Cited by 355Posttraumatic Stress Disorder ResearchChild Abuse and TraumaSleep and related disorders

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Cognitive-Behavioral Therapy for PTSD in Children and Adolescents: A Preliminary Randomized Controlled Trial

SMITH, PATRICK, YULE, WILLIAM, PERRIN, SEAN, TRANAH, TROY, DALGLEISH, TIM, CLARK, DAVID M.·2007·Journal of the American Academy of Child & Adolescent Psychiatry

DOI 10.1097/chi.0b013e318067e288

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Abstract

Objective To evaluate the efficacy of individual trauma-focused cognitive-behavioral therapy (CBT) for treating posttraumatic stress disorder (PTSD) in children and young people.Method Following a 4-week symptom-monitoring baseline period, 24 children and young people (8-18 years old) who met full DSM-IV PTSD diagnostic criteria after experiencing single-incident traumatic events (motor vehicle accidents, interpersonal violence, or witnessing violence) were randomly allocated to a 10-week course of individual CBT or to placement on a waitlist (WL) for 10 weeks.Results Compared to the WL group, participants who received CBT showed significantly greater improvement in symptoms of PTSD, depression, and anxiety, with significantly better functioning. After CBT, 92% of participants no longer met criteria for PTSD; after WL, 42% of participants no longer met criteria. CBT gains were maintained at 6-month follow-up. Effects of CBT were partially mediated by changes in maladaptive cognitions, as predicted by cognitive models of PTSD.Conclusions Individual trauma-focused CBT is an effective treatment for PTSD in children and young people.

