Cited by 290Posttraumatic Stress Disorder ResearchChild Therapy and DevelopmentChild Abuse and Trauma

The DOI matches its Crossref record; 34 of the 35 references it cites were found in a registry or an index; 4 of the 46 sources its claims cite were checked for support.

Treating children traumatized by war and Tsunami: A comparison between exposure therapy and meditation-relaxation in North-East Sri Lanka

Open access

Abstract

BACKGROUND: The North-Eastern part of Sri Lanka had already been affected by civil war when the 2004 Tsunami wave hit the region, leading to high rates of posttraumatic stress disorder (PTSD) in children. In the acute aftermath of the Tsunami we tested the efficacy of two pragmatic short-term interventions when applied by trained local counselors. METHODS: A randomized treatment comparison was implemented in a refugee camp in a severely affected community. 31 children who presented with a preliminary diagnosis of PTSD were randomly assigned either to six sessions Narrative Exposure Therapy for children (KIDNET) or six sessions of meditation-relaxation (MED-RELAX). Outcome measures included severity of PTSD symptoms, level of functioning and physical health. RESULTS: In both treatment conditions, PTSD symptoms and impairment in functioning were significantly reduced at one month post-test and remained stable over time. At 6 months follow-up, recovery rates were 81% for the children in the KIDNET group and 71% for those in the MED-RELAX group. There was no significant difference between the two therapy groups in any outcome measure. CONCLUSION: As recovery rates in the treatment groups exceeded the expected rates of natural recovery, the study provides preliminary evidence for the effectiveness of NET as well as meditation-relaxation techniques when carried out by trained local counselors for the treatment of PTSD in children in the direct aftermath of mass disasters. TRIAL REGISTRATION: ClinicalTrials.gov Identifier:NCT00820391.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

In a randomized treatment comparison in post-tsunami north-east Sri Lanka, 31 children with preliminary PTSD received either six sessions of KIDNET or six sessions of meditation-relaxation (MED-RELAX), both delivered by trained local counselors. Both groups showed significant PTSD symptom reduction with no significant between-group differences; at 6-month follow-up, 81% of KIDNET children and 71% of MED-RELAX children no longer met the PTSD diagnostic threshold.

Key findings

  • PTSD symptoms decreased significantly in both groups: repeated-measures ANOVA showed a significant main effect of Time, F(2,56) = 54.15, p < 0.001, with no significant Time × Treatment interaction (p = 0.9).
  • At 6-month follow-up, recovery rates were 81% for KIDNET and 71% for MED-RELAX; differences between groups were non-significant.
  • Functioning problems also improved significantly across both conditions, F(2,54) = 19.54, p < 0.001; physical complaints showed only a slight improvement that did not reach significance, F(2,56) = 2.47, p = 0.09.
  • Within-group effect sizes were large and similar: KIDNET d = 1.76 at post-test and 1.96 at follow-up; MED-RELAX d = 1.83 at post-test and 2.20 at follow-up.

Methods

  • Randomized treatment comparison in two provisional refugee camps in Manadkadu, northern Sri Lanka; 31 children aged 8–14 with preliminary PTSD were randomly assigned by coin flip to six sessions of KIDNET (n = 16) or MED-RELAX (n = 15), each 60–90 minutes over about two weeks.
  • Treatments were delivered by six trained female local counselors; interviewers at post-test and follow-up were blind to treatment condition.
  • Outcomes included UCLA PTSD Index for DSM-IV (UPID) total and subscale scores, PTSD diagnosis, a five-item functioning-problems scale, and five physical complaints, assessed at pre-test, 1-month post-test, and 6-month follow-up using repeated-measures ANOVA and χ² tests.

Limitations

  • The paper states that the major limitation was the lack of a non-treated control or waiting-list group, due to ethical and logistical concerns, so spontaneous remission could not be controlled.
  • The paper also states that planned 1-year follow-up interviews could not be carried out because of increasing violence and political insecurity in Sri Lanka’s North-Eastern provinces.
  • Evident from the text: the sample was small (31 children; 16 KIDNET, 15 MED-RELAX), limiting statistical power to detect between-group differences, and the diagnosis was preliminary because the DSM-IV time criterion could not yet be applied.

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Integrity signals

Registry

Crossref · 10.1186/1471-244x-9-22

Cites

34 of 35 references verified1 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Figure 1 Flowchart of study protocol.
Figure 1 Flowchart of study protocol.CC BY · PubMed Central
Figure 2 Means of UPID subscores for the PTSD symptom clusters intrusions, avoidance, and hyperarousal at pre-treatment, posttest, and follow-up, separately for each treatment group. Error bars indicate 95% confidence intervals.
Figure 2 Means of UPID subscores for the PTSD symptom clusters intrusions, avoidance, and hyperarousal at pre-treatment, posttest, and follow-up, separately for each treatment group. Error bars indicate 95% confidence intervals.CC BY · PubMed Central

Verification

Claims the paper makes

26 Not checked yet · 23 Own result · 19 Own method · 9 Own interpretation · 2 Supported so far · 1 Partly supported · 1 No basis given · accuracy not yet measured

Verify all 42 references — free account

Show all 45 claims

  • It may state two separate claims as one. 15
  • Probably not a substantial claim. 28
36 of 36
  • The paper relies on this without support.

