Comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder in children and adolescents: A systematic review and network meta-analysis
Open accessAbstract
BACKGROUND: Available evidence on the comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder (PTSD) in children and adolescents remains uncertain. OBJECTIVE: We aimed to compare and rank the different types and formats of psychotherapies for PTSD in children and adolescents. METHODS: We searched eight databases and other international registers up to 31 December 2020. The pairwise meta-analyses and frequentist network meta-analyses estimated pooled standardised mean differences (SMDs) and ORs with random-effects model. Efficacy at post-treatment and follow-up, acceptability, depressive and anxiety symptoms were measured. FINDINGS: We included 56 randomised controlled trials with 5327 patients comparing 14 different types of psychotherapies and 3 control conditions. For efficacy, cognitive processing therapy (CPT), behavioural therapy (BT), individual trauma-focused cognitive-behavioural therapy (TF-CBT), eye movement desensitisation and reprocessing, and group TF-CBT were significantly superior to all control conditions at post-treatment and follow-up (SMDs between -2.42 and -0.25). Moreover, CPT, BT and individual TF-CBT were more effective than supportive therapy (SMDs between -1.92 and -0.49). Results for depressive and anxiety symptoms were similar to the findings for the primary outcome. Most of the results were rated as 'moderate' to 'very low' in terms of confidence of evidence. CONCLUSIONS: CPT, BT and individual TF-CBT appear to be the best choices of psychotherapy for PTSD in young patients. Other types and different ways of delivering psychological treatment can be alternative options. Clinicians should consider the importance of each outcome and the patients' preferences in real clinical practice.
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TF-CBT is effective in reducing PTSD symptoms and enhancing overall functioning in children and adolescents.
“It has been determined that TF-CBT is effective in reducing PTSD symptoms and enhancing overall functioning in this population.”
From Clinical Efficacy of Psychotherapeutic Interventions for Post-Traumatic Stress Disorder in Children and Adolescents: A Systematic Review and Analysis. (2024) · cites this paper as [10]
The Discussion reports that TF-CBT reduced PTSD symptoms more than control conditions and some other psychotherapies in children and adolescents. Although it suggests TF-CBT may enhance affective and behavioural functioning, the Discussion also says the analysis could not assess functional improvement because the original studies reported no available data. The claim therefore overstates the evidence for enhanced overall functioning. (LLM, conf=0.91)
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- Authors
- Xiang, Y., Cipriani, A., Teng, T., Del Giovane, C., Zhang, Y., Weisz, J. R., Li, X., Cuijpers, P., Liu, X., Barth, J., Jiang, Y., Cohen, D., Fan, L., Gillies, D., Du, K., Ravindran, A. V., Zhou, X., & Xie, P.
- Affiliations
- The Affiliated Yongchuan Hospital of Chongqing Medical University (CN)
- Oxford Health NHS Foundation Trust (GB)
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
- Second Affiliated Hospital of Chongqing Medical University (CN)
- Harvard University (US)
- Amsterdam Public Health (NL)
- University of Zurich (CH)
- Pitié-Salpêtrière Hospital (FR)
- The University of Sydney (AU)
- Centre for Addiction and Mental Health (CA)
- Corresponding author
- Xie, Peng
- ORCID
- Venue
- Evidence-Based Mental Health
- Publisher
- BMJ
- Published
- 2021-10-01
- Volume
- 24
- Issue
- 4
- Pages
- 153-160
- ISSN
- 1362-0347 (ISSN-L)
- 1468-960X
- PMC
- PMC8543231
- OpenAlex
- W3203185705
- Cited by
- 47
- References
- 42
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 15 · 2023: 12 · 2022: 5
- FWCI
- 1.06
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Evidence-Based Mental Health (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by-nc)
- HAL (submittedVersion, other-oa)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by-nc)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by-nc)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- Chongqing Science and Technology Commission (cstc2020jcyj-jqX0024)
- Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (2019PT320002)
- National Key Research and Development Program of China (2017YFA0505700)
- High-level Talents Special Support Plan of Chongqing (T04040016)
- National Natural Science Foundation of China (81820108015, 81873800)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- post-traumatic stress disorder, children and adolescents, psychotherapy, cognitive processing therapy, behavior therapy, trauma-focused cognitive behavioral therapy, EMDR, supportive therapy, treatment acceptability, depressive symptoms, anxiety symptoms, treatment efficacy
- MeSH terms
- Adolescent, Behavior Therapy, Child, Humans, Psychotherapy, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy
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