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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“The intervention was adapted from our 12-session intervention for older youth (Meiser-Stedman, Smith, et al., 2017; Perrin et al., 2017; Smith et al., 2007) and the prior trial protocol from Scheeringa (Scheeringa et al., 2011).”
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Treatment of Adolescent PTSD: The Impact of Prolonged Exposure Versus Client‐Centered Therapy on Co‐Occurring Emotional and Behavioral Problems
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“…functional impairment, they have generally shown significant reductions on these associated symptoms (e.g., Deblinger, Steer, & Lippmann, 1999; Jensen et al., 2014; Smith et al., 2007) and superior effects compared to nondirective supportive counseling (Cohen, Deblinger, Mannarino, & Steer, 2004).”
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BackgroundMethod
Screening Children with a History of Maltreatment for PTSD in Frontline Social Care Organisations: An Explorative Study
Duffy, M., Walsh, C., Mulholland, C. C., Davidson, G., Best, P., Bunting, L., Herron, S., Quinn, P. C., Gillanders, C., Sheehan, C., et al. (2021) · Child Abuse Review · doi:10.1002/car.2735 · Cited by 15
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A Community Study on the Relationship of Posttraumatic Cognitions to Internalizing and Externalizing Psychopathology in Taiwanese Children and Adolescents
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“Smith et al. (2007) provided good evidence that changes in posttraumatic cognitions could mediate the treatment effects of cognitive behavioral therapy for youth suffering from PTSD.”
Adverse Childhood Experiences and Healthcare Utilization of Children in Pediatric Emergency Departments
Okeson, K., Reid, C. M., Mashayekh, S., Sonu, S. C., Moran, T. P., & Agarwal, M. (2021) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2021.09.016 · Cited by 15
Evaluation of Cognitive-Behavioral Therapy Efficacy in the Treatment of Separation Anxiety Disorder in Childhood and Adolescence: a Systematic Review of Randomized Controlled Trials
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“, 2008; March & Mulle, 1998), post-traumatic stress disorder (Cohen et al., 2000; Smith et al., 2007), social anxiety disorder (Fisher et al.”
THE PAINS OF PARAMILITARISM: The Latent Criminogenic Effects of Exposure to Paramilitary Violence Among Young Men in a Post-Conflict Society
Walsh, C., & Cunningham, T. (2023) · Journal of Child and Adolescent Trauma · doi:10.1007/s40653-023-00516-2 · Cited by 8
“…are likely to persist (Kerig et al., 2012; Guay, Beaulieu-Prévost, Sader and Marchland, 2019) with estimates that up to 30% of cases symptoms can last for five years or more (Smith et al., 2007)- frustrating given that we know that there are highly efficacious models of treatment/intervention?”
Background
Posttraumatic stress symptoms in young people with cancer and their siblings: results from a UK sample
D’Urso, A., Mastroyannopoulou, K., Kirby, A., & Meiser‐Stedman, R. (2018) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2018.1494664 · Cited by 13
Changes in Traumatic Memories and Posttraumatic Cognitions Associate with PTSD Symptom Improvement in Treatment of Multiply Traumatized Children and Adolescents
Kangaslampi, S., & Peltonen, K. (2019) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-019-00255-3 · Cited by 17
Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders
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Posttraumatic Cognitions and Posttraumatic Stress Symptoms Among Young People Who Have Experienced Commercial Sexual Exploitation and Trafficking
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Validation of the Child Post-Traumatic Cognitions Inventory in Korean survivors of sexual violence
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“Traumatic experiences are associated not only with PTSD, but also with various types of psychopathology, and it seems possible to examine post-traumatic cognitions as a transdiagnostic target of therapy and intervention [17, 19, 46, 47].”
Background
Responsive Integrative Treatment of Clients with PTSD and Trauma-Related Disorders: An Expanded Evidence-Based Model
Edwards, D. J. A. (2013) · Journal of Psychology in Africa · doi:10.1080/14330237.2013.10820589 · Cited by 11
“However the principles apply equally to work with children since an adaptation for children of ECCT has proved effective (Smith et al., 2007; Smith, Perrin, Yule, & Clark, 2010), Goodyear-Brown (2010) describes a similar integrative approach using play therapy for trauma processing, and the model fits the treatment of…”
BackgroundMethod
Posttraumatische Belastungsstörung bei Kindern und Jugendlichen
Steil, R., & Rosner, R. (2013) · Springer eBooks · doi:10.1007/978-3-642-35068-9_19 · Cited by 12
Cognitive-behavioral treatment of a second-generation child of Pakistani descent: Ethnocultural and clinical considerations
Mahr, F., McLachlan, N. H., Friedberg, R. D., Mahr, S., & Pearl, A. M. (2013) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104513499766 · Cited by 12
“The reader is referred to the literature for a more detailed account of the CBT model for the treatment of PTSD in children (Smith et al., 2007).”
