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Cited by 239Posttraumatic Stress Disorder ResearchChild Abuse and TraumaPsychoanalysis and Psychopathology Research

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Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents

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Gillies, Donna, Taylor, Fiona, Gray, Carl, O'Brien, Louise, D'Abrew, Natalie·2012·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd006726.pub2PMC PMC12206555
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Abstract

BACKGROUND: Post-traumatic stress disorder (PTSD) is highly prevalent in children and adolescents who have experienced trauma and has high personal and health costs. Although a wide range of psychological therapies have been used in the treatment of PTSD there are no systematic reviews of these therapies in children and adolescents. OBJECTIVES: To examine the effectiveness of psychological therapies in treating children and adolescents who have been diagnosed with PTSD. SEARCH METHODS: We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to December 2011. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: CENTRAL (the Cochrane Central Register of Controlled Trials) (all years), EMBASE (1974 -), MEDLINE (1950 -) and PsycINFO (1967 -). We also checked reference lists of relevant studies and reviews. We applied no date or language restrictions. SELECTION CRITERIA: All randomised controlled trials of psychological therapies compared to a control, pharmacological therapy or other treatments in children or adolescents exposed to a traumatic event or diagnosed with PTSD. DATA COLLECTION AND ANALYSIS: Two members of the review group independently extracted data. If differences were identified, they were resolved by consensus, or referral to the review team.We calculated the odds ratio (OR) for binary outcomes, the standardised mean difference (SMD) for continuous outcomes, and 95% confidence intervals (CI) for both, using a fixed-effect model. If heterogeneity was found we used a random-effects model. MAIN RESULTS: Fourteen studies including 758 participants were included in this review. The types of trauma participants had been exposed to included sexual abuse, civil violence, natural disaster, domestic violence and motor vehicle accidents. Most participants were clients of a trauma-related support service.The psychological therapies used in these studies were cognitive behavioural therapy (CBT), exposure-based, psychodynamic, narrative, supportive counselling, and eye movement desensitisation and reprocessing (EMDR). Most compared a psychological therapy to a control group. No study compared psychological therapies to pharmacological therapies alone or as an adjunct to a psychological therapy.Across all psychological therapies, improvement was significantly better (three studies, n = 80, OR 4.21, 95% CI 1.12 to 15.85) and symptoms of PTSD (seven studies, n = 271, SMD -0.90, 95% CI -1.24 to -0.42), anxiety (three studies, n = 91, SMD -0.57, 95% CI -1.00 to -0.13) and depression (five studies, n = 156, SMD -0.74, 95% CI -1.11 to -0.36) were significantly lower within a month of completing psychological therapy compared to a control group.The psychological therapy for which there was the best evidence of effectiveness was CBT. Improvement was significantly better for up to a year following treatment (up to one month: two studies, n = 49, OR 8.64, 95% CI 2.01 to 37.14; up to one year: one study, n = 25, OR 8.00, 95% CI 1.21 to 52.69). PTSD symptom scores were also significantly lower for up to one year (up to one month: three studies, n = 98, SMD -1.34, 95% CI -1.79 to -0.89; up to one year: one study, n = 36, SMD -0.73, 95% CI -1.44 to -0.01), and depression scores were lower for up to a month (three studies, n = 98, SMD -0.80, 95% CI -1.47 to -0.13) in the CBT group compared to a control. No adverse effects were identified.No study was rated as a high risk for selection or detection bias but a minority were rated as a high risk for attrition, reporting and other bias. Most included studies were rated as an unclear risk for selection, detection and attrition bias. AUTHORS' CONCLUSIONS: There is evidence for the effectiveness of psychological therapies, particularly CBT, for treating PTSD in children and adolescents for up to a month following treatment. At this stage, there is no clear evidence for the effectiveness of one psychological therapy compared to others. There is also not enough evidence to conclude that children and adolescents with particular types of trauma are more or less likely to respond to psychological therapies than others.The findings of this review are limited by the potential for methodological biases, and the small number and generally small size of identified studies. In addition, there was evidence of substantial heterogeneity in some analyses which could not be explained by subgroup or sensitivity analyses.More evidence is required for the effectiveness of all psychological therapies more than one month after treatment. Much more evidence is needed to demonstrate the relative effectiveness of different psychological therapies or the effectiveness of psychological therapies compared to other treatments. More details are required in future trials in regards to the types of trauma that preceded the diagnosis of PTSD and whether the traumas are single event or ongoing. Future studies should

