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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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“Treatments targeting PTSD and related comorbidities include developmentally focused CBT approaches with psychoeducation, parenting skills and behavior management, coping strategies for anxiety and trauma reminders, trauma narration (gradual exposure and cognitive restructuring), affect regulation, in vivo exposure, an…”
BackgroundGoing to Scale: Experiences Implementing a School-Based Trauma Intervention
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MethodClinician Knowledge and Utilization of Empirically-Supported Treatments for Maltreated Children
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Self-citationFocus on Childhood and Adolescent Mental Health
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“Given trauma-focused CBT is effective for both non-abuse and abuse trauma (Cohen et al. 2004; Deblinger et al. 2006), the present findings illustrate that maladaptive appraisals are likely to be important targets for intervention in children who have experienced psychological abuse.”
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“PTSD symptoms were assessed with the Clinician Administered PTSD Scale (CAPS), Child and Adolescent Version(42), and PTSD diagnoses were defined according to prior studies among youth(13, 43).”
MethodChildren’s Enduring PTSD Symptoms are Related to Their Family’s Adaptability and Cohesion
Birmes, P. J., Raynaud, J., Daubisse‐Marliac, L., Brunet, A., Arbus, C., Klein, R., Cailhol, L., Allenou, C., Hazane, F., Grandjean, H., et al. (2009) · Community Mental Health Journal · doi:10.1007/s10597-008-9166-3 · Cited by 44
Holt, T., Jensen, T. K., & Wentzel‐Larsen, T. (2014) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/1753-2000-8-11 · Cited by 44
“In a later study, it was shown that parents of sexually abused children who participated in TF-CBT along with their children showed more improvements in their own levels of trauma-specific distress compared to parents of children receiving child-centered therapy (CCT), a non-directive child/ parent-centered treatment…”
BackgroundTreatment of Child Abuse : Common Ground for Mental Health, Medical, and Legal Practitioners
Reece, R. M. (2003) · Cited by 44
Barriers to Successful Treatment Completion in Child Sexual Abuse Survivors
McPherson, P., Scribano, P. V., & Stevens, J. H. (2011) · Journal of Interpersonal Violence · doi:10.1177/0886260511416466 · Cited by 43
“This treatment has been shown in multiple trials to decrease behavioral symptomatology acutely when reevaluated at 1- and 2-year follow-up with significantly greater improvement of internalizing and externalizing behaviors, depression, and social competence symptoms of sexually abused children (Cohen et al., 2004; Coh…”
BackgroundMarques, L. M., Dixon, L., Valentine, S. E., Borba, C. P. C., Simon, N. M., & Stirman, S. W. (2016) · Psychological Services · doi:10.1037/ser0000087 · Cited by 44
Ladouceur, C. D., Tan, P. Z., Sharma, V., Bylsma, L. M., Silk, J. S., Siegle, G. J., Forbes, E. E., McMakin, D. L., Dahl, R. E., Kendall, P. C., et al. (2018) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12900 · Cited by 48
“The CBT treatment was delivered using the Coping Cat workbooks (Kendall & Hedtke, 2006) and the CCT treatment was delivered using a manualized supportive psychotherapy based on humanistic principles (CCT; Cohen et al., 2004) (see Silk et al., 2016 for more details).”
BackgroundMethodInfluentialSelf-citationMemarzia, J., Walker, J., & Meiser‐Stedman, R. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.01.016 · Cited by 46
“…the focus of intervention strategies, such as trauma-focussed CBT for children and adolescents, incorporating cognitive restructuring of trauma-related appraisals and reducing fear responses associated with trauma-related stimuli (Cohen, Deblinger, Mannarino, & Steer, 2004; Smith, et al., 2013).”
BackgroundPost traumatic stress disorder
Yule, W., & Smith, P. A. (2015) · Wiley eBooks · doi:10.1002/9781118381953.ch59 · Cited by 44
Godley, S. H., Smith, J. E., Passetti, L. L., & Subramaniam, G. (2014) · Substance Abuse · doi:10.1080/08897077.2014.936993 · Cited by 42
Nakamura, B. J., Chorpita, B. F., Hirsch, M., Daleiden, E. L., Slavin, L. A., Amundson, M. J., Rocco, S. A. L., Mueller, C. W., Osiecki, S., Southam‐Gerow, M. A., et al. (2011) · Clinical Psychology Science and Practice · doi:10.1111/j.1468-2850.2010.01231.x · Cited by 42
Cyr, M., Frappier, J., Hébert, M., Tourigny, M., McDuff, P., & Turcotte, M.-È. (2016) · Journal of Child Sexual Abuse · doi:10.1080/10538712.2016.1228726 · Cited by 42
“Treatment-Focused Cognitive Behavior Therapy (Cohen et al., 2004), a best practice recommended for sexually abused children, has also proved to be efficient in reducing parents’ depressive symptoms and increasing parental skills, particularly supportive and protection interventions.”
