A Multisite, Randomized Controlled Trial for Children With Sexual Abuse–Related PTSD Symptoms
Open accessAbstract
Objective To examine the differential efficacy of trauma-focused cognitive-behavioral therapy (TF-CBT) and child-centered therapy for treating posttraumatic stress disorder (PTSD) and related emotional and behavioral problems in children who have suffered sexual abuse.Method Two hundred twenty-nine 8- to 14-year-old children and their primary caretakers were randomly assigned to the above alternative treatments. These children had significant symptoms of PTSD, with 89% meeting full DSM-IV PTSD diagnostic criteria. More than 90% of these children had experienced traumatic events in addition to sexual abuse.Results A series analyses of covariance indicated that children assigned to TF-CBT, compared to those assigned to child-centered therapy, demonstrated significantly more improvement with regard to PTSD, depression, behavior problems, shame, and abuse-related attributions. Similarly, parents assigned to TF-CBT showed greater improvement with respect to their own self-reported levels of depression, abuse-specific distress, support of the child, and effective parenting practices.Conclusions This study adds to the growing evidence supporting the efficacy of TF-CBT with children suffering PTSD as a result of sexual abuse and suggests the efficacy of this treatment for children who have experienced multiple traumas.
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Cognitive behavioral therapy (CBT) including trauma exposure techniques has proven effective for child victims of sexual abuse and other forms of violence.
“In particular, cognitive behavioral therapy (CBT) including trauma exposure techniques has proven to be effective for child victims of sexual abuse [8-10] and other forms of violence [11,12].”
From Treating children traumatized by war and tsunami: a comparison between exposure therapy and meditation-relaxation in north-east Sri Lanka (2009) · cites this paper as [8]
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“TF-CBT was evaluated in five studies [13, 14, 16, 24, 76].”
BackgroundMethodInfluentialCollin‐Vézina, D., Coleman, K., Milne, L., Sell, J., & Daigneault, I. (2011) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-011-9323-8 · Cited by 232 · see citing works
“Several empirical studies have demonstrated the efficacy of TF-CBT in reducing PTSD symptoms, symptoms of depression and behavioral problems amongst children who have experienced sexual abuse (See Cohen et al. (2004) for a recent randomized controlled trial directly related to the TF-CBT model).”
Cary, C. E., & McMillen, J. C. (2012) · Children and Youth Services Review · doi:10.1016/j.childyouth.2012.01.003 · Cited by 231 · see citing works
Dyregrov, A., & Yule, W. (2006) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2005.00384.x · Cited by 217 · see citing works
Filial Dependency and Recantation of Child Sexual Abuse Allegations
Malloy, L. C., Lyon, T. D., & Quas, J. A. (2007) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000246067.77953.f7 · Cited by 229 · see citing works
“Intervention research indicates that caregiver supportiveness can be increased by direct instruction on appropriate responses (e.g., Jinich and Litrownik, 1999) and involving caregivers in children_s therapy (e.g., Cohen et al., 2004).”
BackgroundFoa, E., Gillihan, S. J., & Bryant, R. (2013) · Psychological Science in the Public Interest · doi:10.1177/1529100612468841 · Cited by 211 · see citing works
Murray, L. K., Skavenski, S. V. W., Kane, J. C., Mayeya, J., Dorsey, S., Cohen, J., Michalopoulos, L., Imasiku, M. L., & Bolton, P. A. (2015) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2015.0580 · Cited by 217 · see citing works
Self-citationWethington, H. R., Hahn, R. A., Fuqua-Whitley, D. S., Ma, Sipe, T., Crosby, A., Johnson, R. L., Liberman, A., Mościcki, E., Price, L. N., et al. (2008) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2008.06.024 · Cited by 123 · see citing works
Prolonged Exposure Versus Dynamic Therapy for Adolescent PTSD: A Pilot Randomized Controlled Trial
Gilboa‐Schechtman, E., Foa, E. B., Shafran, N., Aderka, I. M., Powers, M. B., Rachamim, L., Rosenbach, L., Yadin, E., & Apter, A. (2010) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2010.07.014 · Cited by 197 · see citing works
