Cited by 1,123Child Abuse and TraumaPosttraumatic Stress Disorder ResearchChild Therapy and Development

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A Multisite, Randomized Controlled Trial for Children With Sexual Abuse–Related PTSD Symptoms

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Cohen, Judith A., Deblinger, Esther, Mannarino, Anthony P., Steer, Robert A.·2004·Journal of the American Academy of Child & Adolescent Psychiatry

DOI 10.1097/00004583-200404000-00005PMC PMC1201422

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Abstract

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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“There now is considerable evidence supporting different variants of cognitive behavioral therapy (CBT) for the treatment of school children who have PTSD resulting from multiple traumatic events, including sexual abuse [13] and other forms of violence [14].”
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“Cohen et al. (2004) in J Am Acad Child Adolesc Psychiatry Objective To examine the differential efficacy of trauma-focused cognitive behavioral therapy (TF-CBT) and child-centered therapy for treating PTSD and related emotional and behavioral problems in children who suffered sexual abuse Method…”
Background
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BackgroundMethodSelf-citation
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Background
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“Although cognitive behavioral interventions have been used effectively with children exposed to domestic violence (Cohen et al. 2004; Graham-Bermann 2001; for a review, see Vickerman and Margolin 2007), none have focused specifically on children’s efforts to explain why violence occurred in their family.”
Method
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BackgroundMethodInfluentialSelf-citation
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Background
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MethodResult
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ResultSelf-citation
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BackgroundResult
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An Empirical Theory of the Development of Homicide within Individuals
Zagar, R. J., Busch, K. G., Isbell, S. A., & Hughes, J. R. (2009) · Psychological Reports · doi:10.2466/pr0.104.1.199-245 · Cited by 84
Implementation of CBT for youth affected by the World Trade Center disaster: Matching need to treatment intensity and reducing trauma symptoms
CATS Consortium (2010) · Journal of Traumatic Stress · doi:10.1002/jts.20594 · Cited by 83
A Randomized Trial of Cognitive Behaviour Therapy and Cognitive Therapy for Children with Posttraumatic Stress Disorder Following Single-Incident Trauma
Nixon, R. D. V., Sterk, J., & Pearce, A. (2011) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-011-9566-7 · Cited by 90
Victimization History and Posttraumatic Stress: An Analysis of Psychopathy Variants in Male Juvenile Offenders
Tatar, J. R., Cauffman, E. E., Kimonis, E. R., & Skeem, J. L. (2012) · Journal of Child & Adolescent Trauma · doi:10.1080/19361521.2012.671794 · Cited by 92
“The K-SADS-PL is a valid indicator of PTSD symptomatology in clinical settings (ie, Cohen, Deblinger, Mannarino, & Steer, 2004 ) and shows good interrater and test–retest reliability ( Kaufman et al, 1997 ).”
Method
No need to worry: the promising future of child anxiety research
Kendall, P. C., Settipani, C. A., & Cummings, C. M. (2012) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2012.632352 · Cited by 82
“Intended for children ages 3 to 18 with a history of diverse traumas, TF-CBT is an EST (Cohen, Deblinger, Mannarino, & Steer, 2004 ; Cohen, Mannarino, & Knudsen, 2005 ).”
Background
Changes in functional connectivity of the amygdala during cognitive reappraisal predict symptom reduction during trauma-focused cognitive–behavioral therapy among adolescent girls with post-traumatic stress disorder
Cisler, J. M., Sigel, B. A., Steele, J., Smitherman, S., Vanderzee, K. L., Pemberton, J. R., Kramer, T. L., & Kilts, C. D. (2016) · Psychological Medicine · doi:10.1017/s0033291716001847 · Cited by 84
