Associations between therapist factors and treatment efficacy in randomized controlled trials of trauma-focused cognitive behavioral therapy for children and youth: A systematic review and meta-analysis
Open accessAbstract
Previous research suggests that the effect of therapist factors on patient outcomes is significant. Yet, to date, no reviews have explored the potential effects of therapist characteristics on treatment outcomes for children and youth with posttraumatic stress disorder (PTSD). This systematic review and meta-analysis aimed to summarize the professional characteristics of trial therapists delivering trauma-focused cognitive behavioral interventions (TF-CBT) for child PTSD in clinical trials and understand the association between treatment efficacy and therapist factors. Systematic searches for randomized controlled trials (RCTs) published through November 3, 2020, were conducted; 40 RCTs were included in the full review. PTSD treatment outcome data were extracted from each publication along with any available data regarding trial therapists. Subgroup analyses were conducted to compare the outcomes of interventions conducted by different types of therapists. All therapist groups yielded significant effects for TF-CBT relative to active and passive control conditions, with the largest effect size, Hedges' g = -1.11, for RCTs that used clinical psychologists and psychiatrists. A significant moderating effect was found when comparing the treatment outcomes of clinical psychologists and psychiatrists versus other professionals, p = .044; however, this effect was no longer apparent when only studies with an active control arm were included. Further moderator analyses demonstrated no significant differences regarding therapists' educational and professional backgrounds and PTSD treatment outcomes. The current RCT evidence for TF-CBT for children and youth with PTSD does not suggest that therapist educational or professional background influences treatment efficacy. Limitations and implications for future research are discussed.
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TF-CBT has sustainable long-term benefits in significantly reducing PTSD symptoms compared to control treatments.
“researchers in the study [29] affirm the sustainable long-term benefits of TF-CBT in significantly reducing PTSD symptoms compared to control treatments.”
From Clinical Efficacy of Psychotherapeutic Interventions for Post-Traumatic Stress Disorder in Children and Adolescents: A Systematic Review and Analysis. (2024) · cites this paper as [29]
The Results (Meta-analysis; page unavailable) report that TF-CBT reduced PTSD symptoms more than control conditions in trials of children and youth. But the Methods (Statistical analyses; page unavailable) explicitly say follow-up data were excluded, so this paper does not establish that the benefit was sustained long term. (LLM, conf=0.92)
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Geležėlytė, O., Guogaitė, G., Nomeikaitė, A., Bisson, J. I., Lewis, C., & Kazlauskas, E. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06097-0 · Cited by 4 · see citing works
“The demonstration that Spring users can be guided effectively by therapists without a specific background in formal CBT training would allow easier and less expensive programme implementation into practice [54].”
BackgroundGjerdalen, O. S., Zucknick, M., Westlie, I. T., Bull, H. C., Evensen, S., Falkum, E., Grande, M., Hagen, R., Romm, K. L., Jensen, L. H., et al. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1527549 · Cited by 1 · see citing works
Diržytė, A., Radzevičienė, J., Perminas, A., Vijaikis, A., Kazakevičiūtė, I., Jackevičienė, L., Simonavičiūtė, V., & Kumžaitė, M. (2024) · Preprints.org · doi:10.20944/preprints202404.0033.v1
Smith, C., Ford, C. E. L., Dalgleish, T., Smith, P., McKinnon, A., Goodall, B., Wright, I. M., Pile, V., & Meiser‐Stedman, R. (2024) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465824000444
McGuire, A., Gervasio-Pontarelli, M., Rancher, C. E., Glover, J., & Smith, D. W. (2026) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2026.2694422
- Authors
- Grainger, L., Thompson, Z., Morina, N., Hoppen, T., & Meiser‐Stedman, R.
- Affiliations
- University of East Anglia (GB)
- Department of Psychology University of Münster Münster Germany
- University of Münster (DE)
- Corresponding author
- Grainger, Lauren
- Venue
- Journal of Traumatic Stress
- Publisher
- Wiley
- Published
- 2022-04-27
- Volume
- 35
- Issue
- 5
- Pages
- 1405-1419
- ISSN
- 0894-9867 (ISSN-L)
- 1573-6598
- PMC
- PMC9790492
- OpenAlex
- W4225012912
- Cited by
- 9
- References
- 75
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 5 · 2023: 1 · 2022: 1
- FWCI
- 0.33
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Traumatic Stress (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- trauma-focused cognitive behavioral therapy, therapist factors, clinical psychologists, psychiatrists, treatment efficacy, children and young people, trauma treatment
- MeSH terms
- Adolescent, Child, Humans, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome
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