Lewis, T. H., McElroy, E. M., Harlaar, N., & Runyan, D. K. (2015) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2015.11.016 · Cited by 195 · see citing works
A Pilot Study of Modified Cognitive-Behavioral Therapy for Childhood Traumatic Grief (CBT-CTG)
Cohen, J. A., Mannarino, A. P., & STARON, V. R. (2006) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000237705.43260.2c · Cited by 189 · see citing works
“Cohen et al. (2004) demonstrated that significant improvement in PTSD symptoms and adaptive functioning occurred only during the trauma-focused treatment module (first eight sessions) of this protocol, whereas CTG significantly improved during both the traumafocused module and grief-focused module…”
BackgroundResultInfluentialSelf-citationMetzger, I. W., Anderson, R. E., Are, F., & Ritchwood, T. (2021) · Child Maltreatment · doi:10.1177/1077559520921457 · Cited by 189 · see citing works
“…the limited literature exploring racial differences does not indicate significant disparities in TF-CBT treatment outcomes between racial groups (Cohen et al., 2004; Weiner et al., 2009), individuals from traditionally marginalized groups may be at increased risk of trauma exposure (López et…”
BackgroundTrauma focused CBT for children with co-occurring trauma and behavior problems
Cohen, J. A., Berliner, L., & Mannarino, A. (2010) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2009.12.003 · Cited by 188 · see citing works
Self-citationHetzel‐Riggin, M. D., Brausch, A. M., & Montgomery, B. S. (2007) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2006.10.007 · Cited by 180 · see citing works
Trauma-Focused Cognitive-Behavioral Therapy for Children
Mannarino, A. P., Cohen, J. A., Deblinger, E., Runyon, M. K., & Steer, R. A. (2012) · Child Maltreatment · doi:10.1177/1077559512451787 · Cited by 184 · see citing works
Self-citationTreating Childhood Traumatic Grief: A Pilot Study
Cohen, J. A., Mannarino, A. P., & Knudsen, K. J. (2004) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000135620.15522.38 · Cited by 180 · see citing works
Self-citationRathbone, A. L., Clarry, L., & Prescott, J. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.8598 · Cited by 158 · see citing works
“CBT has shown effectiveness for treating both children [15] and adults [16] suffering from posttraumatic stress disorder (PTSD).”
TOL, W. A., KOMPROE, I. H., JORDANS, M. J. D., VALLIPURAM, A., SIPSMA, H., SIVAYOKAN, S., MACY, R. D., & DE JONG, J. T. (2012) · World Psychiatry · doi:10.1016/j.wpsyc.2012.05.008 · Cited by 176 · see citing works
“78 for depressive symptoms in earlier intervention outcome studies which applied the same instruments (30,31).”
Weiner, D. A., Schneider, A., & Lyons, J. S. (2009) · Children and Youth Services Review · doi:10.1016/j.childyouth.2009.08.013 · Cited by 177 · see citing works
“Though not developed only for minority youth, these treatments were all tested among diverse populations of children (Cohen et al., 2004; DeRosa and Pelcovitz, 2006; Habib, Labruna, DeRosa, Sunday, Pelcovitz, & Kaplan, 2008; Lieberman et al., 2005).”
BackgroundUnderstanding the Behavioral and Emotional Consequences of Child Abuse
Stirling, J., Amaya-Jackson, L. M., & Amaya-Jackson, L. M. (2008) · PEDIATRICS · doi:10.1542/peds.2008-1885 · Cited by 176 · see citing works
Treatment for childhood refugee trauma: A randomized, controlled trial.
Schottelkorb, A. A., Doumas, D. M., & Garcia, R. (2012) · International Journal of Play Therapy · doi:10.1037/a0027430 · Cited by 175 · see citing works
Calhoun, C. D., Stone, K. J., Cobb, A. R., Patterson, M. W., Danielson, C. K., & Bendezú, J. J. (2022) · Psychiatric Quarterly · doi:10.1007/s11126-022-10003-w · Cited by 199 · see citing works
“For instance, incorporating a caregiver to both model and promote coping has become an important element of empirically supported treatments for youth, such as Trauma-Focused Cognitive Behavior Therapy (TF-CBT) [106] and Risk Reduction through Family Therapy (RRFT) [107].”
BackgroundTol, W. A., Komproe, I. H., Jordans, M. J., Ndayisaba, A., Ntamutumba, P., Sipsma, H., Smallegange, E. S., Macy, R. D., & de Jong, J. T. (2014) · BMC Medicine · doi:10.1186/1741-7015-12-56 · Cited by 170 · see citing works
“78 for depressive symptoms [27,28], a twosided α equal to 0.”