Method
Self-study assisted cognitive therapy for PTSD: a case study
Wild, J., & Ehlers, A. (2010) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v1i0.5599 · Cited by 13
“CT-PTSD is usually delivered in up to 12 weekly sessions and has been demonstrated to be very acceptable to patients and effective in five randomised controlled trials (Duffy, Gillespie, & Clark, 2007; Ehlers et al., 2003; Ehlers, Clark, Hackmann, McManus, & Fennell, 2005; Smith et al., 2007).”
Method
What services and supports are needed to enable trauma survivors to rebuild their lives? Implications of a systematic case study of cognitive therapy with a township adolescent girl with PTSD following rape
Payne, C., & Edwards, D. J. A. (2009) · Child abuse research in South Africa · Cited by 12
Exposure-based therapy for post-traumatic stress disorder in children and adults.
Rachamim, L., Nacasch, N., Shafran, N., Tzur, D., & Gilboa‐Schechtman, E. (2009) · PubMed · Cited by 12
Self‐Monitoring of Reexperiencing Symptoms: A Randomized Trial
Brown, A. J., Bollini, A. M., Craighead, L. W., Astin, M. C., Norrholm, S. D., & Bradley, B. (2014) · Journal of Traumatic Stress · doi:10.1002/jts.21950 · Cited by 11
“Two later studies (Hardy& Stallard, 2008; Smith et al., 2007) applied reexperiencing symptom self-monitoring to the treatment of children showing symptoms of PTSD, and both studies found remission rates of close to 25% in their samples.”
BackgroundResult
Psychometric Properties of the Child Posttraumatic Cognitions Inventory in a Sample of Brazilian Children
Lobo, B. O. M., Brunnet, A. E., Ecker, K., Schaefer, L. S., Arteche, A. X., Gauer, G., & Kristensen, C. H. (2015) · Journal of Aggression Maltreatment & Trauma · doi:10.1080/10926771.2015.1043065 · Cited by 11
“Several studies have shown that reduction in maladaptive appraisals is implicated in recovery from the posttraumatic symptoms following CBT (Bryant et al., 2007; Nixon, Sterk, & Pearce, 2012; Smith et al., 2007).”
Background
Unrecognized hospital trauma as a source of complex psychiatric symptoms: A systematic case study with implications for children's rights and evidence-based practice
Raby, C., & Edwards, D. J. A. (2011) · Psychotherapy Research · doi:10.1080/10503307.2011.587470 · Cited by 11
“As discussed above, CATT has many similarities to a cognitive therapy model for child PTSD which has been shown to be efficacious (Smith et al., 2007).”
Background
DECRYPT trial: study protocol for a phase II randomised controlled trial of cognitive therapy for post-traumatic stress disorder (PTSD) in youth exposed to multiple traumatic stressors
Allen, L. R., Ashford, P., Beeson, E., Byford, S., Chow, J., Dalgleish, T., Danese, A., Finn, J., Goodall, B., Grainger, L., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-047600 · Cited by 11
Self-citation
Cognitive-Behavioral Therapy and Dialectical Behavior Therapy; Adaptations Required to Treat Adolescents
Katz, L. Y., Fotti, S. A., & Postl, L. (2009) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2008.10.005 · Cited by 13
Identifying effective moderators of cognitive behavioural trauma treatment with caregiver involvement for youth with PTSD: a meta-analysis
Somers, K., Spruit, A., Stams, G. J. J. M., Vandevelde, S., Lindauer, R., & Assink, M. (2022) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-022-02088-2 · Cited by 12
“Studies that did not strictly follow the protocol of Cohen and colleagues [14], but still applied the trauma core elements were also included [34–37].”
Posttraumatic stress in school-age children and adolescents: medical providers’ role from diagnosis to optimal management
Marsac, M. L., Donlon, K., Smith, A. J., & Hildenbrand, A. K. (2015) · Pediatric Health Medicine and Therapeutics · doi:10.2147/phmt.s68984 · Cited by 10
“Coping exposure Cognitive restructuring Cognitive therapy 130–132 Uses a cognitive approach to reduce PTS through cognitive restructuring.”
Cognitive–Behavioral Treatment for Pediatric Anxiety Disorders
Read, K. L., Puleo, C. M., Wei, C., Cummings, C. M., & Kendall, P. C. (2013) · Springer eBooks · doi:10.1007/978-1-4614-6599-7_13 · Cited by 11
Efficacy and mechanisms of imagery rescripting and imaginal exposure for nightmares: study protocol for a randomized controlled trial
Kunze, A. E., Lancee, J., Nexhmedin Morina, B., Kindt, M., & Arntz, A. R. (2016) · Trials · doi:10.1186/s13063-016-1570-3 · Cited by 10
“, [36, 65, 66]), it seems worthwhile to construct a measure that can assesses such dysfunctional beliefs about nightmares.”