“…therapy (TF-CBT) is the ‘gold standard’ psychological treatment for pediatric PTSD with numerous randomized clinical trials demonstrating clear efficacy for PTSD symptoms, depression and behavioral problems (Cohen et al. 2004, 2010, 2011; Deblinger et al. 2006, 2011; Cary & McMillen, 2012).”
Background
Childhood Post-Traumatic Stress Disorder: An Overview
Bellis, M. D. D., & Dillen, T. V. (2005) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2005.05.006 · Cited by 87
“Results from a recent randomized controlled trial [162] of 229 children with sexual abuse-related PTSD symptoms, age 8 to 14 years, who were assigned randomly to either trauma-focused (TF-)CBT or child-centered therapy indicated that children assigned to TF-CBT, compared with those assigned to childcentered therapy, d…”
Background
Practitioner Expertise in Evidence-Based Practice Decision Making
Mccracken, S., & Marsh, J. (2008) · Research on Social Work Practice · doi:10.1177/1049731507308143 · Cited by 87
“…of these studies using the Quality of Study Rating Form (Gibbs, 2003) and found promising research supporting two different interventions—cognitive behavioral treatment (CBT; e.g., Cohen et al., 2004) and child parent psychotherapy (CPP; Lieberman, Van Horn, & Ippen, 2005; Toth et al., 2002).”
Method
The Effects of Neighborhood Context on Exposure to Adverse Childhood Experiences (ACE) Among Adolescents Involved in the Juvenile Justice System: Latent Classes and Contextual Effects
Wolff, K. T., Cuevas, C., Intravia, J., Baglivio, M. T., & Epps, N. (2018) · Journal of Youth and Adolescence · doi:10.1007/s10964-018-0887-5 · Cited by 81
Implementing Trauma and Grief Component Therapy for Adolescents and Think Trauma for Traumatized Youth in Secure Juvenile Justice Settings
Olafson, E., Boat, B., Putnam, K. T., Thieken, L., Marrow, M. T., & Putnam, F. W. (2016) · Journal of Interpersonal Violence · doi:10.1177/0886260516628287 · Cited by 83
Much to Do About Trauma: A Systematic Review of Existing Trauma-Informed Treatments on Youth Violence and Recidivism
Zettler, H. R. (2020) · Youth Violence and Juvenile Justice · doi:10.1177/1541204020939645 · Cited by 92
“Exposure therapy requires an individual to recall traumatic events in order to develop strategies designed to reduce the negative emotions associated with the past trauma (Cohen et al., 2004; Cohen & Mannarino, 1993; Deblinger & Heflin, 1996).”
Background
Risky Behaviors and Depression in Conjunction With—or in the Absence of—Lifetime History of PTSD Among Sexually Abused Adolescents
Danielson, C. K., Macdonald, A., Amstadter, A. B., Hanson, R. F., de Arellano, M. A., Saunders, B. E., & Kilpatrick, D. G. (2009) · Child Maltreatment · doi:10.1177/1077559509350075 · Cited by 80
The psychological treatment of sexual abuse in children and adolescents: A meta-analysis
Sánchez‐Meca, J., Alcázar, A. I. R., & Soler, C. L. (2011) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 79
Cognitive Aspects of Posttraumatic Stress Reactions and their Treatment in Children and Adolescents: An Empirical Review and Some Recommendations
Dalgleish, T., Meiser‐Stedman, R., & Smith, P. A. (2005) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465805002389 · Cited by 80
Improving Implementation of a School-Based Program for Traumatized Students: Identifying Factors that Promote Teacher Support and Collaboration
Baweja, S., Santiago, C. D., Vona, P., Pears, G., Langley, A. K., & Kataoka, S. (2015) · School Mental Health · doi:10.1007/s12310-015-9170-z · Cited by 80
Treating Traumatized Children after Hurricane Katrina: Project Fleur-de Lis™
Cohen, J. A., Jaycox, L. H., Walker, D. W., Mannarino, A. P., Langley, A. K., & DuClos, J. L. (2009) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-009-0039-2 · Cited by 78
Self-citation
Mental Health Care for Children and Adolescents in Foster Care: Review of Research Literature
Landsverk, J. A., Burns, B. J., Stambaugh, L. F., & Rolls-Reutz, J. (2006) · Cited by 79
Applying Trauma-Focused Cognitive–Behavioral Therapy in Group Format
Deblinger, E., Pollio, E., & Dorsey, S. (2015) · Child Maltreatment · doi:10.1177/1077559515620668 · Cited by 77
Self-citation
In the best interests of society
