-six traumatized youth (M age = 15.1 years, range = 10-18; 79.5% girls) were randomly assigned to TF-CBT or TAU. Intent-to-treat analysis using mixed effects models showed that youth receiving TF-CBT reported significantly lower levels of posttraumatic stress symptoms (est. = 5.78, d = 0.51), 95% CI [2.32, 9.23]; depression (est. = 7.00, d = 0.54), 95% CI [2.04, 11.96]; and general mental health symptoms (est. = 2.54, d = 0.45), 95% CI [0.50, 4.58], compared with youth in the TAU group. Youth assigned to TF-CBT showed significantly greater improvements in functional impairment (est. = -1.05, d = -0.55), 95% CI [-1.67, -0.42]. Although the same trend was found for anxiety reduction, this difference was not statistically significant (est. = 4.34, d = 0.30), 95% CI [-1.50, 10.19]. Significantly fewer youths in the TF-CBT condition were diagnosed with posttraumatic stress disorder compared to youths in the TAU condition, (chi)2(1, N = 116) = 4.61, p =.031, Phi =.20). Findings indicate that TF-CBT is effective in treating traumatized youth in community mental health clinics and that the program may also be successfully implemented in countries outside the United States. (copyright) 2014 Copyright Tine K. Jensen, Tonje Holt, Silje M. Ormhaug, Karina Egeland, Lene Granly, Live C. Hoaas, Silje S. Hukkelberg, Tore Indregard, Shirley D. Stormyren, and Tore Wentzel-Larsen.
Journal of Clinical Child & Adolescent Psychology, 43(3) : 356-369
- Year: 2014
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- 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)
, Trauma-focused cognitive behavioural therapy (TF-CBT)
Joseph, J. S., Gray, M. J.
Efforts to regain a sense of safety and security following a highly distressing life event are commonly observed. The attribution process is one such effort that has been studied extensively in the context of posttraumatic stress disorder (PTSD). The content of causal explanations often receives attention as a risk factor for PTSD, even though there is some disagreement regarding what constitutes a harmful attribution. Recently, degree of flexibility in generating causal explanations has been examined as well. Prevention and intervention efforts targeting explanatory style and flexibility for depression populations have found success. However, this approach has yet to be evaluated among PTSD populations. Randomized assignment to immediate treatment or a delayed treatment control group was used to provide information about the efficacy of attribution retraining. Intervention resulted in significant alterations in causal attributions that were associated with large decreases in PTSD symptoms. Implications of these findings and suggestions for future research are presented and discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)
Psychological Trauma: Theory, Research, Practice, & Policy, 6(6) : 708-715
- 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: Psychological Interventions (any)
, Other Psychological Interventions
Brownlow, J. A., McLean, C. P., Gehrman, P. R., Ross, R. J., Foa, E. B.
Introduction: Chronic insomnia and nightmares are prominent features of posttraumatic stress disorder (PTSD). There is evidence that these sleep disturbances may not respond to trauma-focused therapies for PTSD and may be associated with poor functional outcomes. Little is known about the effects of trauma-focused treatment on sleep disturbance and general functioning in adolescents with PTSD. The present study examined the effects of trauma-focused therapy on sleep-related PTSD symptoms, and the effect of disturbed sleep on general functioning. Methods: Sixty-one adolescent females ages 13-18 (M = 15.34, SD = 1.54) seeking treatment at a rape crisis center for PTSD related to sexual assault participated in a single-blind randomized clinical trial of prolonged exposure for adolescents (PE-A; n = 30) compared to clientcentered therapy (CCT; n = 31). Both treatments consisted of fourteen 60-90 minute sessions. The Child PTSD Symptom Scale-Interview (CPSS-I) was used to diagnosis PTSD and to assess frequency of insomnia and nightmares; it was completed at baseline, post-treatment, and at 6- and 12- months follow-ups. The Children's Global Assessment Scale (CGAS) was used to assess general functioning. The CPSS-I and CGAS were administered by independent evaluators who were blind to participants' treatment condition. Results: General Linear Model (GLM) repeated measures analyses were conducted on insomnia and nightmare symptoms with treatment condition (PE-A/CCT) as the between subjects variable. No signiicant time by condition interactions were found; however, statistically and clinically signiicant effects of time (p < .001) were found for frequency of nightmares and insomnia, with symptoms decreasing from baseline to post-treatment. Both nightmare and insomnia symptoms signiicantly predicted general functioning and accounted for 20.3%-28.9% of the variance in this measure over time. Conclusion: Both treatments produced signiicant improvements in sleep-related PTSD symptoms; however, these sleep symptoms continued to impair general functioning over time.