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ResultSelf-citation
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
“The sample size was determined by power calculations based on the effect size of 2.20 in one RCT study (Smith et al., 2007).”
BackgroundMethodResultInfluential
Psychological and Pharmacologic Treatment of Youth with Posttraumatic Stress Disorder
Keeshin, B. R., & Strawn, J. R. (2014) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2013.12.002 · Cited by 74
“A 10-week CBT trial for children with single-incident traumatic exposure and PTSD maintained for a 4-week lead-in period showed significant improvement compared with a waitlist comparison group, with only 10% in the active arm meeting criteria for PTSD at the end of treatment compared with 60% in the waitlist group.(7…”
Method
Research Methods in Child Disaster Studies: A Review of Studies Generated by the September 11, 2001, Terrorist Attacks; the 2004 Indian Ocean Tsunami; and Hurricane Katrina
Pfefferbaum, B. J., Weems, C. F., Scott, B. G., Nitiéma, P., Noffsinger, M. A., Pfefferbaum, R. L., Varma, V., & Chakraburtty, A. (2013) · Child & Youth Care Forum · doi:10.1007/s10566-013-9211-4 · Cited by 80
“Using the CPTCI in an intervention study of children who had experienced single-incident trauma, Smith et al. (2007) found a strong correlation between changes in PTSD symptoms and changes in appraisals, a significant effect of the intervention on both PTSD symptoms and misappraisals, and a…”
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
“…have demonstrated theeffectiveness of exposure-based cognitive behavioral therapy (CBT) for posttraumatic stress disorder (PTSD) in children and adolescents who sustained sexual abuse (Cohen and Mannarino 1998; King et al. 2000; Cohen et al. 2004; Smith et al. 2007; GilboaSchechtman et al. 2010).”
Background
Treatment of posttraumatic stress disorder in children and adolescents
Smith, P. A., Perrin, S. G., Dalgleish, T., Meiser‐Stedman, R., Clark, D. M., & Yule, W. (2012) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e32835b2c01 · Cited by 70
Self-citation
Children and war: the work of the Children and War Foundation
Yule, W., Dyregrov, A., Raundalen, M., & Smith, P. A. (2013) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v4i0.18424 · Cited by 70
“…CBT being endorsed to help adults who have developed PTSD (Ehlers, Clark, Hackmann, McManus, & Fennell, 2005), it has also been adapted to form the basis of interventions with children who have been exposed to peacetime single event traumas (Smith, Perrin, Yule, & Clark, 2010; Smith et al. 2007).”
BackgroundMethodSelf-citation
Mental imagery, emotion and psychopathology across child and adolescent development
Burnett Heyes, S., Lau, J. Y. F., & Holmes, E. A. (2013) · Developmental Cognitive Neuroscience · doi:10.1016/j.dcn.2013.02.004 · Cited by 70
The Picture Anxiety Test (PAT): A new pictorial assessment of anxiety symptoms in young children
Dubi, K., & Schneider, S. (2009) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2009.07.020 · Cited by 75
Evidence based treatments for trauma-related psychological disorders : a practical guide for clinicians
Schnyder, U., & Cloître, M. (2015) · Zurich Open Repository and Archive (University of Zurich) · Cited by 67
The effects of social support and negative appraisals on acute stress symptoms and depression in children and adolescents
Ellis, A. A., Nixon, R. D. V., & Williamson, P. (2009) · British Journal of Clinical Psychology · doi:10.1348/014466508x401894 · Cited by 67
“The association between unhelpful appraisals and trauma response supports a cognitive restructuring approach to intervention, consistent with CBT being an empirically supported intervention for childhood PTSD (National Collaborating Centre for Mental Health, 2005; Smith et al., 2007).”
Result
Over-time changes in PTSD and depression among children surviving the 1999 Istanbul earthquake
Ekşi, A., & Braun, K. L. (2009) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-009-0745-9 · Cited by 65
“CBT. Various studies concur that CBT is very promising in the treatment of PTSD [7, 10, 11, 15, 26 ].”
Background
Cognitive Therapy for Social Anxiety Disorder in Adolescents: A Development Case Series
Leigh, E., & Clark, D. M. (2016) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465815000715 · Cited by 64
Self-citation
Implementing Cognitive Behavioral Intervention for Trauma in Schools (CBITS) with Latino Youth
Allison, A. C., & Ferreira, R. J. (2016) · Child and Adolescent Social Work Journal · doi:10.1007/s10560-016-0486-9 · Cited by 66
Emerging interventions for PTSD: Future directions for clinical care and research
Bomyea, J. A., & Lang, A. J. (2011) · Neuropharmacology · doi:10.1016/j.neuropharm.2011.05.028 · Cited by 62
“A review of extant treatment outcome literature in PTSD reveals that studies directly examining mechanisms of treatment response are relatively rare (although see for example Smith et al., 2007).”
Outcome Domains in Child Mental Health Research Since 1996: Have They Changed and Why Does It Matter?
Hoagwood, K., Jensen, P. S., Acri, M. C., Olin, S.-C. S., Lewandowski, R. E., & Herman, R. (2012) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2012.09.004 · Cited by 64
The Efficacy of a Group Cognitive Behavioral Therapy for War-Affected Young Migrants Living in Australia: A Cluster Randomized Controlled Trial
Ooi, C. S., Rooney, R. M., Roberts, C. M., Kane, R. T., Wright, B. R., & Chatzisarantis, N. L. D. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01641 · Cited by 58
A New Method for Assessing Content Validity in Model-Based Creation and Iteration of eHealth Interventions
Kassam‐Adams, N., Marsac, M. L., Kohser, K. L., Kenardy, J. A., March, S., & Winston, F. K. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.3811 · Cited by 58
“For each of these goals, we drew from the empirical literature on intervention for posttraumatic stress and anxiety in children [15-17] to delineate more specific actionable intervention targets and then”
Practice Parameter on Disaster Preparedness
Pfefferbaum, B. J., & Shaw, J. A. (2013) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2013.08.014 · Cited by 56
Conducting a Meta-Analysis of Counseling Outcome Research
Erford, B. T., Savin‐Murphy, J., & Butler, C. (2010) · Counseling Outcome Research and Evaluation · doi:10.1177/2150137809356682 · Cited by 54
“In Study 3 (Smith et al., 2007), three dependent variables were combined to form the overall study effect size: Child PTSD Symptoms Scale (CPSS) score, Children’s Revised Impact of Event Scale (C-RIES), and Clinician Administered PTSD Scale for Children and Adolescents (CAPS-CA).”
MethodInfluential
A Pilot Study Comparing Traumatic Stress Symptoms by Child and Parent Report Across Pediatric Chronic Illness Groups
Ingerski, L. M., Shaw, K., Gray, W. N., & Janicke, D. M. (2010) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e3181f17c52 · Cited by 55
“The overall model predicting parent-proxy reported traumatic stress symptoms was also not significant (F[5,34] 2.”
Background
Assessing Therapy-Relevant Cognitive Capacities in Young People: Development and Psychometric Evaluation of the Self-Reflection and Insight Scale for Youth