Posttraumatic Stress Disorder in Maltreated Youth: A Review of Contemporary Research and Thought
Kearney, C. A., Wechsler, A., Kaur, H., & Lemos-Miller, A. (2010) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-009-0061-4 · Cited by 169 · see citing works
“Cohen et al. (2004) examined 203 youths with sexual abuse-related PTSD who attended at least 3 sessions of trauma-focused cognitive-behavioral therapy or a control condition of client-centered therapy.”
Diehle, J., Opmeer, B. C., Boer, F., Mannarino, A. P., & Lindauer, R. (2014) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-014-0572-5 · Cited by 170 · see citing works
Self-citationFoa, E. B., McLean, C. P., Capaldi, S., & Rosenfield, D. (2013) · JAMA · doi:10.1001/jama.2013.282829 · Cited by 194 · see citing works
Psychosocial interventions for maltreated and violence-exposed children
Cohen, J., Mannarino, A., Murray, L., & Igelman, R. (2006) · Journal of Social Issues · doi:10.1111/j.1540-4560.2006.00485.x · Cited by 174 · see citing works
“Thus, an optimal intervention for school-aged children with PTSD related to sexual abuse is likely to be effective for school-aged children with PTSD related to community violence as well (Cohen et al., 2004; Saunders, 2003).”
BackgroundSelf-citationThe prevalence of unwanted online sexual exposure and solicitation among youth: A meta-analysis
Madigan, S., Villani, V., Azzopardi, C., Laut, D., Smith, T., Temple, J. R., Browne, D., & Dimitropoulos, G. (2018) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2018.03.012 · Cited by 164 · see citing works
An evaluation of trauma focused cognitive behavioral therapy for children in Zambia
Murray, L. K., Familiar, I., Skavenski, S. V. W., Jere, E., Cohen, J., Imasiku, M. L., Mayeya, J., Bass, J., & Bolton, P. A. (2013) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2013.04.017 · Cited by 160 · see citing works
Self-citationFord, J. D., Steinberg, K. L., Hawke, J. M., Levine, J., & Zhang, W. (2012) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2012.632343 · Cited by 162 · see citing works
“Consistent with this view, TF-CBT contraindicates trauma memory narrative work if the youth is continuing to experience actual or threatened traumatic events, in order to not inadvertently increase the distress associated with trauma memories (Cohen et al., 2004).”
Cognitive-behavioural interventions for children who have been sexually abused
Macdonald, G., Higgins, J. P., Ramchandani, P., Valentine, J. C., Bronger, L. P., Klein, P., O'Daniel, R., Pickering, M., Rademaker, B., Richardson, G., et al. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001930.pub3 · Cited by 161 · see citing works
Kid's stuff: The nature and impact of peer and sibling violence on younger and older children
David Finkelhor, B., Turner, H. A., & Ormrod, R. K. (2006) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2006.06.006 · Cited by 160 · see citing works
Greca, A. M. L., & Silverman, W. K. (2009) · Child Development Perspectives · doi:10.1111/j.1750-8606.2008.00069.x · Cited by 157 · see citing works
Characteristics of child physical and sexual abuse as predictors of psychopathology
Adams, J., Mrug, S., & Knight, D. C. (2018) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2018.09.019 · Cited by 178 · see citing works
“Likewise, studies solely examining childhood sexual abuse have found that it precedes depression (Jumper, 1995; Kendler, Kuhn, & Prescott, 2004), PTSD (Cohen et al., 2004) and poorer overall psychological health in adulthood (Molnar et al.”