Harris, W. W., Lieberman, A. F., & Marans, S. R. (2007) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2007.01732.x · Cited by 79
Post-traumatic stress disorder in children.
Kaminer, D., Seedat, S., & Stein, D. J. (2005) · PubMed Central · Cited by 74
Randomized Controlled Trial of Group Cognitive Behavioural Therapy for Post-Traumatic Stress Disorder in Children and Adolescents Exposed to Tsunami in Thailand
Pityaratstian, N., Piyasil, V., Ketumarn, P., Sitdhiraksa, N., Ularntinon, S., & Pariwatcharakul, P. (2014) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465813001197 · Cited by 75
Effectiveness of a single-session early psychological intervention for children after road traffic accidents: a randomised controlled trial
Zehnder, D., Meuli, M., & Landolt, M. A. (2010) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/1753-2000-4-7 · Cited by 75
“Based on the literature on the effectiveness of trauma-focused cognitive-behavioural therapy (tf-CBT) in children [ 25 ] we hypothesised that none of these moderating factors would yield any significant main effects.”
Background
Contributors to traumatic exposure and posttraumatic stress disorder in juvenile justice youths
Wasserman, G. A., & McReynolds, L. S. (2011) · Journal of Traumatic Stress · doi:10.1002/jts.20664 · Cited by 74
Outcome of cognitive behavioral therapy in adolescents after natural disaster
Shooshtary, M. H., Panaghi, L., & Moghadam, J. A. (2008) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2007.09.011 · Cited by 74
“The results showed that children assigned to TF-CBT had significantly more improvement with regard to PTSD, depression, behavior problems, shame, and abuserelated attributions [ 15 ].”
Background
Prävalenz von traumatischen Stresserfahrungen und seelischen Erkrankungen bei in Deutschland lebenden Kindern von Asylbewerbern
Ruf, M., Schauer, M., & Elbert, T. R. (2010) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/1616-3443/a000029 · Cited by 74
Psychosocial Treatment of Children in Foster Care: A Review
Racusin, R. J., Maerlender, A., Sengupta, A., Isquith, P. Κ., & Straus, M. B. (2005) · Community Mental Health Journal · doi:10.1007/s10597-005-2656-7 · Cited by 77
Impact, psychological sequelae and management of trauma affecting children and adolescents
Caffo, E., Forresi, B., & Lievers, L. S. (2005) · Current Opinion in Psychiatry · doi:10.1097/01.yco.0000172062.01520.ac · Cited by 73
Jack Tizard Lecture: Cognitive Behaviour Therapies for Children: Passing Fashion or Here to Stay?
GRAHAM, P. J. (2005) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2005.00119.x · Cited by 74
Responding to Students with Posttraumatic Stress Disorder in Schools
Kataoka, S., Langley, A. K., Wong, M., Baweja, S., & Stein, B. D. (2012) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2011.08.009 · Cited by 73
Acceptance and Commitment Therapy for the Treatment of Posttraumatic Stress Among Adolescents
Woidneck, M. R., Morrison, K. L., & Twohig, M. P. (2014) · Behavior Modification · doi:10.1177/0145445513510527 · Cited by 73
Trauma-Focused Cognitive-Behavioral Therapy
Mannarino, A. P., Cohen, J. A., & Deblinger, E. (2013) · Child maltreatment · doi:10.1007/978-94-007-7404-9_10 · Cited by 74
Self-citation
Randomized Placebo-Controlled D-Cycloserine with Cognitive Behavior Therapy for Pediatric Posttraumatic Stress
Scheeringa, M. S., & Weems, C. F. (2014) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2013.0106 · Cited by 72
“(2004) reported that 21% of the CBT group continued to have full PTSD diagnosis with a mean of more than five PTSD symptoms posttreatment (Cohen et al. 2004).”
BackgroundInfluential
The Racial and Gender Differences in the Impact of Adverse Childhood Experiences on Juvenile Residential Placement
Zettler, H., Wolff, K. T., Baglivio, M. T., Craig, J. M., & Epps, N. (2018) · Youth Violence and Juvenile Justice · doi:10.1177/1541204017698213 · Cited by 71
Prolonged exposure therapy and supportive counselling for post-traumatic stress disorder in adolescents: Task-shifting randomised controlled trial
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Interventions for caregivers of children who disclose sexual abuse: A review