Background
The Sequential Relation Between Changes in Catastrophizing and Changes in Posttraumatic Stress Disorder Symptom Severity
Pimentel, S. D., Adams, H., Ellis, T., Clark, R., Sully, C., Paré, C., & Sullivan, M. J. L. (2020) · Journal of Traumatic Stress · doi:10.1002/jts.22519 · Cited by 10
“appraisals are correlated with changes in PTSD symptom severity (Kleim et al., 2013; Smith et al., 2007).”
Background
Parent Training for Childhood Anxiety
Lewin, A. B. (2011) · Springer eBooks · doi:10.1007/978-1-4419-7784-7_27 · Cited by 10
“Moreover, parents may strengthen (i.e., reinforce) the likelihood of anxiety-related behaviors via escape, avoidance, attention, and accommodation of behaviors (Barrett, Dadds, & Rapee, 1996; Barrett, Duffy, Dadds, & Rapee, 2001; Geffken et al., 2006; Kendall, Hudson, Gosch, Flannery-Schroeder, & Suveg, 2008; Last et…”
BackgroundInfluential
Sociodemographic characteristics of youth in a trauma focused‐cognitive behavioral therapy effectiveness trial in the city of Philadelphia
Last, B. S., Rudd, B. N., Gregor, C. A., Kratz, H. E., Jackson, K., Berkowitz, S. J., Zinny, A., Cliggitt, L. P., Adams, D. R., Walsh, L., et al. (2019) · Journal of Community Psychology · doi:10.1002/jcop.22306 · Cited by 10
“This is striking in comparison to RCT samples where, on average, only 5–15% of the sample met CPSS criteria for severe PTSD (Gilboa‐Schechtman et al., 2010; Jensen, Holt, & Ormhaug, 2017; Smith et al., 2007).”
Result
Supervision Experiences of New Professional School Counselors
Bultsma, S. A. (2012) · Michigan Journal of Counseling Research Theory and Practice · doi:10.22237/mijoc/1325376060 · Cited by 10
Mental Health Therapy as a Core Strategy for Increasing Human Capital: Evidence from Ghana
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“2008), or post-traumatic stress disorder (Smith et al. 2007).”
Background
Associations between therapist factors and treatment efficacy in randomized controlled trials of trauma-focused cognitive behavioral therapy for children and youth: A systematic review and meta-analysis
Grainger, L., Thompson, Z., Morina, N., Hoppen, T., & Meiser‐Stedman, R. (2022) · Journal of Traumatic Stress · doi:10.1002/jts.22840 · Cited by 9
The efficacy and acceptability of group trauma-focused cognitive behavior therapy for the treatment of post-traumatic stress disorder in children and adolescents: A systematic review and meta-analysis
Xie, S., Cheng, Q., Tan, S., Li, H., Huang, T., Xiang, Y., & Zhou, X. (2024) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2023.11.012 · Cited by 17
Psychotherapeutic interventions for childhood posttraumatic stress disorder: an update
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“There is some evidence for the effectiveness ofCT-PTSD [16,17] aswell as forCPT [9 & ,18 & ], with developmentally adapted CPT (D-CPT)”
Method
A Disorder-Specific, Cognitively Focused Group Treatment for Childhood Generalized Anxiety Disorder: Development and Case Illustration of the No Worries! Program
Holmes, M. C., Donovan, C. L., & Farrell, L. J. (2015) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.29.4.275 · Cited by 9
“…& March, 2004; Farrell, Schlup, & Boschen, 2010; Freeman et al., 2007; Gillihan, Williams, Malcoun, Yadin, & Foa, 2012), and posttraumatic stress disorder (e.g., Cohen, Deblinger, Mannarino, & Steer, 2004; Deblinger, Mannarino, Cohen, & Steer, 2006; Dowd & McGuire, 2011; Smith et al., 2007).”
Translating the Cognitive Model of PTSD to the Treatment of Very Young Children: A Single Case Study of an 8‐Year‐Old Motor Vehicle Accident Survivor
Goodall, B., Chadwick, I., McKinnon, A., Werner‐Seidler, A., Meiser‐Stedman, R., Smith, P. A., & Dalgleish, T. (2017) · Journal of Clinical Psychology · doi:10.1002/jclp.22449 · Cited by 9
“…work with children and adolescents, aged 8–17 years, showing that TF-CT improves symptoms of PTSD, anxiety, and depression, as compared to a waitlist control group, we adapted this program (Smith et al., 2007; Meiser-Stedman et al., 2016) for use with much younger children (Dalgleish et al., 2015).”
BackgroundMethodInfluentialSelf-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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