Sauter, F. M., Heyne, D. A., Blöte, A. W., van Widenfelt, B. M., & Westenberg, P. M. (2010) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465810000020 · Cited by 50
“Indeed, there is increasing evidence for the short- and long-term efficacy of CBT for a range of difficulties in childhood and adolescence (e.g. Schmidt et al., 2007; Smith et al., 2007).”
Background
Efficacy of imagery rescripting and imaginal exposure for nightmares: A randomized wait-list controlled trial
Kunze, A. E., Arntz, A. R., Nexhmedin Morina, B., Kindt, M., & Lancee, J. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.06.005 · Cited by 57
“Dysfunctional beliefs play an important role in sleep disorders (e.g., Lancee et al., 2015) and a range of other psychological disorders (e.g., Boden et al., 2012; Clark, 1986; Smith et al., 2007).”
Background
Efficacy of Self-Management Smartphone-Based Apps for Post-traumatic Stress Disorder Symptoms: A Systematic Review and Meta-Analysis
Goreis, A., Felnhofer, A., Kafka, J. X., Probst, T., & Kothgassner, O. D. (2020) · Frontiers in Neuroscience · doi:10.3389/fnins.2020.00003 · Cited by 53
A meta-analysis of dropout from evidence-based psychological treatment for post-traumatic stress disorder (PTSD) in children and young people
Simmons, C., Meiser-Stedman, R., Baily, H., & Beazley, P. I. (2021) · European Journal of Psychotraumatology · doi:10.1080/20008198.2021.1947570 · Cited by 46
Treatment of post‐traumatic stress disorder in children using cognitive behavioural writing therapy
der Oord, S. V., Lucassen, S., van Emmerik, A., & Emmelkamp, P. M. G. (2009) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.670 · Cited by 48
“, 2000), while others make more use of cognitive techniques instead (Smith et al., 2007).”
BackgroundMethodInfluential
Cognitive Behavioral Therapy for Symptoms of Trauma and Traumatic Grief in Refugee Youth
Murray, L. K., Cohen, J. A., Ellis, B. H., & Mannarino, A. (2008) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2008.02.003 · Cited by 47
Intrusive memories and depression following recent non-traumatic negative life events in adolescents
Meiser‐Stedman, R., Dalgleish, T., Yule, W., & Smith, P. A. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.12.020 · Cited by 47
“Cognitive behavioral techniques aimed at facilitating the processing of trauma memories have been successfully implemented with children and adolescents experiencing PTSD (Chemtob et al., 2002; Smith et al., 2007; Stein et al., 2003), and may also be applied to the intrusive memories experienced by depressed youth fol…”
BackgroundSelf-citation
Mechanisms of change in psychological interventions for posttraumatic stress symptoms: A systematic review with recommendations
Kangaslampi, S., & Peltonen, K. (2022) · Current Psychology · doi:10.1007/s12144-019-00478-5 · Cited by 45
PTSD’s Underlying Dimensions in Typhoon Haiyan Survivors: Assessing DSM-5 Symptomatology-Based PTSD Models and Their Relation to Posttraumatic Cognition
Mordeno, I. G., Carpio, J. G. E., Nalipay, M. J. N., & Saavedra, R. L. J. (2017) · Psychiatric Quarterly · doi:10.1007/s11126-016-9429-z · Cited by 46
“notion that the evolution and persistence of PTSD symptoms are significantly affected by having negative trauma-related cognitions [35, 38, 43, 44].”
Background
Cognitive Therapy for PTSD: Updating Memories and Meanings of Trauma
Ehlers, A., & Wild, J. (2015) · Springer eBooks · doi:10.1007/978-3-319-07109-1_9 · Cited by 38
A controlled evaluation of the ‘FRIENDS for Life’ emotional resiliency programme on overall anxiety levels, anxiety subtype levels and school adjustment
Rodgers, A., & Dunsmuir, S. (2013) · Child and Adolescent Mental Health · doi:10.1111/camh.12030 · Cited by 46
Using Compassion Focused Therapy as an adjunct to Trauma-Focused CBT for Fire Service personnel suffering with trauma-related symptoms
Beaumont, E., Durkin, M. A., McAndrew, S., & Martin, C. R. (2016) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x16000209 · Cited by 58
“Regardless of the above, other studies have demonstrated the effectiveness of TF-CBT and its acceptability to those who experience PTSD (Ehlers et al. 2005; Smith et al. 2007).”
Result
Focus on Childhood and Adolescent Mental Health
DelBello, M. P. (2006) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v67n0101 · Cited by 45
Childhood Predictors of Adult Intimate Partner Violence Perpetration and Victimization
Curtis, A., Harries, T., Pizzirani, B., Hyder, S., Baldwin, R., Mayshak, R., Walker, A., Toumbourou, J. W., & Miller, P. G. (2022) · Journal of Family Violence · doi:10.1007/s10896-022-00451-0 · Cited by 47
“…positive impacts on antisocial and disruptive behavior (Forgatch et al., 2009; Menting et al., 2013; Reynolds et al., 2007), or trauma informed cognitive behavioral therapy for those children who have witnessed or experienced abuse (Cohen et al., 2011; Scheeringa et al., 2011; Smith et al., 2007).”
Background
A cross-cultural validation of the Clinician Administered PTSD Scale for Children and Adolescents in a Dutch population
Diehle, J., de Roos, C., Boer, F., & Lindauer, R. (2013) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v4i0.19896 · Cited by 44
“…severity and treatment outcome, the original English version of the CAPS-CA has proven useful in a variety of studies including randomized controlled trials and neurobiological and prediction studies (e.g., Carrion, Weems, Richert, Hoffman, & Reiss, 2010; Daviss et al., 2000; Smith et al., 2007).”
Method
An Affective Cognitive Neuroscience-Based Approach to PTSD Psychotherapy: The TARGET Model
Ford, J. D. (2015) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.29.1.68 · Cited by 48
“…can account for—reductions in PTSD and associated internalizing disorder (e.g., anxiety, depression) symptoms (Adenauer et al., 2011; Diehle, Schmitt, Daams, Boer, & Lindauer, 2014; Gallagher & Resick, 2012; Kindt, Buck, Arntz, & Soeter, 2007; Smith et al., 2007; Sobel, Resick, & Rabalais, 2009).”
Method
The change and the mediating role of parental emotional reactions and depression in the treatment of traumatized youth: results from a randomized controlled study
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
Change in post-traumatic cognitions mediates treatment effects for traumatized youth—A randomized controlled trial.
Jensen, T. K., Holt, T., Ormhaug, S. M., Fjermestad, K. W., & Wentzel‐Larsen, T. (2018) · Journal of Counseling Psychology · doi:10.1037/cou0000258 · Cited by 52
“…CBT interventions lead to larger reductions in trauma-related cognitions than non-trauma focused control conditions (Diehle et al., 2014; Smith et al., 2007), we hypothesize that the superior performance of TF-CBT to TAU will be mediated (i.e., explained by) differences in cognitive…”
Background
Post traumatic stress disorder
Yule, W., & Smith, P. A. (2015) · Wiley eBooks · doi:10.1002/9781118381953.ch59 · Cited by 44
Self-citation
An Update on the Clinical Utility of the Children's Post‐Traumatic Cognitions Inventory
McKinnon, A., Smith, P. A., Bryant, R. A., Salmon, K., Yule, W., Dalgleish, T., Dixon, C., Nixon, R. D. V., & Meiser‐Stedman, R. (2016) · Journal of Traumatic Stress · doi:10.1002/jts.22096 · Cited by 41
“One clinical trial suggested these cognitions are important treatment targets during cognitive therapy for PTSD in children and young people (Smith et al., 2007).”
BackgroundInfluentialSelf-citation

