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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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“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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“106,107 The effectiveness of these evidence-based therapies may be reduced if targeted interventions are not used to address emerging areas of risk or if universal primary preventions are not applied as well.”
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“Symptomatic parents and children need treatment following disasters, and fortunately, effective evidence-based treatments are increasingly available (Cohen, Deblinger, Mannarino, & Steer, 2004 ).”
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“36,38 CBT for PTSD as a comorbid psychiatric condition PTSD is often observed as a comorbidity of other psychiatric disorders, most commonly depressive or anxiety disorders.”
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“…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…”
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“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).”
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Stirling, J., Amaya-Jackson, L. M., & Amaya-Jackson, L. M. (2008) · PEDIATRICS · doi:10.1542/peds.2008-1885 · Cited by 181
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
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 230
“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
“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
“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
Self-citationFoa, E. B., McLean, C. P., Capaldi, S., & Rosenfield, D. (2013) · JAMA · doi:10.1001/jama.2013.282829 · Cited by 194
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
“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
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 167
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
“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
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
Greca, A. M. L., & Silverman, W. K. (2009) · Child Development Perspectives · doi:10.1111/j.1750-8606.2008.00069.x · Cited by 157
Rathbone, A. L., Clarry, L., & Prescott, J. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.8598 · Cited by 158
“CBT has shown effectiveness for treating both children [15] and adults [16] suffering from posttraumatic stress disorder (PTSD).”
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
“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
Sachser, C., Keller, F., & Goldbeck, L. (2017) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12640 · Cited by 156
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 177
Anxiety in medically ill children/adolescents
Pao, M., & Bosk, A. (2011) · Depression and Anxiety · doi:10.1002/da.20727 · Cited by 151
“[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
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
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
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 158
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
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
“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 158
“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 165
Disseminating and Implementing Trauma-Focused CBT in Community Settings
Cohen, J., & Mannarino, A. (2008) · Trauma, Violence, & Abuse · doi:10.1177/1524838008324336 · Cited by 142
Self-citationGearing, R. E., Schwalbe, C. S. J., Lee, R., & Hoagwood, K. (2013) · Depression and Anxiety · doi:10.1002/da.22118 · Cited by 155
Koenen, K. C., Sumner, J. A., Gilsanz, P., Glymour, M. M., Ratanatharathorn, A., Rimm, E. B., Roberts, A. L., Winning, A., & Kubzansky, L. D. (2017) · Psychological Medicine · doi:10.1017/s0033291716002294 · Cited by 136
“One possibility is to add assessments of cardiometabolic-related biomarkers and behaviors to new clinical trials of PTSD treatment that have not yet started (Cohen et al. 2004; Cloitre et al. 2010).”
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
“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).”
Method
Metadata
- 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
- Semantic Scholar
- e7e2575d79a4663a3567a3968e82ee3b300677a3
- 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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