    The expected rates of natural recovery are lower than the recovery rates observed in the treatment groups.

    “As recovery rates in the treatment groups exceeded the expected rates of natural recovery, the study provides preliminary evidence for the effectiveness of NET as well as meditation-relaxation techniques when carried out by trained local counselors for the treatment of PTSD in children in the direct aftermath of mass disasters.”
  • The paper relies on this without support.

    Meditation-relaxation techniques such as breathing exercise or mantra chanting are rooted in Tamil (Hindu) culture and are well known to both children and local counselors.

    “Meditation-relaxation techniques such as breathing exercise or mantra chanting represent exercises that are rooted in the Tamil (Hindu) culture and are well known to both children and local counselors.”
  • The paper relies on this without support.

    Resources for the provision of mental health assistance in mass disasters are usually very low despite high need.

    “As most mass disasters strike low-income countries, and because emergency situations call for a variety of humanitarian aid beyond psychological interventions, resources for the provision of mental health assistance are usually very low despite the high need.”
  • The paper relies on this without support.

    Most mass disasters strike low-income countries.

    “As most mass disasters strike low-income countries, and because emergency situations call for a variety of humanitarian aid beyond psychological interventions, resources for the provision of mental health assistance are usually very low despite the high need.”
  • The paper relies on this without support.

    Emergency situations call for a variety of humanitarian aid beyond psychological interventions.

    “As most mass disasters strike low-income countries, and because emergency situations call for a variety of humanitarian aid beyond psychological interventions, resources for the provision of mental health assistance are usually very low despite the high need.”
  • The authors state this as an assumption.

    The context of a humanitarian emergency after a mass disaster in a country with limited resources probably interfered with recovery.

    “it is reasonable to assume that the context of a humanitarian emergency after a mass disaster in a country with limited resources has probably also interfered with recovery”
6 of 6

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Each contradiction between two passages listed here was confirmed by an independent check.

2 of 2

Citations

Cites

Show all 34 references

Research works printed but not linked: 3

  1. Schauer E, Kohiladevy M, Catani C, Onyut P, Schauer M, Neuner F, Elbert T: Building local capacity for mental health service provision in the face of large-scale traumatisation: a cascade-model from Sri Lanka. Annual Meeting of the European Society of Traumatic Stress Studies: 2005; Stockholm, Sweden. 2005
  2. Sivajokan S, Mahendrarajah K, Somasundaram D: Child Mental Health: Teacher's handbook to help primary school children. 2003, Shanthiham, Jaffna: GTZ/BECARE, Vavuniya
  3. Pynoos RS, Rodriguez N, Steinberg A, Stuber ML, Frederick C: UCLA PTSD Index for DSM-IV. 1998

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Metadata

Authors
Catani, C., Kohiladevy, M., Ruf, M., Schauer, E., Elbert, T., & Neuner, F.
Affiliations
  • Bielefeld University (DE)
  • University of Konstanz (DE)
Corresponding author
Catani, Claudia
Venue
BMC Psychiatry
Published
2009-05-13
Volume
9
Issue
1
Pages
22-22
ISSN
1471-244X (ISSN-L)
OpenAlex
W2022822901
Cited by
290
References
34
Citations by year
2026: 7 · 2025: 12 · 2024: 17 · 2023: 19 · 2022: 18 · 2021: 14 · 2020: 14 · 2019: 18 · 2018: 13 · 2017: 25 · 2016: 17 · 2015: 25 · 2014: 20 · 2013: 23 · 2012: 15
FWCI
16.58
Type
journal article
Language
en
Open access
Locations
  • BMC Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • KOPS (University of Konstanz) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • PUB – Publications at Bielefeld University (Bielefeld University) (submittedVersion, other-oa)
  • Publikationen an der Universität Bielefeld (Universität Bielefeld) (submittedVersion, other-oa)
Funders
Deutsche Forschungsgemeinschaft
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Child Therapy and Development
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Keywords
post-traumatic stress disorder, children, 2004 Indian Ocean tsunami, narrative exposure therapy, trauma treatment, disaster aftermath, refugee camps
MeSH terms
Adaptation, Psychological, Child, Disasters, Female, Humans, Implosive Therapy, Life Change Events, Male, Psychotherapy, Group, Surveys and Questionnaires, Relaxation Therapy, Sri Lanka, Stress Disorders, Post-Traumatic, Warfare, Treatment Outcome, Meditation, Tidal Waves

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