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  1. Dominguez RZ Evaluation of cognitive-behavioral and supportive treatments for sexually abused children: Analyzing the process of change using individual growth curve analyses Dissertation Abstracts International 2001 5370
  2. Ehntholt K A Smith P Yule W School-based CBT group intervention for refugee children who have experienced war-related trauma 31st Annual Conference of the British Association for Behavioural and Cognitive Psychotherapies; 2003 July 16 - 19, York 2003
  3. Jaberghaderi, 2002, A comparison of CBT and EMDR for sexually-abused Iranian girls
  4. Jeffres MJ The efficacy of EMDR with traumatized children Dissertation Abstracts International 2004 4042
  5. Shelby JS Crisis intervention with children following Hurricane Andrew: a comparison of two treatment approaches Dissertation Abstracts International 1995 1121
  6. Stallard P Velleman R Salter E Howse I Yule W Taylor G A randomised controlled trial to determine the effectiveness of an early intervention with child trauma victims 31st Annual Conference of the British Association for Behavioural and Cognitive Psychotherapies; 2003 July 16 - 19, York 2003 83
  7. Trowell, 1995, Design and Methodological Issues In Setting Up A Psychotherapy Outcome Study With Girls Who Have Been Sexually Abused
  8. Wang, 2011, Effects of group intervention on depression and post-traumatic stress symptoms among junior middle school students in earthquake area, Chinese Mental Health Journal, 25, 284
  9. Achenbach, 1983, Manual for the Child Behavior Checklist
  10. Spielberger, 1973, Manual for the State-Trait Anxiety Inventory for Children
  11. World Health Organization, 1990, Chapter V: Mental and Behavioural Disorders (F40-F48)

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Metadata

Authors
Gillies, D., Taylor, F., Gray, C., O'Brien, L., & D'Abrew, N.
Affiliations
  • Cumberland Hospital (AU)
  • Sydney West Area Mental Health Service; Prevention, Early Intervention and Recovery Service; 2A Fennell Street Parramatta NSW Australia 2150
  • Western Sydney Local Health Network, New South Wales Health Service; Department of Child and Adolescent Psychiatry; Redbank House Institute Road Westmead NSW Australia 2145
  • University of Newcastle and Greater Western Area Health Service, New South Wales Health Service; School of Nursing and Midwifery; Bloomfield Campus, Centre for Rural and Remote Mental Health Locked Bag 6005 Orange NSW Australia 2800
  • Sydney School of Nursing, University of Sydney and Sydney Cancer Centre, Royal Prince Alfred Hospital; Cancer Nursing Research Unit; Level 6, Gloucester House Royal Prince Alfred Hospital, Missenden Road Camperdown NSW Australia 2050
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2012-12-12
Volume
2012
Issue
12
Pages
1004-116
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd006726.pub2
PMC
PMC12206555
OpenAlex
W2009426981
Cited by
239
References
131
Citations by year
2026: 2 · 2025: 7 · 2024: 8 · 2023: 6 · 2022: 11 · 2021: 37 · 2020: 22 · 2019: 21 · 2018: 17 · 2017: 25 · 2016: 25 · 2015: 23 · 2014: 24 · 2013: 9
FWCI
2.61
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Figshare (submittedVersion)
  • NOVA (University of Newcastle Australia) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
post-traumatic stress disorder, children, adolescents, psychotherapy, cognitive behavioral therapy, exposure therapy, EMDR, psychodynamic psychotherapy, narrative therapy, supportive counseling, trauma exposure, sexual abuse, domestic violence, natural disasters, motor vehicle accidents, civil violence, treatment effectiveness, symptom relief, anxiety, depression
MeSH terms
Adolescent, Child, Child, Preschool, Female, Humans, Male, Psychotherapy, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic

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