Authors: SMITH, P., YULE, W., PERRIN, S., TRANAH, T., DALGLEISH, T., & CLARK, D. M.
Affiliations: King's College London (GB)
Corresponding author: SMITH, PATRICK
ORCID: SMITH, PATRICK
YULE, WILLIAM
PERRIN, SEAN
DALGLEISH, TIM
CLARK, DAVID M.
Venue: Journal of the American Academy of Child & Adolescent Psychiatry
Publisher: Elsevier BV
Published: 2007-08
Volume: 46
Issue: 8
Pages: 1051-1061
ISSN: 0890-8567 (ISSN-L)
DOI: 10.1097/chi.0b013e318067e288
OpenAlex: W2080647715
Semantic Scholar: e169a8a5f99b88f15ee0bfe497d010a97797c476
Cited by: 355
References: 49
Citations by year: 2026: 5 · 2025: 13 · 2024: 8 · 2023: 9 · 2022: 19 · 2021: 21 · 2020: 12 · 2019: 33 · 2018: 11 · 2017: 10 · 2016: 21 · 2015: 35 · 2014: 23 · 2013: 34 · 2012: 27
FWCI: 19.59
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
PubMed (publishedVersion)
Research Portal (King's College London) (submittedVersion)
Lund University Publications (Lund University) (submittedVersion)
Funders: Wellcome Trust (069777)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords: post-traumatic stress disorder, children and adolescents, trauma-focused cognitive behavioral therapy, individual psychotherapy, maladaptive cognitions, depression, anxiety, motor vehicle accidents, interpersonal violence, witnessing violence, treatment efficacy, symptom maintenance
MeSH terms: Adolescent, Child, Female, Humans, Male, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy, Treatment Outcome, Diagnostic and Statistical Manual of Mental Disorders

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Cognitive-Behavioral Therapy for PTSD in Children and Adolescents: A Preliminary Randomized Controlled Trial

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