BackgroundBernard‐Bonnin, A., Hébert, M., Daignault, I. V., & Allard‐Dansereau, C. (2008) · Paediatrics & Child Health · doi:10.1093/pch/13.6.479 · Cited by 42
Family Support in Prevention Programs for Children at Risk for Emotional/Behavioral Problems
Cavaleri, M. A., Olin, S.-C. S., Kim, A., Hoagwood, K., & Burns, B. J. (2011) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-011-0100-9 · Cited by 43
“Not surprisingly, a focus of information provision in the treatment interventions emphasized information about mental disorders, their symptoms, course, and treatments (e.g., Cognitive Behavioral Family Therapy, Barrett et al. 2004; Cognitive Behavioral Therapy + Parent Anxiety Management, Cobham et al. 1998; Trauma F…”
BackgroundMental health consequences of child sexual abuse
Mullers, E.-S., & Dowling, M. (2008) · British Journal of Nursing · doi:10.12968/bjon.2008.17.22.31871 · Cited by 41
Cook, M. C., Barnert, E. S., Ijadi‐Maghsoodi, R., Ports, K. D., & Bath, E. P. J. (2018) · Behavioral Medicine · doi:10.1080/08964289.2018.1432552 · Cited by 41
Psychosocial interventions for responding to child sexual abuse: A systematic review
McTavish, J. R., Santesso, N. A., Amin, A., Reijnders, M., Ali, M. U., Fitzpatrick‐Lewis, D., & MacMillan, H. L. (2019) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2019.104203 · Cited by 41
Kirlić, N., Cohen, Z. P., & Singh, M. K. (2020) · Adversity and Resilience Science · doi:10.1007/s42844-020-00001-x · Cited by 44
Everett, Y., Martin, C. G., & Zalewski, M. (2021) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-021-00355-3 · Cited by 49
Psychotherapeutic options for traumatized children
Cohen, J. A., & Mannarino, A. P. (2010) · Current Opinion in Pediatrics · doi:10.1097/mop.0b013e32833e14a2 · Cited by 42
Self-citationSexual Crime Against Schoolchildren With Disabilities: A Nationwide Prospective Birth Cohort Study
Christoffersen, M. N. (2022) · Journal of Interpersonal Violence · doi:10.1177/0886260520934442 · Cited by 40
“Child sexual abuse places children at increased risk for suffering potential lifelong difficulties (Briere, 1996; Cohen et al., 2004; Kendall-Tackett et al., 1993).”
BackgroundMcMakin, D. L., Ricketts, E. J., Forbes, E. E., Silk, J. S., Ladouceur, C. D., Siegle, G. J., Milbert, M., Trubnick, L., Cousins, J. C., Ryan, N. D., et al. (2018) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2018.1463534 · Cited by 40
Ross, S. L., Sharma-Patel, K., Brown, E. J., Huntt, J. S., & Chaplin, W. F. (2020) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2020.104734 · Cited by 40
Community Outreach Program for Child Victims of Traumatic Events
de Arellano, M. A., Waldrop, A. E., Deblinger, E., Cohen, J. A., Danielson, C. K., & Mannarino, A. P. (2004) · Behavior Modification · doi:10.1177/0145445504270878 · Cited by 40
Self-citationAdler‐Tapia, R., & Settle, C. (2009) · Journal of EMDR Practice and Research · doi:10.1891/1933-3196.3.4.232 · Cited by 40
Dorsey, S., Conover, K. L., & Cox, J. R. (2014) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2013.876643 · Cited by 40
“Initial studies focused on children with sexual abuse histories, primarily with polyvictimized youth (e.g., Cohen et al., 2004; Deblinger, Lippmann, & Steer, 1996).”
BackgroundChildhood Abuse, Nonadherence, and Medical Outcome in Pediatric Liver Transplant Recipients
Shemesh, E., Annunziato, R. A., Yehuda, R., Shneider, B. L., Newcorn, J. H., Hutson, C., Cohen, J. A., Briere, J., Gorman, J. M., & Emre, S. (2007) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e3180f62aff · Cited by 38
“Cognitive-behavioral therapy has been shown to be efficacious for posttraumatic stress disorder in children who have been abused ( Cohen et al., 2004, 2005 ), and it may be indicated in some of the cases that we have evaluated.”
BackgroundSelf-citationAberdein, C., & Zimmerman, C. (2015) · International Journal of Mental Health Systems · doi:10.1186/s13033-015-0008-8 · Cited by 39
The role of day-to-day emotions, sleep, and social interactions in pediatric anxiety treatment
Wallace, M. L., McMakin, D. L., Tan, P. Z., Rosen, D. K., Forbes, E. E., Ladouceur, C. D., Ryan, N. D., Siegle, G. J., Dahl, R. E., Kendall, P. C., et al. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.12.012 · Cited by 39
“CCT was previously used as an active comparison condition for trauma-focused CBT for youth with PTSD to account for effects of attention and therapeutic alliance (Cohen, Mannarino, & Iyengar, 2011; Cohen, Mannarino, & Knudsen, 2005; Cohen et al., 2004).”
MethodSelf-citation
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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