BackgroundEvidence-based psychosocial interventions for ethnic minority youth: the 10-year update
Pina, A. A., Polo, A. J., & Huey, S. J. (2019) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2019.1567350 · Cited by 155 · see citing works
Sachser, C., Keller, F., & Goldbeck, L. (2017) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12640 · Cited by 156 · see citing works
Gillies, D. M., Taylor, F., Gray, C., O’Brien, L., & D’Abrew, N. (2013) · Evidence-Based Child Health A Cochrane Review Journal · doi:10.1002/ebch.1916 · Cited by 157 · see citing works
Anxiety in medically ill children/adolescents
Pao, M., & Bosk, A. (2011) · Depression and Anxiety · doi:10.1002/da.20727 · Cited by 151 · see citing works
“[62]”
Child Sexual Abuse: Consequences and Implications
Hornor, G. (2010) · Journal of Pediatric Health Care · doi:10.1016/j.pedhc.2009.07.003 · Cited by 209 · see citing works
McLean, C. P., Yeh, R., Rosenfield, D., & Foa, E. B. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.03.008 · Cited by 147 · see citing works
Psychological therapies for children and adolescents exposed to trauma
Gillies, D., Maiocchi, L., Bhandari, A. P., Taylor, F., Gray, C., & O'Brien, L. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012371 · Cited by 143 · see citing works
Williams, N. J., Wolk, C. B., Becker‐Haimes, E. M., & Beidas, R. S. (2020) · Implementation Science · doi:10.1186/s13012-020-0970-7 · Cited by 151 · see citing works
Thielemann, J. F. B., Kasparik, B., König, J., Unterhitzenberger, J., & Rosner, R. (2022) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2022.105899 · Cited by 140 · see citing works
Ashamed and Afraid: A Scoping Review of the Role of Shame in Post-Traumatic Stress Disorder (PTSD)
Saraiya, T. C., & López‐Castro, T. (2016) · Journal of Clinical Medicine · doi:10.3390/jcm5110094 · Cited by 147 · see citing works
“Cohen et al. (2004) Sexually abusedchildren (n = 203) Longitudinal; RCT 1 K-SADS-PL CAPS Children randomized to TF-CBT showed greater reductions in shame attributions and PTSD from baseline to post-treatment in comparison to children in CCT 1.”
BackgroundInfluentialZelechoski, A. D., Sharma, R., Beserra, K., Miguel, J. L., DeMarco, M., & Spinazzola, J. (2013) · Journal of Family Violence · doi:10.1007/s10896-013-9534-9 · Cited by 157 · see citing works
“showed significant reductions in PTSD symptoms, depression, and total behavior problems when compared to participants in the child-centered therapy condition (Cohen et al. 2004).”
BackgroundResultInfluentialLang, C. M., & Sharma-Patel, K. (2011) · Trauma Violence & Abuse · doi:10.1177/1524838010386975 · Cited by 151 · see citing works
Disseminating and Implementing Trauma-Focused CBT in Community Settings
Cohen, J., & Mannarino, A. (2008) · Trauma, Violence, & Abuse · doi:10.1177/1524838008324336 · Cited by 142 · see citing works
Self-citationGearing, R. E., Schwalbe, C. S. J., Lee, R., & Hoagwood, K. (2013) · Depression and Anxiety · doi:10.1002/da.22118 · Cited by 136 · see citing works
EMDR treatment for children with PTSD: Results of a randomized controlled trial
Ahmad, A., Larsson, B., & Sundelin-Wahlsten, V. (2007) · Nordic Journal of Psychiatry · doi:10.1080/08039480701643464 · Cited by 135 · see citing works
“Intentto-treat (ITT) analysis (24) was used to examine potential differences in the results when subjects with less than four EMDR sessions (n 3) were considered as drop-outs compared with outcome for per-protocol subjects (completers).”
MethodTrauma-focused cognitive behavioral therapy for children and families
Cohen, J. A., Deblinger, E., & Mannarino, A. P. (2018) · Psychotherapy Research · doi:10.1080/10503307.2016.1208375 · Cited by 126 · see citing works
“Several of our studies, for example, have documented improvements with respect to parenting practices and children’s personal safety skills (e.g., Cohen et al., 2004a, 2004b; Deblinger et al., 1996, 2011; Deblinger, Stauffer, & Steer, 2001).”
BackgroundResultInfluentialSelf-citation
- Authors
- Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A.
- Affiliations
- Allegheny General Hospital (US)
- Corresponding author
- Cohen, Judith A.
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2004-04
- Volume
- 43
- Issue
- 4
- Pages
- 393-402
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC1201422
- OpenAlex
- W1987755633
- Cited by
- 1,123
- References
- 32
- Citations by year
- 2026: 14 · 2025: 17 · 2024: 26 · 2023: 24 · 2022: 40 · 2021: 47 · 2020: 65 · 2019: 53 · 2018: 55 · 2017: 42 · 2016: 108 · 2015: 90 · 2014: 63 · 2013: 77 · 2012: 66
- FWCI
- 42.39
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- NIMH (R10 MH55963, R10 MH56224)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child Therapy and Development
- Keywords
- post-traumatic stress disorder, child sexual abuse, trauma-focused cognitive behavioral therapy, child-centered therapy, depression, behavioral problems, shame, parental depression, parenting practices, polytrauma, children
- MeSH terms
- Adolescent, Analysis of Variance, Child, Child Abuse, Sexual, Female, Humans, Male, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy
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