Sleep, 37 : A273
- Year: 2014
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Other Psychological Interventions
Beyer, J. A., Lumley, M. A., Latsch, D. V., Oberleitner, L. M., Carty, J. N., Radcliffe, A. M.
Standard written emotional disclosure (WED) about stress, which is private and unguided, yields small health benefits. The effect of providing individualized guidance to writers may enhance WED, but has not been tested. This trial of computer-based WED compared two novel therapist-guided forms of WED - advance guidance (before sessions) and real-time guidance (during sessions, through instant messaging) - to both standard WED and control writing; it also tested Big 5 personality traits as moderators of guided WED. Young adult participants (n = 163) with unresolved stressful experiences were randomized to conditions, had three, 30-min computer-based writing sessions, and were reassessed six weeks later. Contrary to hypotheses, real-time guidance WED had poorer outcomes than the other conditions on several measures, and advance guidance WED also showed some poorer outcomes. Moderator analyses revealed that participants with low baseline agreeableness, low extraversion, or high conscientiousness had relatively poor responses to guidance. We conclude that providing guidance for WED, especially in real-time, may interfere with emotional processing of unresolved stress, particularly for people whose personalities have poor fit with this interactive form of WED.
Anxiety, Stress & Coping, 27(5) : 477-493
- 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)
, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Chen, Y-R., Hung, K-W., Tsai, J-C., Chung, M-H., Chen, S-R., Liao, Y-M., Ou, K-L., Chang, Y-C., Chou, K-R.,
Background: We performed the first meta-analysis of clinical studies by investigating the effects of eye-movement desensitization and reprocessing (EMDR) therapy on the symptoms of posttraumatic stress disorder (PTSD), depression, anxiety, and subjective distress in PTSD patients treated during the past 2 decades.; Methods: We performed a quantitative meta-analysis on the findings of 26 randomized controlled trials of EMDR therapy for PTSD published between 1991 and 2013, which were identified through the ISI Web of Science, Embase, Cochrane Library, MEDLINE, PubMed, Scopus, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature electronic databases, among which 22, 20, 16, and 11 of the studies assessed the effects of EMDR on the symptoms of PTSD, depression, anxiety, and subjective distress, respectively, as the primary clinical outcome.; Results: The meta-analysis revealed that the EMDR treatments significantly reduced the symptoms of PTSD (g = -0.662; 95% confidence interval (CI): -0.887 to -0.436), depression (g = -0.643; 95% CI: -0.864 to -0.422), anxiety (g = -0.640; 95% CI: -0.890 to -0.390), and subjective distress (g = -0.956; 95% CI: -1.388 to -0.525) in PTSD patients.; Conclusion: This study confirmed that EMDR therapy significantly reduces the symptoms of PTSD, depression, anxiety, and subjective distress in PTSD patients. The subgroup analysis indicated that a treatment duration of more than 60 min per session was a major contributing factor in the amelioration of anxiety and depression, and that a therapist with experience in conducting PTSD group therapy was a major contributing factor in the reduction of PTSD symptoms.;
PLoS ONE, 9(8) : e103676-e103676
- Year: 2014
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Eye movement desensitisation and reprocessing (EMDR)
Chen, Y., Shen, W. W., Gao, K., Lam, C. S., Chang, W. C., Deng, H.
Objective: Many children who lost parents in the 2008 earthquake in Sichuan Province China, experienced symptoms of posttraumatic stress disorder (PTSD) and depression. This randomized controlled study compared the treatment effectiveness of short-termcognitivebehavioral therapy (CBT) with a general supportive intervention and with a control group of nontreatment. Methods: Thirty-two Chinese adolescents were randomly assigned to three treatment groups. Participants were compared for psychological resilience (Connor-Davidson Resilience Scale), symptoms of PTSD (Children's Revised Impact of Events Scale), and depression (Center for Epidemiologic Studies Depression Scale) at baseline, after treatment, and three-month follow-up. Results: CBT was effective in reducing PTSD and depressive symptoms and improved psychological resilience. General support was more effective than no intervention in improving psychological resilience. Conclusions: Short-term CBT group intervention seems to be a robust intervention for natural disaster victims. Shortterm CBT group intervention was more effective than the general supportive intervention and the notreatment group in enhancing psychological resilience and reducing PTSD and depression among adolescents who had lost parents in the earthquake. The general supportive intervention was effective only in improving psychological resilience.
Psychiatric Services, 65(2) : 259-262
- Year: 2014
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Supportive therapy