van Toledo, A., & Seymour, F. W. (2013) · Clinical Psychology Review · doi:10.1016/j.cpr.2013.05.006 · Cited by 73
“In several of these studies caregivers were providedwith their own individual Sexual Abuse Specific Cognitive Behavioural Therapy (SAS-CBT) or Trauma-Focussed Cognitive Behavioural Therapy (TFCBT) to decrease parental emotional distress, enhance parental support for their child, and manage child behavioural difficulti…”
Background
Play to the Whistle: A Pilot Investigation of a Sports-Based Intervention for Traumatized Girls in Residential Treatment
D'Andrea, W. M., Bergholz, L., Fortunato, A., & Spinazzola, J. (2013) · Journal of Family Violence · doi:10.1007/s10896-013-9533-x · Cited by 71
Clinical Considerations Related to the Behavioral Manifestations of Child Maltreatment
Sege, R. D., Amaya-Jackson, L. M., Flaherty, E. G., Idzerda, S. M., Legano, L. A., Leventhal, J. M., Lukefahr, J. L., & Sege, R. D. (2017) · PEDIATRICS · doi:10.1542/peds.2017-0100 · Cited by 83
A Systematic Review of Trauma Interventions in Native Communities
Gameon, J. A., & Skewes, M. C. (2019) · American Journal of Community Psychology · doi:10.1002/ajcp.12396 · Cited by 70
“Trauma-focused CBT was originally designed for sexually abused children and has been adapted for other types of interpersonal trauma (Bigfoot & Schmidt, 2010; Cohen et al., 2004; Deblinger et al., 2006).”
Background
Young Burned Children: The Course of Acute Stress and Physiological and Behavioral Responses
Stoddard, F. J., Ronfeldt, H. M., Kagan, J., Drake, J. E., Snidman, N. C., Murphy, J. M., Saxe, G., Burns, J., & Sheridan, R. L. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.6.1084 · Cited by 70
Psychological consequences of child trafficking: An historical cohort study of trafficked children in contact with secondary mental health services
Ottisova, L., Smith, P. A., Shetty, H., Stahl, D. R., Downs, J. M., & Oram, S. (2018) · PLoS ONE · doi:10.1371/journal.pone.0192321 · Cited by 69
“Narrative exposure therapy [21] and the child version KidNET [22] are trauma-focused therapies with a strong evidence base with survivors of multiple trauma and human rights violations, and trauma-focused cognitive behavioural therapy (tf-CBT) has been shown to successfully treat PTSD in child survivors of sexual abus…”
Background
The Prospective Role of Cognitive Appraisals and Social Support in Predicting Children’s Posttraumatic Stress
Hitchcock, C., Ellis, A. A., Williamson, P., & Nixon, R. D. V. (2015) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-015-0034-7 · Cited by 69
“…Clark 2000); omen formation (Meiser-Stedman et al. 2009); appraisals about the trauma and symptoms following the trauma, other people’s responses to the trauma (Ehlers and Clark 2000); self-blame (Cohen et al. 2004) and appraisals of the usefulness of talking about the event (Meiser-Stedman 2002).”
Background
Post-traumatic Stress Response to Life-Threatening Illnesses in Children and Their Parents
Stuber, M. L., & Shemesh, E. (2006) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2006.02.006 · Cited by 69
“The only rigorously investigated approach for the treatment of PTSD in children to date [27] used a manual to deliver an imaginal exposure–based CBT treatment in nonmedical PTSD.”
Method
Lessons learned while building a trauma-informed public behavioral health system in the City of Philadelphia
Beidas, R. S., Adams, D. R., Kratz, H. E., Jackson, K., Berkowitz, S. J., Zinny, A., Cliggitt, L. P., DeWitt, K. L., Skriner, L. C., & Evans, A. C. (2016) · Evaluation and Program Planning · doi:10.1016/j.evalprogplan.2016.07.004 · Cited by 68

Authors: Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A.
Affiliations: Allegheny General Hospital (US)
Corresponding author: Cohen, Judith A.
ORCID: Cohen, Judith A.
Deblinger, Esther
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)
DOI: 10.1097/00004583-200404000-00005
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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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A Multisite, Randomized Controlled Trial for Children With Sexual Abuse–Related PTSD Symptoms

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